“I don’t know who’s going to pay for that. I don’t know when we’re going to have the testing capability to do that. There’s not enough testing capability to do that today,” said David Spillers, who heads the system that includes hospitals in Morgan and Limestone counties. “… If the president wants to write us a check and give us all the test equipment, we’d be glad to do it.”

In an ABC News interview Tuesday, Trump was asked whether workers should be able to obtain testing, and have the confidence that none of their co-workers who may be asymptomatic have also received testing.

“They have to test if they want,” Trump said. “You know, some people are strong believers in testing.. … They should have no problem.”

Until Wednesday, Alabama Department of Public Health criteria only allowed for COVID-19 testing of asymptomatic people if they lived or worked in a long-term care facility with staff or residents with lab-confirmed cases.

Late Wednesday, ADPH expanded its criteria to allow testing of asymptomatic people who are at high risk because of underlying medical conditions, who live in a congregate setting such as a homeless shelter or long-term care facility, or for screening of asymptomatic populations “based on a case-by-case review and approval by the state health department.”

Meanwhile, an ADPH administrator on Wednesday said the timing of a recent jump in statewide and north Alabama COVID-19 cases was in part due to a backlog in some private labs.

Testing capacity in Alabama has increased significantly in recent weeks, with the ADPH reporting that about 112,000 tests have been administered in the state since the pandemic began. Not all private labs report negative tests, so the total number of tests is likely higher.

While it might be ideal for all people to receive a coronavirus test before entering their workplace, Spillers said there are several practical impediments.

One of those is access to testing supplies.

“We’re nowhere near ready to give everybody who wants a test a test,” Spillers said.

Another hurdle is cost. Processing a test through a private lab costs about $100, Spillers said.

“Somebody has to pay for them eventually. We’ve done a lot for free up to this point, but we can’t do free tests for everybody … at $100 a pop,” Spillers said.

The other problem, he said, is the limited information provided by a negative coronavirus test.

“Getting the test today only means you’re not positive today. It doesn’t mean you’re not positive come Friday,” he said.

For an employer to ensure there are no asymptomatic carriers of the coronavirus infecting their co-workers, the test would have to be given every couple of days.

“And who wants to do that, because it’s not the nicest test in the world to get done if you’ve seen it done. Somebody’s sticking something about 6 inches down your nose. It’s just not pleasant. I’m not sure who wants to get that done every other day,” Spillers said.

While numbers of confirmed COVID-19 cases in Madison and Limestone counties have been increasing slowly in recent days, other north Alabama counties have been less fortunate. Marshall and Franklin counties in particular had dramatic one-day increases in the last week.

Statewide the number of confirmed cases per day has topped 300 only three times, according to ADPH calculations. The highest daily increase was April 9, when 339 new cases were reported. The second highest, with 335, was Tuesday. As of 6 p.m., the number of newly reported cases Wednesday was 254. Twenty-eight COVID-19 deaths were reported Wednesday, raising the total to 343.

Reporting backlog

Judy Smith, administrator of the Alabama Department of Public Health Northern District, said the timing of some recent jumps in the number of confirmed cases were somewhat deceptive.

“A lot of that was a backlog from some lab reporting, so it’s not all current cases. They’re catching up with a backlog that were reported, particularly from some out-of-state labs. So it’s not all current cases. It does show there were more cases all along than had been reported. It reemphasizes the importance of doing all of the things we have talked about doing,” Smith said.

ADPH has stressed the need for social distancing, frequent hand washing and the wearing of masks.

“The backlog actually affected numerous counties. The two that were probably affected the most in this area were Marshall and Franklin counties. Now some of those (cases included in the rapid increase) are current. Some of those are people that are in the middle of a quarantine and some of those are people that are already past quarantine,” Smith said, referring to quarantines that last 14 days. “But there was a backlog of reporting, so not all of these are new, current cases.”

The numbers could be important, as State Health Officer Scott Harris and Gov. Kay Ivey have both pointed to federal “gating criteria” as being a primary reason the state remains under a “safer at home” health order that has left restaurant dining rooms and close-contact businesses closed. While the state met two of the three gating criteria as of April 30, the date the stay-at-home order expired, it did not meet the third criterion: a “downward trajectory of documented cases within a 14-day period.”

The current safer-at-home order expires May 15 if not extended.

Franklin County, with 164 cases and a population of 31,362, now has the highest rate of confirmed cases in north Alabama at 522.9 per 100,000 residents. Marshall County is next with 485.7 per 100,000, followed by Marion County at 309.7.

With 81 confirmed cases as of Wednesday evening, Madison County’s rate was 63.8 per 100,000. Limestone, with 49 cases, had a rate of 49.5. Madison has four confirmed COVID-19 deaths while Limestone has none.

“This is still out there,” Spillers said Wednesday. “It’s still a very contagious virus. You can get in a large group and if you’re just unlucky enough to be in that group where there’s just one sick person, they could infect four or five who could easily infect four or five more, and then four or five more. All of the sudden, we’ve got a real issue on our hands.”