HOUSTON – When health officials quietly removed about 3,500 cases of COVID-19 from the official Texas total on Wednesday, it launched a deluge of conspiracy theories about inflated and unreliable data amid a growing pandemic.
The 3,484 cases eliminated were diagnosed using FDA-approved antigen tests. The FDA has said that positive antigen test results are “highly accurate” and can be It is used to diagnose current infections with COVID-19. But state health officials pointed to the definition of a coronavirus case that the CDC released in early April to explain why the cases were dropped.
“The case data on our website reflects confirmed cases, and cases identified by antigen testing are considered probable cases by the national case definition,” said Chris Van Deusen, spokesman for the Texas Department of State Health Services.
By that definition, CDC only considers “confirmed” cases if they are diagnosed using a molecular test, often called PCR. Cases that are detected by antigen tests are classified as “probable”. If someone is diagnosed with an antigen test, Texas will not count their case among the state total.
The cases dropped were from Bexar County, which includes San Antonio. The city’s mayor said Thursday that San Antonio was one of three cities in Texas that tracks antigen testing, and that the tests help local health officials “see the big picture” of COVID-19 in the area.
“The state wants an apple-to-apple comparison with all cities in its reports, so they are eliminating antigen counts,” said Mayor Ron Nirenberg. “It now means that the State of Texas will not count thousands of FDA-approved COVID-19 positive tests in its reports. That is troubling, to say the least.
The FDA approved the first COVID-19 antigen test in May. When you see a COVID-19 image, you usually see a white ball with a bunch of red spikes sticking out. A molecular test (PCR) looks for the genetic material of the virus in the white ball. An antigen test looks for proteins that make up the red spikes.
“Each category of diagnostic test has its own unique role in fighting this virus,” according to the FDA. “PCR tests can be incredibly accurate, but running the tests and analyzing the results can take time. One of the main advantages of an antigen test is the speed of the test, which can provide results in minutes. “
While some concluded that the removal of the state was proof that the state’s record case numbers were inflated and that all fear of the virus had been exaggerated, it actually suggests otherwise. In a state that is already struggling to keep up with testing demands and rising hospitalizations, Texas risks accounting for cases:and undermining trustBy not recognizing the positive results of antigen tests, experts said.
Dr. Sarah Bezek, an assistant professor of emergency medicine at Baylor College of Medicine in Houston, said the most transparent way for the state to report cases would be to include data from each type of coronavirus test.
“Just say, ‘This is the number of positives from the PCR tests, this is the number of positives from the antigen tests, and these are the positives from serological studies (antibody tests),” said Bezek, who works on the front line in the Houston area emergency departments. “That would be complete transparency of the data.”
A positive antigen test result is reliable, Bezek argument. The two FDA-approved COVID-19 antigen tests are very specific, which means they can distinguish between COVID-19 and other respiratory viruses.
The legitimate blow antigen tests is that they are less sensitive than PCR tests, which means they return more false negatives. But Bezek pointed that out even the PCR tests are not 100 percent accurate, further away preventIn g the ability of local health officials to accurately track contacts.
Depending on how and when a PCR test is administered, too, can return a false negative.
“We have patients who are having a negative test after the negative test,” said Bezek. “There are certain constellations of symptoms that, after seeing enough coronavirus patients, that when you see someone testing negative, you can say, ‘Well, I’m pretty sure it’s coronavirus.'”
Those cases, she additionalThey are also not counted by the state.
On Thursday, outrage over the removal of cases spread like an online forest fire. But many of the answers were not persons concerned about reduced disease surveillance. Instead, they were The conspiracy theorists who suggested the withdrawals somehow indicated that the crisis had been exaggerated.
“It was all a lie,” said a Twitter user. “They locked us up and destroyed the economy with lies.”
Texas Senator Ted Cruz got into the action, sharing a misleading tweet suggesting that those 3,484 people whose cases were dropped were never examined and that the San Antonio health department had made a mistake. Cruz added the comment, “Problems”.
Local health officials insisted that this was not the case.
“Probable cases do not mean ‘maybe’ COVID-19 cases,” said Colleen Bridger, acting director of San Antonio Metro Health. “The antigen tests are FDA approved, and the positive tests are very accurate.”
Dr. Seema Yasmin, director of the Stanford Health Communication Initiative, said acting to erase cases as Texas did was the “worst thing” they could have done in a climate where mistrust is mounting.
“The last thing you need when you see a surge is for people to suddenly think that the numbers are inaccurate and that things are not really as tragic and at a crisis point as they really are,” Yasmin said.
Texas reported 10,256 new cases on Friday and hit a new daily record for hospitalizations (10,632) and deaths (174).
According to the COVID Monitoring Project in The atlanticMany states report confirmed and probable cases in their state totals. The CDC did not respond to a request for comment on whether they planned to issue updated guidance on counting positive antigen tests as confirmed rather than probable.
Because antigen tests return more false negatives than molecular tests (PCR), there is a good case for keeping molecular and antigen test data separate so that researchers can better determine the positivity rates of each ( how often the tests are positive).
Joseph Petrosino, chairman of the Baylor College of Medicine department of molecular virology and microbiology, believes that data sets should be kept separate for epidemiological research purposes.
“You want to compare apples to apples,” said Petrosino. Monitoring of SARS-CoV-2 began with counting positive PCR tests. Adding additional test methods of different sensitivity levels can make screening efforts and epidemiological studies more difficult, such as where the virus is spreading faster and which individuals are most at risk. “
Yasmin accepts that, behind the scenes, it makes sense to keep the two data sets separate. But when it comes to informing the public about infections, you have to report the total number of positive cases, diagnosed using molecular and antigen tests, she argued.
“We make decisions about our lives and whether the children will go back to school or whether we will go to the grocery store often based on community broadcast,” said Yasmin. “You need that data transparency. When it comes to antigen tests, they’re a good indicator of whether someone is a case or not. ”
.
