Frustrated by the continued lack of widespread testing for COVID-19, mayors from every city in Santa Clara County co-signed a letter to county leaders this week offering their assistance in new testing sites.

The letter submitted by the Cities Association of Santa Clara County reflects a growing concern among local officials about the county's slow ramp up in testing capacity, even as shelter-at-home rules are starting to loosen and city leaders are formulating strategies for reopening business. Testing in the county remains largely limited to people with symptoms, health care professionals and other frontline workers. Even as other jurisdictions have made testing more available for the general population (Los Angeles announced Wednesday that any resident who needs a test can get one for free), the county has been testing about 600 people per day over the past month, a fraction of what officials believe is needed to safely reopen the economy.

The numbers have been slowing climbing. County had conducted an average of 898 tests daily over the past seven days, an improvement from mid-April, when there were fewer than 400 tests conducted on some days, according to the county's dashboard. But city leaders and some members of the Board of Supervisors underscored this week that much more needs to be done.

"Our businesses and schools must have some certainty for their plans to reopen, which appears directly tied to the availability and the amount of testing," states the letter that is signed by 15 mayors, including Adrian Fine of Palo Alto and Margaret Abe-Koga of Mountain View. "It's not clear how much testing is sufficient, and that is of concern to us."

The letter addressed to the Board of Supervisors, County Executive Jeff Smith and Health Officer Dr. Sara Cody requests that the county compile and publicize a comprehensive list of testing sites; create partnerships with cities to create more testing sites; and make sure all government, medical and food-distribution workers have testing readily available.

The letter also pointed to a recent request from Gov. Gavin Newsom's COVID-19 Testing Task Force that communities create partnerships and more testing sites.

"But information on how we get there is not forthcoming," the letter states. "It may be timely to form a Santa Clara County Testing Task Force. Without testing … we do not reopen our county."

County and state officials have consistently maintained that testing capacity is a critical factor in loosening stay-at-home rules and reopening the economy. On Wednesday, Cody listed key indicators that are guiding her decisions on loosening shelter-in-place rules. These include the county's ability to meet its need for testing residents who are in vulnerable populations or in high-risk settings or occupations.

County officials had noted in recent meetings that their ability to test is hampered by shortages of reagents (chemicals used to analyze tests) and key equipment, as well as the fact that most of the tests are conducted by hospitals and academic institutions. Their rough estimate is that testing capacity will need to get to about 4,000 per day, which Cody said amounts to roughly two tests per 1,000 people per day per population.

Smith cited at the Wednesday meeting of the county's Health and Hospital Committee a number of factors that have contributed to the lack of widespread testing, many of which he said are beyond the county's control. These include supply shortages in reagent, the complex approval process for tests and the fact that the tests that the Centers for Disease Control and prevention had initially provided were ineffective. These factors, Smith said, have "put us behind the eight ball."

"And then we have many parts of the country that are doing much worse that we are, so they are sucking up the capacity," Smith said.

Even so, the slow progress remains a topic of significant concern, both for county officials and city leaders. In Palo Alto, Councilwoman Liz Kniss has been a leading proponent of greatly expanding testing. Kniss, a former nurse, made the case at recent meetings that the city and the county need to do much more to ramp up testing. She and others pointed to examples in other cities and counties of drive-thru testing stations that are available for the broader populations – not just frontline workers and people with symptoms.

Kniss argued at the April 20 City Council meeting that testing today is woefully insufficient, particularly in the north end of the county.

"I just know we're not doing sufficient testing," Kniss said. "And we actually should be testing people who do not have symptoms, especially if you go to work in some places like a nursing home or grocery store — where you're going to be in close contact with people on a regular basis."

Palo Alto City Manager Ed Shikada said at the April 20 meeting that unlike Fremont and Hayward, which have instituted drive-thru testing sites, his city has opted not to be an "active player" in pursuing more testing. It has, however, initiated a conversation with the county.

"If there is a role for cities, we in Palo Alto are ready and interested in participating in any appropriate role," Shikada said.

Supervisor Joe Simitian, whose district includes Palo Alto and who serves on the Health and Hospital Committee, said at the Wednesday meeting that he thinks the letter signed by the mayors is "on point." He also said that he would like to use the committee to make testing "dramatically more robust."

"It's time to test. I think it's past time to test," Simitian said.

Simitian said he has spoken to Shikada about a possible partnership and had also been in discussions with El Camino Hospital CEO Dan Woods, who has expressed a willingness to not only partner with the county but to provide physical space for testing.

While Simitian acknowledged the limitations cited by Smith, he said the county has to look at those as "challenges we need to overcome, not impediments that we simply accept."

One of the fundamental challenges, he said, is the fact that no one at the federal, state, county or city government level has taken responsibility for testing. The county, he said, needs to step up and take initiative to see what it can do to "dramatically increase the number of tests."

"I think it's pretty clear at this point that if we wait for someone who has control to show up on our doorstep and start offering tests in some great number, we can be waiting a while," Simitian said.

Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.