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Only one state in the nationWest Virginiahas not reported any COVID-19 cases. But that doesnt mean the new coronavirus isnt there. It turns out the state has done very little testingeven compared to states of a similar size.

The West Virginia Department of Health and Human Resources reports that a bare 84 West Virginians have received a test as of Tuesday afternoon. Of those 80 came back negative and four are pending.

Nebraska, by contrast, has tested 188 individuals, and 18 were positive. Vermont, which has scant more than one-third of West Virginias population, has tested more than 500 of its residents and 10 were positive.

U.S. Sen. Joe Manchin (D-WV) says his his state has only 500 kitsand hes not happy about it.

Theres no excuse for it, the senator told reporters this week, the Charleston Gazette-Mail reported.

The lack of testing could be deadly. While most cases of coronavirus are mild, Manchin noted a recent study found the state has the highest likelihood51 percentfor adults gettingseriously ill after a COVID-19 infection. Thats due mainly to the large proportion of elderly residents, and the prevalence of residents under age 60 with health issuesthe two group most at risk.

With only 84 tests given and 80 of them evaluated so far in a state where more than one million people are at risk, we shouldnt be naive enough to think weve been spared, the senator said.

The state acknowledged in a press release Monday that supplies are limited, and that it had prioritized testing of two groups of people: those hospitalized for a serious ailment, and those who have both coronavirus-like symptoms and have experienced recent exposure either to an infected person or region.

Testing for COVID-19 may not be appropriate for everyone, said state Health Officer Dr. Cathy Slemp. A providers decision to order COVID-19 testing is based on several factors, including clinical judgment and the availability of testing supplies and lab resources.

Dr. Diane Gross, an associate professor at the West Virginia University School of Public Health, cited a range of limiting factors that have likely prevented a positive diagnosis so far.

On one hand, she told The Daily Beast, West Virginians likely travel internationally less frequently than residents of many other states, which at first insulated them from the global outbreak.

But she also said many medical facilities in the state initially lacked the proper swabs and other sampling materials necessary to check for infectionand decades of budget cuts have decimated the public health system.

We have no real surge capacity. That is making it more difficult to get people sampled, Gross, who also serves as a regional epidemiologist in the northeast corner of the state, told The Daily Beast. It is much more likely that we do have some cases and have not detected them yet.

Gov. Jim Justice struck a similar note in a Monday press conference.

This virus is, without question, in West Virginia somewhere right now, Gov. Jim Justice said Monday afternoon. Were trying to be ready in every way we possibly can be. Lets not get caught, then say, Oh no. Lets err on the safe side.

Despite the absence of positive tests, West Virginia has taken steps to contain the virus that is lurking unseen, shuttering all schools and declaring a state of emergency.

Read more: https://www.thedailybeast.com/west-virginia-hasnt-reported-a-covid-19-case-but-it-only-tested-84