As debates continue over relaxing stay at home orders, there’s widespread agreement among county officials, the governor, and business leaders that testing for coronavirus is key to re-opening the economy.

Yet when it comes to the share of residents who have gotten tested, Orange County continues to lag behind other large California counties.

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Residents in San Diego County, which has a similar population size to OC, have been tested at a 54 percent higher rate as of Tuesday night, when taking population into account. In raw numbers, OC’s southern neighbor reported about 63,000 total tests, while OC reported about 41,000.

Riverside County, which has fewer residents that OC, also has conducted more testing, with about 63,000 tests as of Wednesday, to OC’s 41,000.

The lower testing rates in OC have prompted questions about whether cases, and potentially deaths, are being undercounted in the data.

Asked why OC has a lower rate of tests-per-resident, Orange County’s public health officer at first sidestepped the question this week.

“As far as our testing numbers compared to surrounding counties, I’m not going to comment on what surrounding counties are doing,” said Dr. Nichole Quick, Orange County’s health officer, in response to questions from Voice of OC at a county media briefing Monday.

Asked again, she said the counties are different.

“If you look at our numbers of deaths and positives for San Diego, the counties look different. So I think it’s most appropriate to look at rates per number of deaths that we’ve had, and/or our positive test rate, rather than comparing county to county. Because we have different dynamics going on in each county,” Quick said.

In Los Angeles County, any resident can schedule a coronavirus test regardless of whether they are showing symptoms of COVID-19, according to the city of Los Angeles.

As of earlier this week, OC had limited its county testing to people with symptoms who have undergone a screening, according to Orange County’s testing website. OC officials indicated Wednesday they had no plans to expand testing access to everyone.

People with no symptoms can spread coronavirus for up to 14 days before they show symptoms, and sometimes never show noticeable symptoms while they’re contagious, according to health researchers.

Asked later on Wednesday if OC would be offering testing to everyone regardless of symptoms, like LA County does, the Orange County Health Agency said in a statement: “We hope to have more information to share with you by the end of next week.”

Orange County’s testing started later than LA and San Diego Counties, and with strict limits on testing due to supply shortages, the public became more reluctant to try to get tested, said Dr. Thomas Cesario, an infectious disease doctor in Orange County and former longtime dean of UC Irvine’s medical school.

“We were a little bit later getting started with the testing here” than LA and San Diego counties, Cesario said this week.

“We had very strict limitations on who could be tested, because there weren’t a lot of test kits available,” he added. “We sensitized both the [doctors] and the public as to the restrictions on the tests, which probably made people a little bit reluctant to try to get it.”

As the number of new cases levels off, Cesario said, people may start to feel more comfortable coming into medical clinics to get tested.

Orange County officials have set a goal of being able to test 4,000 county residents per day through their county testing network, which is separate from the private network.

“We need to get there before any of the cases start to increase, which is likely what we’ll see with the lessening of the stay-at-home order,” Quick said of the goal of being able to do 4,000 daily tests.

But they expect to still be 3,000 tests short of their 4,000-per-day goal for the county network, even after all the county and state sites in OC are up and running in the next few weeks.

“When all sites are fully operational, the county will have 7,510 tests per week. The math breaks down to approximately a little over 1,000 tests per day. This leaves us with a gap of 3,000 tests per day,” said Lilly Simmering, the county’s interim director of public health services, at Tuesday’s county supervisors meeting.

Overall, about 1,600 test results have been reported each day in OC, on average, for the past week. Those results include tests from private health care networks, as well as the county testing network.

Business leaders are looking to effective and widespread testing as a key component to re-opening.

“The business community fully supports ramping up tests as quickly and efficiently as possible,” said Lucy Dunn, president and CEO of the Orange County Business Council, in an interview Monday with Voice of OC.

“It’s not the only tool in the tool chest…but making sure the tool is there is critically important, for both good business and good health,” Dunn said.

The pandemic is “far from over,” she added. “We have to balance good health and good businesses. Because you can’t have a livelihood with out a life.”

Emile Haddad, who leads one of OC’s largest real estate companies, also emphasizes the importance of testing.

“I think that testing will be critical, not only for medical reasons but to provide psychological comfort for people to be able to gradually start feeling comfortable going back to some normalcy,” said Haddad, chairman and CEO of FivePoint Holdings. He also is a member of business recovery task forces at the county and state level.

Haddad added he has not worked with the county on any COVID-19 testing efforts and thus is not in position to comment on local testing programs or the county’s current state of preparedness.

On Wednesday, state officials launched an online map of testing sites, which in Orange County mainly showed private testing sites where people must first get a doctor’s order in order to get a test.

When testing expands, county officials say the number of confirmed COVID cases are likely to rise as well.

“Although Orange County’s numbers are low, as we expand testing and continue to address outbreaks at skilled nursing facilities, jails and other congregate living facilities, the number of cases are expected to rise,” Simmering said Tuesday.

Quick and other county officials say there continues to be a shortage of swabs and other materials to expand testing for coronavirus.

“What we still do not have, and continue to need, is a free-flowing supply of swabs and other test components,” Quick said.

For the last several weeks, county officials have asked that people with mild symptoms generally not seek testing and instead isolate at home, due to the supply shortage.

Asked how people can get tested in Orange County, Quick referred to a county website where residents can call a clinic to arrange testing.

The county testing network are limited to people who have symptoms and who can’t been access tests through a doctor.

“Our OC COVID-19 network, at this stage, is geared for community members who have symptoms of the virus and are unable to get tested through a health care provider or do not have insurance,” Orange County Health Care Agency spokeswoman Jessica Good said in an emailed response to questions Wednesday.

“You will receive a medical assessment before being tested and you will only be tested if you have symptoms of the disease,” the OC testing website stated as of this week.

As of Wednesday, the seven clinics in the county testing network are: AltaMed in Anaheim, Santa Ana, and Huntington Beach, Family Health Matters Community Health Center in Fullerton, Families Together of Orange County in Tustin, Korean Community Services in Buena Park, Nhan Hoa Comprehensive Health Care Clinic in Garden Grove, and UCI Health clinics at locations not disclosed until people call.

All of the clinics require an advanced phone call and medical screening for symptoms before testing is provided, according to the county.

Orange County COVID-19 Testing Locations

The following map shows the county’s COVID-19 testing network sites as provided by the County of Orange. Last Updated: May 6, 2020

LA County appears to be offering more expanded access to testing. As of the same time Monday afternoon, its website said testing is available for people with symptoms as well as “All essential workers regardless of symptoms” and “People who are either over 65 or have chronic underlying health conditions.”

Coronavirus hospitalization and death rates are significantly lower in Orange County than surrounding counties, county officials said Monday, while noting a rise in hospitalizations.

“I think it’s important to note right now, in Orange County compared to our neighbors, we generally have been seeing less cases, less deaths in Orange County. However, our trend for hospitalization has been increasing,” Quick said Monday.

Coronavirus hospitalizations have been rising in Orange County – up more than 80 percent in the month of April, according hospital data.

OC hospitals have reported an increase in COVID patients from 117 on April 1 to 214 on Monday. Overall hospital beds for all patients have been at about 50 percent capacity of their total 5,900 beds, according to county officials.

A daily report Wednesday from the county said 13 nursing and care homes have COVID outbreaks in Orange County, with 18 residents and one staff member dying and 461 confirmed infections within the facilities.

A total of 299 residents and 162 staff have have tested positive for COVID at the 13 care homes as of Tuesday, according to the county report.

OC’s goal of 4,000 tests per day is slightly more than one-tenth of 1 percent of the overall county population of 3.2 million people.

Dunn, the business council president, said people’s safety will be key to re-opening the economy.

“From a business standpoint, we certainly are watching very carefully where the governor’s orders are. We certainly are grateful for a start to carefully re-open businesses,” said Dunn, the business council president.

She encouraged businesses to start planning for “common sense protocols” like social distancing, masks, and sanitizers.

“At the end of the day, business can open up. Will the customers come if they don’t feel safe, if they don’t feel protected?”

Nick Gerda covers county government for Voice of OC. You can contact him at

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