Nobody Has a Clue How Many People Have COVID-19
Local data simply isn’t available, while state and national totals woefully underreport the reality
Across the United States, an unknown but presumably large number of people are packing COVID-19 around without knowing it, while only the most severely ill typically even get tested. As for knowing whether someone in your town or community might have the disease, well, fuhgettaboutit it.
A mish-mash of local and state reporting protocols, an utterly insufficient testing capacity, and the multi-day wait for results have conspired to render the total case count woefully lower than reality, while offering no insight to the public into what might be happening in outlying communities, small towns or even large cities.
Just one example: As the relatively modest but rapidly growing number of diagnosed COVID-19 cases in Arizona rises, residents of Anthem, an unincorporated community of about 25,000 people straddling the City of Phoenix and Maricopa County, have wondered how many of their neighbors might be infected.
“It would be helpful to breakdown the # of cases per zip code!” Marisha Dowdell wrote on the North Phoenix News Facebook page. “We have the right to know exactly where this virus is!!”
That information is not being distributed.
“Public Health does not report this data at the city level,” Fields Moseley, director of communications for Maricopa County, told me. “That is not an effective way to track and respond to disease when there is community spread [meaning people are getting it from other people in counties across the state]. It can give a false sense of safety or a false sense of danger. Everyone should assume they can come in contact with COVID-19 at this time and take precautions as outlined by ADHS,” he said, referring to the Arizona Department of Health Services.
The situation is similar nationwide, and even county-by-county data is hard to come by in many states.
The U.S. Centers for Disease Control and Prevention, the agency you might expect to be the clearinghouse for COVID-19 case data, updates its stats just five times a week and includes only state-level data.
“No single agency has provided the public with an accurate, up-to-date record of coronavirus cases, tracked to the county level,” according to the New York Times, which is now doing such tracking itself. “Individual states and counties have tracked their own cases and presented them to the public with varying degrees of speed and accuracy, but those tallies provide only limited snapshots of the nation’s outbreak.”
Johns Hopkins University also has a helpful COVID-19 caseload dashboard that’s updated regularly.
Both tracking efforts require data, however, data that isn’t always available from the combination of government-run and private labs, even after tests are done. “Not all labs are reporting yet (or promptly),” Surgeon General Jerome Adams tweeted on March 22.
Sorry, you’re not sick enough to be tested
The CDC’s recommendation for testing criteria may surprise some people: “Not everyone needs to be tested for COVID-19,” the agency states. “Most people have mild illness and are able to recover at home.”
The CDC’s advice to people who wish to be tested would be somewhat humorous if it weren’t so deadly serious: “If you have symptoms of COVID-19 and want to get tested, try calling your state or local health department or a medical provider. While supplies of these tests are increasing, it may still be difficult to find a place to get tested.”
Mosely, the Maricopa County spokesperson, outlined how test eligibility and results are handled in his county:
Individual hospitals follow guidelines from the CDC and Arizona’s health department to determine who gets tested. “Those results are reported to the state and county,” Moseley said. “Maricopa County Department of Public Health does not report results by hospital or community.”
He adds: “If a person tests positive for COVID-19, they will be contacted by Maricopa County Department of Public Health. They will be advised to take precautions to lower the spread of disease, including reaching out to potential contacts. In some cases they might meet with an investigator. While Public Health must protect their private information (because of federal and state law) some people choose to self-report to their community.”
So if a person diagnosed with COVID-19 doesn’t inform neighbors or community leaders, others simply won’t know about it.
Total number of cases unknown
For every person diagnosed with COVID-19, perhaps five to 10 other people are infected but have not been tested and, in some cases, may not realize they have it, suggested one study, published March 16 in the journal Science based on data out of China (which may or may not be relevant to the situation in the U.S. now).
I asked Dr. Peter Gulick, an oncologist and infectious-disease specialist at Michigan State University’s College of Osteopathic Medicine, if he could take a guess at the real number of cases, and whether the five-to-10 multiplier might be accurate.
“Other than mathematical theoretical calculations, I’m not sure we will really know that answer with any degree of certainty,” Gulick said.
I reached out to several epidemiologists who either declined to take a guess or didn’t even bother to reply to this apparently unanswerable question.
*** UPDATE April 6: Michael Mina, assistant professor of epidemiology at Harvard T.H. Chan School of Public Health, weighed in on this: “We really don’t know if we’ve been 10 times off or a hundred times off in terms of the cases,” Mina says. “Personally, I lean more to 50 or a hundred times off.” For more on what this means to cities and counties that have yet to experience severe outbreaks, see “COVID-19 Pandemic Has Only Just Begun.” END UPDATE ***
Don’t Walk In
In many if not most states and locales, only people with relatively clear and obvious (and relatively serious) COVID-19 symptoms—difficulty breathing and fever—or who were in close contact with some diagnosed with the disease, are eligible for testing, amid a clear lack of testing capability nationwide. If you’ve only lost your sense of smell, which recently emerged as a possible indicator of COVID-19, don’t expect a test.
In Arizona, HonorHealth is among the facilities capable of testing for COVID-19. In a statement to me, the company advised people who think they might have COVID-19 not to walk in to any healthcare facility. That’s advice echoed by health officials nationwide, of course — healthcare professionals need a chance to prepare for infectious patients.
Meantime, the testing bar is high. “If you have the following symptoms — fever over 100.4, cough, shortness of breath — please call the nurse line at 480–587–6200, so that we can direct you to the most appropriate place for care,” HonorHealth said in a provided statement.
“At this time, COVID-19 testing capabilities are continuing to expand across the state,” said ADHS spokesperson Caroline Oppleman. “Physicians can order lab tests for patients who meet certain criteria, which can be found on our website. “County public health departments typically announce new cases to the public as they get lab results,” Oppleman told me. “Counties also report these cases to ADHS and they are reflected in the statewide case count available on azhealth.gov the following day at 9 a.m.”
However, it can take up to five days for test results to be returned, according to HonorHealth, a timeframe typical across the country. That’s yet another reason why the total case count is unknown. Everyone who tests positive today won’t even be in the various databases until next week. Meantime, more people are being infected and won’t realize it for anywhere from 2 to 14 days—the coronavirus incubation period—if they realize it at all.
There is a vital need for much, much more testing with faster results, “not 4 to 7 days,” Gulick says.
Portions of this article were first published on North Phoenix News.