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Update on West Virginia, now 5 positive, four different counties, scattered, all travel related. The State lab only has five hundred test kits, and is rationing them based on strict criteria. Drive through testing is just beginning in several places, you have to call ahead, meet criteria, etc.

Private labs are doing testing, so our totals should begin to move. The governor was tested as he had met one of the first patients at a function.

Limited closures - the usual restaurants, fitness centers, beauty salons.

We are well past the time for any semblance of containment and are quietly building up hidden exposures like many other smaller, rural areas. We are no.1 in opioids, diabetes, obesity, high in elderly, lots of kids with cormobidities.

We may have been the last to the ball but we are going to have a grand old time!!

Forget to add, due to declining population in West Virginia, many rural hospitals and clinics have closed. We have very little resilience in our hospital capacity. Due to our proximity to five other states, many go out of state for any kind of advanced treatment - to Winchester, Harrisonburg, even Richmond in the east, Cumberland and Pittsburgh in the north, similar places to Ohio and Kentucky in the west and south.

No real way to enforce shelter in place. On the good side neighbors will not let neighbors go hungry here.

Test kits is not the only constraint—lab supplies may be an issue as well:

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Gov. Charlie Baker (R) of Massachusetts. He said his state was following the President’s call to go out and buy needed equipment without waiting for the feds.

But then his state found the feds were out bidding them for those same materials.

https://twitter.com/jamiedupree/status/1240998058000818177

This happens in the corporate world from time to time.

The President of the corporation will tell shareholders that “We will produce a million widgets next month.” But, what the President does not know is that in order to produce widgets, the factory requires several different supplies which are currently low in stock. Then, when the factory fails to produce the quota of widgets everybody starts pointing fingers at everyone else.

When I was a manager (in my younger days) I always walked the factory floor and talked to the workers about issues, particularly supply and other constraints they were dealing with on a day to day basis.

At the end of the day, you cannot count on paper-pushing middle managers to have a clue what is happening on the ground in the real world.