REMOVEy official number, less people diagnosed with COVID-19 right now than at any other time during the pandemic. As of April 19, there were an average of 40,000 new cases per day, compared with more than 800,000 per day at the height of the US Omicron wave.
But the official count is increasingly misleading. More Americans than ever are testing positive for home test—Results are rarely reported to public health authorities, and are therefore not included in official documents. Public health experts worry that case numbers are currently an unreliable way to gauge the state of the pandemic, and that there are far more infections than statistics show.
Under CARES . ActCOVID-19 testing website be asked to report the results to public health departments. Results of televised tests — sometimes required for activities that include commuting and having a medical professional monitor the test via video — are also commonly reported. But individuals are not required to report the results of their standardized tests at home. Some state health departments, such as those in Colorado and Washington, collect self-reported data. Others, like Massachusetts, referred to the local health department. But in many places, there is no established system.
The CDC recommends that people share their positive results with their healthcare provider, who can recommend a lab test to confirm the result and add it to the official statement . But many people don’t tell their doctor they’ve had a positive rapid test – 25% of American adults don’t even have a primary care doctor, according to a study—And some doctors don’t bother recommending secondary testing. According to a survey in January from the COVID States Project.
That might help explain why Overall test volume in the lab dropped from more than 2 million tests per day in January to about half a million tests per day in mid-April — along with closure of some mass testing locationsthe End of free trial for uninsured peopleand the easing of pandemic prevention measures across the country.
In some respects, it’s surprising how many people do do another test after getting a positive result at home. David Lazer, co-author of the COVID Countries Project survey and professor of computer science and politics at Northeastern University, said he was surprised by his team’s findings; he predicts more than 30% of people will skip the secondary test. At this point in the pandemic, he suspects that the real number is higher, as people are increasingly comfortable with home tests and it’s increasingly difficult to find free testing sites.
“There is every reason to believe that the disappearance is much larger now than it was in January,” Lazer said.
That’s a problem, medical experts agree. With wastewater monitoring and hospitalization rates, testing data is one of the main ways public health officials track the spread of the virus and look for potential outbreaks and hotspots. Agencies including the CDC have said measures such as the mask duty can be flexibly applied depending on current transmission patterns in a given area. But if health officials don’t have an accurate picture of where the virus is spreading, they won’t be able to use appropriate mitigation strategies.
A national reporting system of home testing data could help with that – but the question is how to make a result work and if that is the best use. public health resources are increasingly strained or not.
Mixed blessings of home trials
Dr Michael Mina, chief scientific officer of remote testing company eMed, has long argued that rapid tests are crucial to controlling the pandemic. Such as a quick wipe before traveling or social events, can prevent people from unknowingly infecting others. It’s great that people are finally using regular self-testing, Mina said, but it’s time to better track outcome data.
“Two years ago, I tried for the test at home Regardless of the report, he said, because of this great urgency and need “to have better prevention tools. “Now, we’ve got two years to catch up.”
The need for better tracking is obvious. During the Omicron wave, about 20% of people in the US with COVID-like symptoms used home testing, according to CDC data. Now, more people are testing at home than ever before. For the first time in a pandemic, more people tested positive at home than with other types of tests in the week ending April 16, according to new data from researchers at the Hospital. Children’s Boston and Momentive survey company (unpublished. in a peer-reviewed journal). About 58% of the positive cases reported by 474,000 people surveyed were tested at home.
It’s better for individuals because it’s convenient, says John Brownstein, innovation director at Boston Children’s Hospital. “But it’s not better for public health, as public health data relies on detailed reporting.”
Many home-testing kits include a way to voluntarily report results to the manufacturer, often by downloading an app; The company may then choose to share the results with public health officials. But few people use that option. Through a testing program run by the CDC and the National Institutes of Health, more than 1.4 million do-it-yourself tests were distributed to households in Tennessee and Michigan by 2021 — but less than 10,000 test results were then logged into a companion appAccording to an article in Health problems.
Similarly, only about 5,700 people have reported a positive result through the Washington State hotline as of August 2021, a representative for the health department told TIME. That also represents a fraction of the tests performed within that timeframe; During the peak of the Omicron surge, the state recorded thousands of cases a day.
Looking for a better system
It would be technologically easy for the CDC or another US government agency to build a website where users could quickly record their home diagnoses. Brownstein’s research team ran so website to “bring the ‘community’ back to public health,” he said. Community sourcing data benefits individuals as well as researchers, because “you get epidemic weather maps where you can understand what’s happening and make informed decisions.” for themselves and their families”.
But using that approach to inform federal statistics is risky, Lazer said, because a few “half-eaten apples” could choose to misreport many cases and skew the data. And without knowing how many tests were taken in total, it’s hard to know the significance of a few reported results, Mina said. (However, Brownstein argues that there is value in a national monitoring site, even without 100% participation. “Not many people. [write Amazon reviews]but there are enough people willing to give you a feel for the value of a product,” he said.)
For more people to opt into the reporting system, they’ll need a reason other than being a “good Samaritan,” says Mina. His company, eMed, is trying to encourage self-reporting. Once someone uses an eMed-compatible home test, the company generates a lab report that is shared with public health departments. It also benefits individuals, Mina said, as they can use the report to get cleared for travel, work or school if they are negative. If the result is positive, they have proof of it and will be remotely connected by the treating doctor to a doctor who can prescribe treatment. Mina says that might be a better motivator for the average person than just contributing to the stats.
Public health officials should also leverage existing tools by working with diagnostic companies to make their self-report systems easier and more accessible, Brownstein said. For example, instead of downloading an app, people can send their results via text message.
Another option, Lazer said, would be to conduct large, repetitive surveys of American households, asking if anyone in the home has recently tested positive for COVID-19. No and if yes, what kind of test?
A bigger problem than self-examination
For Beth Blauer, executive director of the Center for Community Impact at Johns Hopkins University and an expert on government data systems, the data problem in the US involves more than trials at home. Two years after the pandemic, states still don’t have a standardized way to collect and evaluate the test results they receive from testing sites, meaning testing data and federal records are wrong. missed even before considering missing data from unlocked snapshots, she said.
The situation is especially dire, Blauer adds, as some public testing sites shut down and those without insurance can no longer get free testing. Instead, some people can test at home, but many cannot. The data show that home tests are most common among relatively young, white, highly educated and wealthy people—Perhaps unsurprisingly, each test costs about $10. Many people, especially those from underserved communities, won’t get tested if they can’t get a free diagnosis through an agency, school or a public testing site, Blauer said. conveniently, that means many cases will never go undetected.
“If COVID has taught us anything, it’s that we have to be much more agile in how we adapt and test public health interventions,” Blauer said. “As we dilute that data, it gets harder and harder to be agile.”
Finding a way to include home testing data in the official case count could create a crack in that regard. But that will only work if everyone has access to at-home tests and knows what to do with the information they reveal, said Benjamin Rader, a graduate researcher at Boston Children’s Hospital, said.
“When we were trying to create a comprehensive surveillance system, it was imperative that we make sure we reached everyone in society,” says Rader. “We need to make sure we’re doing everything we can to target everyone and not leave the US pocket.”
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