Foolproof coronavirus tracking continues to elude Texas.
Sunday, Dallas County reported a spike of more than 5,000 additional COVID-19 cases after the state’s health department unloaded a backlog of previously unreported positives. The majority of those date to July, when the county was already setting record highs in daily case counts.
Aside from the data errors, the backlog in cases could have other consequences, said Dr. Erin Carlson, an associate clinical professor in the College of Nursing and Health Innovation at the University of Texas at Arlington.
“We already have some members of our public who are hesitant to believe information about COVID,” she said. “So if you add a situation like this, then that gives them more fuel to doubt government officials when they speak about COVID.”
If Texans doubt the veracity of the latest coronavirus guidance, that could worsen the state and county’s case rate, especially as schools begin to reopen.
Texans are already leery of government overreach related to the coronavirus, and some believe that media coverage of the pandemic is overblown. Data discrepancy could weaken their trust in what health experts recommend, such as universal mask-wearing and social distancing, Carlson said.
With schools opening up, the number of additional cases will likely rise. Carlson said the rate will be exponentially higher, though, if students and parents have been persuaded to ignore health experts’ recommendations.
Just because someone feels well doesn’t mean they don’t have the disease, she added; they may be an asymptomatic carrier.
In addition, Carlson fears that the sudden backlog in cases could overwhelm county health department employees.
“They are working day and night,” she said. “They are working so hard, and now you put 5,000 cases on the table that they have to integrate into their systems.”
Carlson said that contributing to the backlog problem is the fact that the state is having to report data for both positive and negative test results. Prior to COVID-19, she said, it would only accommodate positive ones.
This weekend, the Department of State Health Services reported that coding errors and a system upgrade resulted in large-scale commercial laboratories submitting backlogs of test results. That meant that certain local health departments, including Dallas County’s, received a substantial number of previously unreported positives, said DSHS spokeswoman Lara Anton.
Patients were notified of their diagnosis shortly after testing via a separate system, she added.
Last Tuesday, the coding error prompted Texas’ seven-day positivity rate to soar to an artificial high of 24.5%, Anton said. This Sunday, however, it had plummeted to 11.87%.
Although that’s better than it was last week, it’s still significantly higher than the nation’s current seven-day moving average of 6.7%, according to a database compiled by Johns Hopkins University.
Anton said the state’s health department was not prepared to process the numbers of test results it has received during the pandemic. Before COVID-19, it would manage fewer than 2,000 electronic lab reports a day; this summer, it's sometimes been tasked with handling more than its daily capacity of 48,000.
Regardless, the department will work to prevent a similar occurrence, she said.
“We have a team of data analysts and consultants who are right now working on how to streamline our processes,” Anton said, “and make sure that we’re doing all of the quality assurance checks and everything to try and prevent this kind of thing from happening again.”
Meanwhile, Dallas County’s overall testing rate has dropped, said Dr. Philip Huang, director of Dallas County Health and Human Services. He attributes the decline to a lower new case rate.
Huang said that mask mandates, social distancing and hand washing have all played roles in coaxing the county’s testing rate to drop. The lower percentage likely indicates that fewer people are experiencing symptoms of the disease, he said.
“All of those are showing positive signs of working, and we really need to be very vigilant to keep doing it,” he said. “If we get some positive signs with this, don’t let up.”
Dr. Rajesh Nandy, a biostatistics and epidemiology professor at the University of North Texas Health Science Center, said that he prefers to use hospitalization and ER data to determine case rates. That information is often more reliable than testing results, he said.
It’s important to keep the positivity rate at or below 10%, Nandy said; by his last count, Dallas County’s rate was comparable.
High positivity rates are concerning, Nandy said, because they indicate that health experts are missing a large number of cases. That’s because testing can be selective, so the higher the positivity rate, the greater the chance that someone who is asymptomatic was missed.
Another reason for the lower number of tests in Dallas County may be that some people are reluctant to sign up, Nandy said. Earlier this summer, many had to wait hours to get tested in packed parking lots before they were seen.
No matter what, it’s a good thing that the county has enough testing kits to help the number of North Texans seeking them, he said.
“It’s better to have that problem than the opposite problem,” Nandy said.
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