Next week, Kansas and Missouri are set to begin rolling back stay-at-home orders and reopening businesses that have been closed for weeks to prevent the spread of COVID-19.

Many political and business leaders say it’s time to ease the public health efforts, but health experts say that the states are still not testing at rates that they, and even many conservative politicians, have said are needed to keep people safe.

“If you are only testing a small portion of the people who may have the virus, then you don’t really know what’s going on with the virus,” says Josh Michaud, an infectious disease expert with the Kaiser Family Foundation.

During the past two weeks, Kansas and Missouri have seen a gradual "flattening of the curve" in the rate of new COVID-19 cases. And by one significant measure, Missouri is faring much better than many parts of the country.

About 10% of COVID-19 tests in Missouri are positive, according to data from The COVID Tracking Project. That's far lower than the problematic 19% positive national test rate.

“If you are testing say, 10,000 people a week, and 20% of those tests come back positive, that’s exceedingly high, and you’re likely not capturing all the cases that are out there,” says Michaud.

Testing guidelines from the World Health Organization recommend that communities test enough people that 10% or fewer of tests are positive.

Kansas’s positive test rate is 12%, and it has been slowly increasing during April.

The relatively low positive test rates are encouraging, but health experts and others say there hasn’t been enough testing for the data to be reliable.

A new study from Harvard researchers shows how much testing each state needs to do to have solid data on the spread of COVID-19.

The researchers estimated that Kansas needs to test 265 additional people each day by May 1, and Missouri needs to test 549 more people, based on the testing rates for the week ending April 22.

Last week, labs in Missouri conducted 15,989 tests, and the rate of testing has declined since the start of the month. Between Sunday, April 5, and Saturday, April 11, the state conducted 18,267 tests.

The decline in testing may be due in part to low supplies of testing swabs and chemicals, but lack of coordination may be a factor as well.

In mid-April, Steven Kleiboeker, a vice president of Viracor Eurofins Clinical Diagnostics, a lab in Lee’s Summit that has been conducting COVID-19 tests nationally and in the Kansas City area, said that their facility had unused capacity for testing.

Michaud says that across the country, many commercial labs have not been fully integrated into COVID-19 testing efforts by government leaders.

“They haven’t been connected to the care network of the people who are being seen by providers and where tests are being ordered,” Michaud says.

Meanwhile, in Kansas, the rate of testing has increased from 4,765 during the first full week of April to 7,523 last week.

The researchers’ testing goals for Missouri are significantly lower than the goals cited by Missouri Gov. Mike Parson, who said in mid-April the state needed to be conducting 40,000 to 50,000 tests per week to have reliable information.

The Harvard researchers said their testing goals where shaped in part by what might be possible, rather than ideal, for each state.

The Missouri health department announced on Monday that the state and commercial labs had reached the capacity to conduct 50,000 tests per week, and health officials in Kansas say they are working to ramp up testing immediately.

However, even immediate increases in testing would be too late to provide adequate information about reopen businesses by the May 4 dates planned in each state, according to health experts.

Because it may take up to 14 days for an infected person to become symptomatic and because it takes an average of 14 days for someone to die after they have been infected, COVID-19 tests are thought to provide an estimate of full impact of the disease in two weeks, rather than a complete picture of the virus in real time.

The Opening Up America Again plan produced by the White House says that states should be able to demonstrate a declining trajectory of COVID-19 cases over a 14 day period before they take the first steps to end stay-at-home orders and reopen businesses.

Though the rates of new cases have slowed in Kansas and Missouri, neither state has shown a steady decline.

When Kansas and Missouri businesses reopen next week, many people will be at higher risk of being exposed to the coronavirus.

However, Michaud says that without testing at needed levels, the states could be blindsided by another increase in cases and forced to again take dramatic efforts to mitigate the impact of the virus.

“You might not even realize that there’s an increase going on until it’s very far along, which would mean you’d have to reinstate the social distancing measures,” Michaud says. “We’d be back to square one.”

