{"id":268900,"date":"2020-09-16T06:16:05","date_gmt":"2020-09-16T10:16:05","guid":{"rendered":"https:\/\/canadianinquirer.net\/v1\/?p=268900"},"modified":"2020-09-16T06:16:05","modified_gmt":"2020-09-16T10:16:05","slug":"lack-of-antigen-test-reporting-leaves-country-blind-to-the-pandemic","status":"publish","type":"post","link":"https:\/\/canadianinquirer.net\/v1\/2020\/09\/16\/lack-of-antigen-test-reporting-leaves-country-blind-to-the-pandemic\/","title":{"rendered":"Lack of Antigen Test Reporting Leaves Country \u2018Blind to the Pandemic\u2019"},"content":{"rendered":"<figure id=\"attachment_260145\" aria-describedby=\"caption-attachment-260145\" style=\"width: 654px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/canadianinquirer.net\/v1\/wp-content\/uploads\/2020\/07\/united-nations-covid-19-response-m6OZNfmo2Dk-unsplash.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-260145\" src=\"https:\/\/canadianinquirer.net\/v1\/wp-content\/uploads\/2020\/07\/united-nations-covid-19-response-m6OZNfmo2Dk-unsplash-654x1024.jpg\" alt=\"Covid test\" width=\"654\" height=\"1024\" srcset=\"https:\/\/canadianinquirer.net\/v1\/wp-content\/uploads\/2020\/07\/united-nations-covid-19-response-m6OZNfmo2Dk-unsplash-654x1024.jpg 654w, https:\/\/canadianinquirer.net\/v1\/wp-content\/uploads\/2020\/07\/united-nations-covid-19-response-m6OZNfmo2Dk-unsplash-192x300.jpg 192w, https:\/\/canadianinquirer.net\/v1\/wp-content\/uploads\/2020\/07\/united-nations-covid-19-response-m6OZNfmo2Dk-unsplash-768x1203.jpg 768w, https:\/\/canadianinquirer.net\/v1\/wp-content\/uploads\/2020\/07\/united-nations-covid-19-response-m6OZNfmo2Dk-unsplash.jpg 1920w\" sizes=\"auto, (max-width: 654px) 100vw, 654px\" \/><\/a><figcaption id=\"caption-attachment-260145\" class=\"wp-caption-text\">Federal officials are prioritizing the tests to quickly detect COVID-19\u2019s spread over slower, but more accurate, PCR tests. (File photo: United Nations COVID-19 Response\/Unsplash)<\/figcaption><\/figure>\n<p>More than 20 states either don\u2019t release or have incomplete data on the rapid antigen tests now considered key to containing the coronavirus, which has sickened more than 6 million Americans. The lapses leave officials and the public in the dark about the true scope of the pandemic as untold numbers of cases go uncounted.<\/p>\n<p>The gap will only widen as tens of millions of antigen tests sweep the country. Federal officials are prioritizing the tests to quickly detect COVID-19\u2019s spread over slower, but more accurate, PCR tests.<\/p>\n<p>Relying on patchy data on COVID testing carries enormous consequences as officials decide whether to reopen schools and businesses: Go back to normal too quickly and risk even greater outbreaks of disease. Keep people at home too long and risk an even greater economic crisis.<\/p>\n<p>\u201cThe absence of information is a very dangerous thing,\u201d said Janet Hamilton, executive director of the Council for State and Territorial Epidemiologists, which represents public health officials. \u201cWe will be blind to the pandemic. It will be happening around us and we will have no data.\u201d<\/p>\n<p>The states that don\u2019t report antigen test results or don\u2019t count antigen positives as COVID cases are California, Colorado, Georgia, Illinois, Maryland, Minnesota, Missouri, Montana, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Pennsylvania, South Dakota, Tennessee, Texas, Vermont, Virginia, Washington, Wisconsin and Wyoming, as well as the District of Columbia.<\/p>\n<p>So far, most of the COVID tests given in the U.S. have been PCR tests, which are processed in medical labs and can take days to return results. By contrast, antigen tests offer results in minutes outside of labs, appealing to everyone from medical clinics to sports teams and universities.<\/p>\n<p>Each relies on swabs to test patients. But unlike using tests run through labs, many providers who would use antigen tests don\u2019t have an easy way to send data electronically to public health authorities.<\/p>\n<p>Since July, though, the federal government has pushed roughly 5 million antigen tests into nearly 14,000 nursing homes to contain outbreaks among staff members and residents. The Department of Health and Human Services also awarded a $760 million contract to buy 150 million rapid antigen tests from Abbott, the Illinois-based diagnostics behemoth. It plans to send 750,000 of those to nursing homes starting this week, Brett Giroir, the HHS official heading the Trump administration\u2019s testing efforts, told industry executives on Sept. 8. Federal officials have not elaborated on how many tests will be sent elsewhere but have suggested many will go to governors to distribute as schools reopen.<\/p>\n<p>The rush of antigen tests, however, won\u2019t be particularly useful to officials if the results are not publicly and uniformly reported.<\/p>\n<p>KHN surveyed 50 states and the District of Columbia on their collection of antigen test results and what is reported publicly. Forty-eight responded between Sept. 3 and 10, revealing significant variation over whether people who test positive for COVID-19 with an antigen test are counted as cases and whether states even publicly report antigen data in their testing numbers:<\/p>\n<ul>\n<li>21 states and D.C. do not report all antigen test results.<\/li>\n<li>15 states and D.C. do not count positive results from antigen tests as COVID cases.<\/li>\n<li>Two states do not require antigen test providers to report results, and five others require only positive results to be reported.<\/li>\n<li>Nearly half of states believe their antigen test results are underreported.<\/li>\n<\/ul>\n<p>Consequently, many state counts of infected people could be artificially low. For instance, the lack of reporting could imply infection rates are declining because the virus isn\u2019t spreading as widely \u2014 when really more antigen tests are being used and not counted, public health officials and experts say.<\/p>\n<p>\u201cIt\u2019s going to look like your cases are coming down when they\u2019re not,\u201d said Jeffrey Morris, a biostatistics professor at the University of Pennsylvania.<\/p>\n<p>HHS recognizes that antigen tests are underreported but maintained that officials are not missing the full scale of the pandemic, an agency spokesperson said.<\/p>\n<p>\u201cThere is sufficient testing to achieve all objectives outlined in the testing strategy, including identifying newly emergent outbreaks, supporting public health isolation and contact tracing, protecting the vulnerable, supporting safe reopening of schools and businesses, and enabling state testing plans,\u201d spokesperson Mia Heck said.<\/p>\n<p>Part of the problem on antigen test reporting stems from what counts as a COVID case. <a href=\"https:\/\/wwwn.cdc.gov\/nndss\/conditions\/coronavirus-disease-2019-covid-19\/case-definition\/2020\/08\/05\/\">Guidance<\/a> from the Centers for Disease Control and Prevention defines a \u201cconfirmed\u201d COVID case as one that is determined from a PCR test. Positive results from antigen tests are considered \u201cprobable\u201d cases because the tests can be less accurate.<\/p>\n<p>Months after the first COVID antigen test received emergency authorization from the Food and Drug Administration, the CDC revised its COVID case definition in early August to allow a positive antigen test to count as a probable case without assessing whether a person had clinical symptoms or was in close contact with a confirmed infected person.<\/p>\n<p>That prompted many states \u2014 including Arkansas, starting Sept. 2 \u2014 to adjust how they report cases.<\/p>\n<p>\u201cIt\u2019s easy for people to think since we use the word \u2018probable\u2019 that maybe it\u2019s a case, maybe it isn\u2019t. But that\u2019s not how we think of it,\u201d said Dr. Jennifer Dillaha, medical director for the Arkansas Department of Health. \u201cIt is a real case in the same way that a PCR is a real case.\u201d<\/p>\n<p>Dr. Karen Landers, an assistant state health officer for the Alabama Department of Public Health, said her biggest concern was the potential undercounting of antigen test results as they continue to grow in popularity. While the state has been trying to work with each urgent care or other medical provider, some struggle to submit the results.<\/p>\n<p>\u201cWe can\u2019t afford to miss a case,\u201d she said.<\/p>\n<p>The CARES Act, which Congress passed in March, requires a broad range of health care providers to report any COVID test result to state or local health departments. Nonetheless, two states \u2014 Montana and New Jersey \u2014 said they weren\u2019t requiring antigen test providers to report results, positive or negative. Colorado, Maine, Mississippi, New Hampshire and Wyoming require only positive results to be reported, which can distort the positivity rate.<\/p>\n<p>Sara Mendez, the support services manager for the Brazos County Health Department in Texas, said the department saw an increase of antigen tests being administered as Texas A&amp;M University students returned. Even though the state health department was not including positive COVID cases from antigen tests in its public reports, the local health department felt obligated to do so.<\/p>\n<p>\u201cA lot of the college students will just go and get those done as opposed to the PCR tests,\u201d Mendez said, \u201cso we felt like we were missing out.\u201d<\/p>\n<p>Indiana University undertook a massive antigen testing operation for students living on campus in August, administering 14,870 antigen tests across four campuses through drive-thrus, according to Graham McKeen, an assistant university director for public health. The test results were delivered while students waited in cars for about 30 minutes, with 159 coming back positive. Each night, a university staff member would manually download the spreadsheet off each of the test machines and securely email it to the state health department.<\/p>\n<p>But Indiana began reporting antigen testing only on Aug. 24, adding over 16,000 antigen tests into its public dashboard that day and saying in a news release that it plans to retroactively add in earlier antigen testing figures.<\/p>\n<p>McKeen said that, even though the state is now reporting some antigen data, tests are still missed under the cumbersome reporting system. The state said some of the data is being sent by fax.<\/p>\n<p>\u201cIt doesn\u2019t give the community a good handle on the infection in the community,\u201d McKeen said.<\/p>\n<p>Heck, the HHS spokesperson, said that federal agencies are working to improve the reporting of results and that problems were likely to be eased in the future, citing that Abbott\u2019s antigen test includes an electronic reader for automated reporting. By October, 48 million of those tests will be in circulation each month, she said.<\/p>\n<p>Still, to date, \u201cwhat this is exposing is the antiquated systems that public health agencies have had for years,\u201d said Scott Becker, executive director of the Association of Public Health Laboratories. \u201cSo much of the data we\u2019ve gotten is incomplete.\u201d<\/p>\n<p>That data barrier is playing out in nursing homes as well.<\/p>\n<p>Victoria Crenshaw is holding off on using antigen tests to screen residents and staff members at Westminster Canterbury on Chesapeake Bay nursing home in Virginia Beach, Virginia. As senior director, she sees one major holdup: No technology platform is in place to easily send results to health officials. Instead, she and colleagues would need to resort to taping pieces of paper together to deliver details of who was tested, and hope local officials would accept it.<\/p>\n<p>The Trump administration is pushing for nursing homes to use the tests for required screenings at least once a month and as often as twice a week. Under new federal regulations, nursing homes that don\u2019t comply with regular testing and reporting requirements are subject to citations or fines.<\/p>\n<p>\u201cWe have no technology today to submit this information,\u201d Crenshaw said, \u201cwhich leaves us in a vulnerable position.\u201d<\/p>\n<p><em><a href=\"http:\/\/www.kaiserhealthnews.org\/\">Kaiser Health News<\/a> (KHN) is a national health policy news service. It is an editorially independent program of the <a href=\"http:\/\/www.kff.org\/\">Henry J. Kaiser Family Foundation<\/a> which is not affiliated with Kaiser Permanente.<\/em><\/p>\n<h3>USE OUR CONTENT<\/h3>\n<p>This story can be republished for free (<a href=\"https:\/\/khn.org\/news\/lack-of-antigen-test-reporting-leaves-country-blind-to-the-pandemic\/view\/republish\/\">details<\/a>).<\/p>\n<p><a href=\"https:\/\/khn.org\/morning-briefing\/\">Subscribe<\/a> to KHN&#8217;s free Morning Briefing.<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/ssl.google-analytics.com\/collect?v=1&amp;t=event&amp;ec=Republish&amp;tid=UA-53070700-2&amp;z=1600250383408&amp;cid=a01f8348-ccb0-41ff-96e8-d2c042791397&amp;ea=https%3A%2F%2Fkhn.org%2Fnews%2Flack-of-antigen-test-reporting-leaves-country-blind-to-the-pandemic%2F&amp;el=Lack%20of%20Antigen%20Test%20Reporting%20Leaves%20Country%20%E2%80%98Blind%20to%20the%20Pandemic%E2%80%99\" \/><\/p>\n","protected":false},"excerpt":{"rendered":"<p>More than 20 states either don\u2019t release or have incomplete data on the rapid antigen tests now considered key to &hellip;<\/p>\n","protected":false},"author":44,"featured_media":268141,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[16,17],"tags":[],"class_list":["post-268900","post","type-post","status-publish","format-standard","has-post-thumbnail","category-news","category-news-w","mauthors-rachana-pradhan","mauthors-lauren-weber","mauthors-hannah-recht","mauthors-kaiser-health-news"],"_links":{"self":[{"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/posts\/268900","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/users\/44"}],"replies":[{"embeddable":true,"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/comments?post=268900"}],"version-history":[{"count":1,"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/posts\/268900\/revisions"}],"predecessor-version":[{"id":268901,"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/posts\/268900\/revisions\/268901"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/media\/268141"}],"wp:attachment":[{"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/media?parent=268900"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/categories?post=268900"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/canadianinquirer.net\/v1\/wp-json\/wp\/v2\/tags?post=268900"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}