Here’s something behind all those coronavirus overdose cases in Texas

County health authorities in Texas are still sorting through a backlog of previously unreported test results of coronavirus, shaking some confidence from local officials in the figures and leaving them wondering if they are missing opportunities to carry the disease.

A statewide data dump led to gigantic daily counts of counting in some North Texas counties over the weekend, including Dallas County, where officials had to force four days with more than 7,600 previously unknown positive cases – the majority of them were back from June and July.

Because local health officials have so far been unaware of the cases, no contact tracing has been done on them. That could have serious implications, said Dr. Matt Richardson, director of public health at Denton County.

“We missed that opportunity because of the late report, which could just make the pandemic grow,” he said. ‘That’s why we have a pandemic. We missed opportunities for containment and unfortunately that was beyond our control. “

Richardson said the county was uncomfortable with data on tests across statewide and said it was frustrating that some “inherent flaws” with the state’s database were exacerbated by the delays.

“That just makes it less valuable,” he said, adding that the data is still useful because it shows what happened and provides demographic information.

The overdue cases came to light after the state upgraded its reporting system on August 1 to better handle the high volume of daily test results.

Before the coronavirus pandemic, the Department of State Health took less than 2,000 lab test results per day for a long list of conditions, including measles, meningitis, and some STDs. But when COVID-19 testing expanded – and the state had to track positive and negative results – the tracking system could not keep up, said Lara Anton, a spokeswoman for the state health department.

After the upgrade, which allowed the state to process more than 100,000 test results per day, the state removed the backlog in the first week of August, Anton said.

But once these results were processed, the state encountered coding problems with test results, the commercial Quest Diagnostics labs reported that prevented the state from importing its data.

That led to a backlog of 354,000 tests by Quest, Anton said.

Quest Diagnostics told KTVT-TV (Channel 11) that the state had changed servers without letting them know that it did not realize the results were not being received.

Coding problems also led to problems obtaining data from CHRISTUS Meditech, a multi-hospital lab that had a backlog of about 95,000 test results, and then a backlog of about 59,000 test results from Walgreens pharmacies, Anton said.

By Sunday, each of the backlogs had been resolved and test results were available for counties, she said. Now, the sorting of cases is in the hands of county health officials, who must determine whether the results are for cases they knew before or whether they are new, Anton said.

“The prospect you need to have is that with COVID there are hundreds of labs reporting now that were not previously reported to public health,” she said. “Walgreens, for example, do not typically test for infectious diseases, but for COVID they do tests. So they had a long way to go … to be set up to process the tests and then have a report and then get them in a format where they could send it to us. “

The delays do not cause delays in retrieving patients from their test results.

However, they could feed skepticism into the numbers for people who already doubt them, said Timothy Bray, director of the Institute for Urban Policy Research at UT Dallas. And for people, including business owners and school leaders, who rely on local day-to-day business counts, including data to make decisions about safe operation, they may feel they are ‘flying blind’, Bray said.

Collin County officials did not say how many of their cases were part of the backlog, but after reporting more than 1,100 cases Friday and no Sunday, officials warned residents they had “no confidence” in state data. in a message that was posted on the province dashboard Tuesday.

“The Commissioner’s Court is 100% certain that the COVID-19 data reported for Collin County is inaccurate,” Collin County Judge Chris Hill wrote on Facebook.

Anton, a spokeswoman for the state Department of Health Services, said that since Collin County chose the state to take over its case management in June, the state has “provided the most complete data available each day.”

“Like all COVID-19 data, it is subject to change as more information comes in,” she said.

Gov. Greg Abbott stood by the state data in an interview Wednesday with KXAS-TV (NBC 5).

“We used a very robust system team that came in, that corrected all the data metrics and now we have good accurate information flow,” he said. “It could take another day or two while this information is being leaked. But when the week ends, we should have pretty accurate data. ”

He also stressed that the backlog problem only affected test result data.

The most important and accurate information that exists is the information about the people who are hospitalized due to COVID-19. That information has never been questioned, ”the mayor told KXAS. “That information is both the most accurate and the most important information we have.”

Holes in understanding

In Dallas County, officials have indicated that most of the more than 7,600 previously unknown cases came from tests conducted in July.

In Tarrant County, health officials said many of the 1,487 cases reported Saturday were part of the backlog.

Within the last five days, Denton County received more than 7,000 previously unreported test results, and 893 were positive. Some of the lab results were carried out a few days ago, but some come from May and June, officials said.

Richardson, director of public health at Denton County, said the county is investigating the overdue cases to see if there are any duplicates and that contact persons are checking them.

He said the overdue cases will be added to new daily case counts after they have been investigated and identified as active or recovered cases.

Candy Blair, director of public health at Collin County, said officials saw the problem when they saw a sudden spike in data last week. They reported 1,175 new cases August 14 – almost 10 times the daily average in cases.

Directors of public health in the region asked the state about the problem, and that is when they learned about the backlog, she said.

Now she wants to make people understand that things are not suddenly nailed down.

“You don’t want them to panic,” she said. “That’s the last thing we want to do is to see if our numbers have doubled or are 10 times the amount they are normal.”

Officials in other counties also expressed a need for rest.

“People need to have patience and understanding,” Tarrant County Director of Public Health Vinny Taneja told the county commissioners’ court. ‘We are afraid that what we do not know may come back and bite us, and … [the backlog is] a prime example of things that have passed and we had no idea this was a problem. ”

What comes next?

Diana Cervantes, an epidemiologist for infection and an assistant professor at the University of North Texas Health Science Center, said public health authorities should focus on stopping the transmission of the disease.

“That’s your one goal; you want to focus on that,” she said.

That health departments can make investigation of new cases a priority over traces of old ones. Cervantes said that if departments have to sift through overdue cases, they try to determine if people could be people in institutions with high transmission and whether there is a chance of preventing an infectious person from spreading the virus.

“You need to be able to figure it out – is it even possible to intervene at this point?” sei se.

View of the pandemic

Bray, director of UT Dallas’ Institute for Urban Policy Research, said the backlog is a matter of critical concern for public health and public policy, but it should not change people’s behavior in response to the pandemic.

“We have to get it to the bottom,” he said. “We need to make sure it does not happen again, but it does reduce the need to be vigilant about public health and public safety measures.”

And despite the unexpected leap in the case, experts are still seeing encouraging trends in the spread of the virus.

Dallas County has recently seen a significant drop in confirmed cases, despite the backlog, County Judge Clay Jenkins said Tuesday.

He has also noticed less demand for tests in recent weeks.

“It’s pretty understandable at this point that people should have worried about computer programs, coding errors, contractors not sending things in time and other human errors around testing and reporting,” Jenkins said in a written statement. “However, the underlying science and the medical recommendations to you and the public are healthy.”

Dr Philip Huang, the province’s director of public health, reported on Tuesday that in – room visits have been sluggish since its peak in June. The rate of positive testing from hospitals, although still high at 14%, has also dropped recently.

He said people need to continue with good public health practices.

“We need to keep the physical distance, wash hands, stay home when you can,” Huang said. ‘All of these things are important, and they show to work. That just everyone should be waiting for. Do not give up. ”

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