By official count, there will be fewer people diagnosed with COVID-19 right now than at almost any other time during the pandemic. There was an average of 40,000 new cases per year. day per April 19, compared to more than 800,000 per. day at the height of the US Omicron wave.
But official counts are increasingly misleading. More Americans than ever test positive home testWhose results are rarely reported to the public health authorities and are therefore missing in official inventories. Public health experts are concerned that case numbers are now an unreliable way of assessing the state of the pandemic and that there are countless more infections than statistics show.
Below CARES lawCOVID-19 test sites is required to report results to public health departments. The results of controlled remote tests – which are sometimes necessary for activities, including travel and involve a healthcare professional monitoring the test over video – are usually also reported. However, individuals are not required to report the results of their standard home test. Some state health authorities, like those in Colorado and Washington, collect self-reported data. Others e.g. Massachusetts, refer to local health departments. But in many places there is no established system.
That The CDC recommends that people share their positive results with their health nurse, who in turn can recommend a laboratory test to confirm the result and add it to official inventories. But many people do not tell their doctors that they have had a positive rapid test – 25% of American adults do not even have a doctor in primary care, according to a study-and some doctors do not bother to recommend a secondary test. About 30% of people who tested positive for COVID-19 via a do-it-yourself diagnosis did not receive a confirmatory test and were therefore probably not counted, according to a January study from the COVID States Project.
It may help explain why total laboratory test volume fell from more than 2 million tests per day in January to about half a million per. day in mid-April – along with closure of some mass experimental sitesthat the end of free test programs for people who are uninsuredand the nationwide easing of pandemic measures.
In some respects, it is surprising that so many people do get a new test after getting a positive result at home. David Lazer, co-author of the COVID States Project study and professor of political and computer science at Northeastern University, says he was surprised by his group’s findings; he expected that more than 30% of people would skip the secondary test. At this point in the pandemic, he suspects the real number is higher as people are more and more comfortable with home testing and it becomes harder to find free test sites.
“There is every reason to believe that the loss is much, much greater now than it was in January,” Lazer says.
This is a problem, health experts agree. Together with wastewater monitoring and hospitalization rates, test data is one of the key ways in which public health authorities track the spread of the virus and look for potential increases and hotspots. Agencies including the CDC have said that measures such as mesh mandates can be applied fluently depending on current transmission patterns in a given area. However, if health authorities do not have an accurate picture of where the virus spreads, they will not be able to use appropriate mitigation strategies.
A national home test data reporting system could help solve that problem – but the question is how to make one work and whether it is the best use of increasingly congested public health resources.
The mixed blessing of home tests
Dr. Michael Mina, chief science officer at the remote testing company eMed, has long argued that rapid testing is essential to control the pandemic. Rapid swabbing before travel or social events, for example, can prevent people from unknowingly infecting others. It’s great that people are finally using self-tests regularly, says Mina, but it’s time to better track the resulting data.
“Two years ago, I pushed for home tests regardless of reporting, out of this massive rush and need for better prevention tools, he says. “Now we’ve had two years to catch up.”
The need for better tracking is clear. During the Omicron wave, about 20% of people in the United States who had COVID-like symptoms used a home test, according to CDC data. Now people at home are testing more than ever. For the first time during the pandemic, more people tested positive for home tests than other types of tests in the week ending April 16, according to new data from researchers at Boston Children’s Hospital and research firm Momentive (which has not yet been published). in a peer-reviewed journal). About 58% of the positive cases reported by the 474,000 respondents were detected by a home test.
It’s better for individuals because it’s convenient, says John Brownstein, head of innovation at Boston Children’s Hospital. “But it’s not better for public health because public health data relies on detailed reporting.”
Many test kits at home include a way to voluntarily report results to the manufacturer, often by downloading an app; the company can then choose to share the results with public health officials. But few use that option. Through a pilot program run by the CDC and the US National Institutes of Health, more than 1.4 million do-it-yourself tests were distributed to households in Tennessee and Michigan by 2021 – but fewer than 10,000 test results were later logged in an accompanying appaccording to an article in Health matters.
Similarly, only about 5,700 people have reported a positive result through Washington State’s hotline since August 2021, a health department representative told TIME. It also represents a small fraction of the tests taken during that time frame; during the peak of the Omicron rise, the state registered thousands of cases every day.
The pursuit of a better system
It would be technologically easy for the CDC or another US government agency to build a website where users could quickly log their home diagnostics. Brownstein’s research group is already running what a website to “put ‘the public’ back in public health,” he says. Crowdsourcing data benefits individuals as well as researchers because “you get a disease weather map where you can understand what’s going on and make decisions for yourself and your family.”
But using this approach to inform federal statistics is risky, Lazer says, because a few “bad apples” could choose to misreport many cases and skew the data. And without knowing how many tests have been taken in total, it is difficult to know the significance of the few results reported, Mina says. (Brownstein, however, believes that there is value in a national monitoring site, even without 100% participation. “Not many people [write Amazon reviews]but there are enough people who are willing to give you a sense of the value of a product, ”he says.)
In order for more people to sign up for a reporting system, they would need a reason beyond being a “Good Samaritan,” Mina says. His company, eMed, tries to encourage self-reporting. After someone uses an eMed-compatible home test, the company generates a lab report that is shared with public health departments. It also benefits the individual, says Mina, because they can use the report to be cleared trip, work or school if they are negative. If they are positive, they have evidence of this result and will be connected via telemedicine to a doctor who can prescribe treatment. They can be better motivators for the average person than just contributing to statistics, Mina says.
Public health officials should also take advantage of existing tools by working with diagnostic companies to make their self-reporting systems easier and more accessible, Brownstein says. Instead of downloading an app, people could e.g. send their results via sms.
Another option, Lazer says, would be to conduct repeated, large-scale surveys of U.S. households, and ask if anyone in the home was recently tested positive for COVID-19, and if so, on what type of test.
A problem bigger than self-tests
For Beth Blauer, executive director of the Centers for Civic Impact at Johns Hopkins University and an expert in state computer systems, the data problem in the United States involves more than home testing. Two years into the pandemic, states still do not have a standardized way to collect and evaluate the test results they receive from test sites, which means that federal case and test data are incomplete, even before considering the missing data from unregistered rapid tests, she says. . .
The situation is especially bad now that some public test sites are closing down and uninsured people can no longer be tested for free, Blauer adds. Some people may want to test at home instead, but many will not. Data shows that Home testing is most common among those who are quite young, white, highly educated and wealthy– perhaps not surprising, as each test costs around $ 10. Many people, especially those from underserved communities, will simply not be tested if they cannot get a free diagnosis through work, school or a convenient public test site, Blauer says, meaning many cases will never be detected.
“If COVID has taught us anything, it is that we need to be much more agile in the way that we call up and call down public health interventions,” Blauer says. “As we dilute that data, it’s getting harder and harder to be agile.”
Finding ways to include test data at home in official case counts could make a dent in that problem. But it will only work if everyone has access to home tests and knows what to do with the information they reveal, says Benjamin Rader, a graduate researcher at Boston Children’s Hospital.
“When trying to create a comprehensive surveillance system, it is imperative that we make sure we reach everyone in the community,” Rader said. “We need to make sure we do things to target everyone and not miss out on US pockets”
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