PITTSBURG — As officials from the local level up to the federal government take unprecedented and drastic actions in response to the novel coronavirus pandemic, one of the most confusing aspects of the situation is attempting to understand how widespread the virus actually is. A lack of testing nationwide is a major factor contributing to this confusion.

“The lack of testing means that it is almost impossible to know how many Americans are infected with the coronavirus and suffering from COVID-19, the disease it causes,” the Atlantic reported earlier this month.

That is certainly the case in Kansas. On Monday, the Crawford County Health Department announced its first two confirmed coronavirus cases — a child under 5 years old and a woman under 60 — leading to a special county commission meeting later that day and approval of a board of health order by the following morning that effectively closed many local businesses and resulted in extensive layoffs.

Among the 98 total positive cases included in its Tuesday daily coronavirus update, however, the Kansas Department of Health and Environment (KDHE) still did not include any in Crawford County.

“The issue that happens is the state only updates that once a day so it does say one, but they are behind sometimes in getting those on there,” Crawford County Health Officer Rebecca Adamson said in an interview Wednesday. “Basically they only have so much capacity but a lot of it boils down to they only update that once a day.”

While KDHE issuing its updates only once a day and the Crawford County results perhaps missing the cutoff time to be included might explain why they were not counted in the Tuesday update, however, more confusingly, in its Wednesday update KDHE included just one Crawford County case.

The Crawford County Health Department issued two press releases on its first two confirmed COVID-19 cases just over an hour apart on Monday morning. If the reason KDHE didn’t include both cases in its daily update by two days later was that one made the cutoff and the other did not, though, it would seem the one that should have been counted would be the child, rather than the adult woman.

The child under 5 was the first Crawford County case announced Monday, but in its Wednesday update, KDHE was still saying the age range of confirmed cases was from 7 to 90 years old. By Wednesday, meanwhile, the Crawford County Health Department announced it had confirmed a third local coronavirus case.

A KDHE spokesperson said Thursday that the discrepancy in the county and state numbers was because the Crawford County cases reported Monday were not tested at an official KDHE lab — even though positive cases tested at private labs are included in the KDHE’s daily update.

“The samples were run in a lab outside of KDHE,” KDHE Director of Communications Kristi Zears said in an email. “Labs coming on board for testing need to have initial results confirmed through the state lab. We will not include them in our numbers until confirmatory testing is done through our lab. The case reported in yesterday’s numbers was not one of those initial cases and direct testing was provided through KDHE.”

At the Monday Crawford County Commission meeting, Adamson pointed out that if the county health department wants to send a test sample to KDHE for testing, it has to meet rather strict criteria, including that the person has to either be 60 or older, have an underlying autoimmune disorder, have been exposed to a known positive case and have developed symptoms, be a healthcare worker and have developed symptoms, or be a member of a high-risk population such as nursing home patients.

“In my mind … the problem with limited testing is that we don’t have an accurate view of what it actually looks like and it can be spreading without us knowing about it,” Crawford County Commissioner Jeremy Johnson said Monday.

Adamson said that because of the strict KDHE guidelines, many clinics are now sending test samples to private laboratories.

“I am in the process of checking with outside laboratories to determine the cost and the price of testing,” Adamson said, adding that she did not have prices as of Monday afternoon — and implying that the county health department was not yet sending its own suspected cases for testing at outside labs.

Besides the health department itself, however, other medical facilities in the county are screening patients for COVID-19 and could have possibly sent a sample to an outside lab that had not yet been approved by KDHE.

“The Crawford County Health Department is aware that daily case updates from KDHE may not always align with County updates,” the department noted in a press release Wednesday, which also said the numbers reported by the county and by KDHE should align by Thursday’s daily update.

The Thursday update, which said it was updated at 11 a.m. but was not posted on KDHE’s website until well after 1 p.m., said there were three cases in Crawford County. It included a note, however, saying “1 case in Douglas and 2 cases in Crawford are presumptive positive at a reference lab, but were not confirmed through the KDHE lab, so are included in the county numbers, but not in the overall state total or demographics at this time.”

Part of the problem for the general public in understanding the extent of the coronavirus pandemic is that privacy of medical information is legally protected, preventing the release of identifying information about who has contracted COVID-19.

“I know it’s frustrating to people and the public,” Adamson said Wednesday. “The state has so many things and sometimes the state has to confirm results. There's a lot behind the scenes that people just don’t understand, it just takes time for them to get their numbers updated.”

As might be inferred from the apparent situation in Crawford County, however, Adamson also seemed to suggest that underreporting or significantly delayed reporting by KDHE in its daily coronavirus updates — not just of total cases that might be going undetected, but of positive results that are being officially reported by local health departments — is an issue statewide, rather than just in southeast Kansas.

“We are not the only county that is having an issue with that either, so it’s just the numbers that are coming through,” Adamson said. “There’s so much volume right now coming through, it’s hard to keep that up to date.”