CARSON CITY, Nevada (AP) – Nevada this week became one of the last states to publicly report rapid antigen testing as part of its coronavirus counts – a move that experts say could provide a picture more complete of the pandemic but also upset the measures used to assess the spread of the virus.
The change leaves Maryland as the only US state that does not integrate rapid tests into its online dashboard or include them in virus statistics, as recommended by the United States Centers for Disease Control, according to an Associated Press review of dashboards and policies for all 50 states. .
Nevada has been among the states hardest hit by the pandemic. The state’s hospitals have been pushed to near capacity, its unemployment has broken national records and 435,000 people have tested positive for COVID-19. The omission of rapid tests from his tally has limited public understanding of the spread of the pandemic in the state, Nevada health officials acknowledge.
The officials said the AP in September 2020 that they were working to publicly declare antigen and molecular tests separately on their dashboard. On Monday, they said the delays stemmed from the state’s overburdened public health system having to juggle competing priorities with limited resources.
Rapid antigen tests, which detect the presence of viral proteins rather than the coronavirus itself, return results within minutes, unlike traditional molecular tests sent to labs, which can take days to process but prove to be more accurate. Their quick turnaround times have led to their widespread use in prisons, schools, and nursing homes.
President Joe Biden praised rapid tests last month, but supply shortages and the various ways states are reporting them reflect the continued lack of a national testing strategy. Some states report antigen tests separately, with positive results as “probable cases,” while others combine them with molecular tests for an overall tally.
Nevada added more than 600,000 new tests to the online dashboard on Monday which shows the number of coronavirus cases and deaths, vaccination rates and positivity rates. The infusion increased the number of reported COVID-19 cases statewide by 9,700 and decreased the positivity rate by one-sixth, from 10.1% to 8.8%.
University of Nevada, Las Vegas epidemiologist Brian Labus said scientists never assumed the test data provided a full picture of COVID-19’s trajectory and instead used it to identify trends . It’s easier to gauge when COVID-19 is rising and falling if cases are counted the same way, he said, especially with regard to statistics used to determine the need for preventive measures like mask warrants.
One criterion that triggers county mask warrants for indoor public spaces is an 8% positivity rate, which the CDC defines as “substantial” transmission.
“Changing now is probably going to disrupt this system,” Labus said.
While other states have adopted antigen testing, also known as point-of-care testing, Nevada has been relatively skeptical. A year ago, federal officials berated the state when it decided to stop their use due to accuracy issues.
Nevada, which was the only state to stop using the tests, later rolled back the ban.
Nevada began reporting rapid prison tests towards its cumulative case count in December and approved them for use in plans to reopen schools and protocols for big events like this month’s Life is Beautiful music festival. last, which brought together 60,000 people. Those approvals, however, did not require the state to include most tests in calculating infection rates.
The Nevada Department of Health and Human Services made the decision to direct its resources and staff to vaccine distribution and contact tracing and, at the height of the pandemic, lacked the capacity to ‘investigate every positive result of a rapid antigen test, the state epidemiologist said. Melissa Peek-Bullock.
While it is inconsistent to report rapid tests only in state prisons, she said not counting them would have deprived inmates, guards and their families of vital information about the scope of the pandemic in prisons.
With a drop in new cases, Nevada now has the capacity to investigate positive antigen tests as probable coronavirus cases, Peek-Bullock said.
“The antigen testing reports really give us a better picture of what’s going on in terms of the disease burden in our state. With schools using it, prisons using antigen tests on a massive scale and numerous tests carried out by employers – we have just reached a point in the pandemic where we absolutely have to take these positive results into account, ”he added. she declared.
An average of 17,700 antigen tests per week were reported to Nevada health officials in August and the first three weeks of September, according to state data.
Nevada wasn’t the only state struggling to process hundreds of thousands of different types of tests, said Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists. Test results are not transmitted electronically from providers to health services, forcing them to process large volumes of paper. These types of time-consuming businesses stem from a lack of long-term funding for public health systems and infrastructure nationwide, she said.
“We should have electronic case reports, but public health, until very recently, was never funded to support it. Providers were never prompted to participate in the process or ensure that their electronic medical record systems sent data to public health, ”said Hamilton.
The lack of infrastructure has been particularly severe in Nevada, where authorities have started relaying the pandemic test the information to the federal government by fax.
Maryland continues to report only molecular tests. State health officials did not respond to requests for comment.
Although 49 states are now publicly declaring positive results from rapid tests as probable cases, epidemiologists are concerned that their incorporation may not provide the full picture.
Home tests, including those that consumers can purchase from Amazon or their local pharmacies, do not require a report to health services. Nevada recommends that people whose home antigen tests return positive results confirm it with molecular testing, which gives the state more comprehensive data and allows them to contact the trace.
“As epidemiologists, this is something we are very aware of. The data you have tells the story either fully or incompletely, ”Hamilton said. “We tell an incomplete story about the total number of people who actually have COVID-19. “
Metz is a member of the Associated Press / Report for America Statehouse News Initiative body. Report for America is a national, nonprofit service program that places reporters in local newsrooms to cover undercover issues.