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COVID-19 case numbers likely underreported to ADPH

Alabama health officials say COVID-19 is likely being under-reported, due to false negatives for rapid tests, health care providers not reporting cases to the state, and people avoiding testing because they don’t want to be placed in isolation or quarantine.

“I’m not saying this to be frightening, but the numbers are probably underestimated,” Judy Smith, public health administrator for the Alabama Department of Public Health Northern District, said this week.

While many health care providers continue to offer lab-evaluated COVID-19 tests, Smith said point-of-care tests that yield results in as few as 15 minutes have become more popular in recent months.

Assistant State Health Officer Dr. Karen Landers on Thursday said while major labs running COVID-19 tests have mechanisms in place for reporting test results, and hospitals are familiar with reporting procedures, some urgent care clinics and pharmacies running rapid tests are not reporting their test results.

“Some entities have not ever been accustomed to reporting those notifiable diseases to the health department because it was not something that they did,” Landers said.

Landers said the ADPH is working with health care providers to remind them of reporting requirements. She said both positive and negative test results are essential information so the ADPH can accurately report the percentage of tests that are positive.

ADPH needs to know of positive test results not just to determine trends, but to initiate contact tracing and quarantines.

Huntsville Hospital Urgent Care spokeswoman Amy Thomas said all of its clinics send daily reports to the ADPH, including both positive and negative cases of COVID-19.

“As of recent, reporting counts were only required for positive tests …. As requested by ADPH, we will now also be reporting negative test counts,” she said.

False negatives

Smith said about 20% of rapid tests that come back negative are actually positive. As a result, Landers said negative rapid test results often need to be investigated further to rule out COVID-19. However, false positives are rare.

“If it’s positive, it’s positive,” Landers said.

“You really cannot test yourself out of quarantine. If you are in contact with someone, and go ahead and get a test the next day, that’s really not going to be very useful,” she said.

Landers said close contacts of someone with COVID-19 should be tested between the fourth and seventh day after contact.

Smith said some people are not getting tested, despite having symptoms or being exposed to the virus, because they don’t want to miss sports, school or work.

“Is it worth it for the long-range price? I can tell you up front, you ask the folks in the hospital and they’ll tell you up front, ‘No, it’s not worth it,’” Smith said. “You certainly don’t want to be a person who creates that problem so that somebody else does have to suffer like that.”

While new cases per day have remained relatively flat in Madison county, cases in Limestone are trending upward. Limestone County experienced its largest number of reported new cases — 30 — in almost seven weeks Thursday. There was also one reported death from Limestone County.

As of Thursday, Madison Hospital had 13 confirmed and suspected COVID-19 patients, including five in intensive care and one on a ventilator. Athens-Limestone Hospital had 11 confirmed and suspected COVID-19 patients Thursday, including four in intensive care and one on a ventilator. Huntsville Hospital and the Women’s and Children’s Center reported 65 patients confirmed and suspected of having COVID-19. They have 12 in the ICU and seven on ventilators.

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