UPDATED: April 15, 2020

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If you have been confused about the number of COVID-19 cases being reported for Moore County recently you are not alone. Hopefully, this will help make some sense out of what is happening. But, expect some confusion to continue.

Currently, there are several sources where you can get the “confirmed” virus counts and the databases are not connected or synchronized. Depending on when the data is entered into each system or when it is published you will see different counts for Moore County. The Moore County Hospital District (MCHD) reports its data to the state and MCHD usually shows higher counts.

Even while writing this article, a date typo was showing on the DSHS dashboard for Moore County. It was eventually corrected. But, how many people saw it and how much confusion has it added?

DSHS COVID-19 dashboard showing incorrect date on April 14, 2020 – Source: https://dshs.texas.gov/coronavirus/cases.aspx screen shot on April 14, 2020 11:56 a.m.
DSHS COVID-19 dashboard showing corrected date on April 14, 2020 – Source: https://dshs.texas.gov/coronavirus/cases.aspx screen shot on April 14, 2020 3:43 p.m.

The U.S. is currently testing for COVID-19 at many different locations. Clinics, hospitals, drive-through testing centers, etc. The primary locations in Moore County are the local clinics in conjunction with the hospital district.

Through a process of verifying test results, the local counts go to the Texas Department of State Health Services (DSHS), then on to the state database and eventually end up on the DSHS COVID-19 Dashboard. At some point Texas counts will also end up on websites like the Johns Hopkins University dashboard site. There is a delay in each of these and some appear to be updated manually and subject to data entry errors. This causes much of the confusion.

Johns Hopkins University COVID-19 Status Report for Moore County – April 15, 2020 – Source: Johns Hopkins University

However, the confusion can go even deeper from there. Not all tests are created equal.

In an attempt to more quickly control the outbreak, regulations have been relaxed at the federal level in order to get more testing kits into the hands of doctors and hospitals across the country. Private companies are rapidly developing various types of new test kits and selling them at a record pace. Some tests use a swab in the nasal passage, some test the blood, and others use saliva. Each test can be looking for something different.

It appears primarily that tests are either looking for the actual virus or antibodies in the blood produced in response to a COVID-19 infection. The two types of tests you will hear the most about are the Polymerase Chain Reaction (PCR) test and the Serological antibody “quick-test”.

The PCR test is the nasal swab test and can take up to a few days to get the results. This test is looking for a very recent or active infection of the COVID-19 virus. This is considered an accurate test by the CDC. These test kits are in limited supply and have been hard for rural areas like ours to get.

The antibody quick test uses a patient’s blood and is looking for antibodies. It doesn’t actually test for the virus. These antibodies appear in the blood of patients who have had the virus for a period of time. This type of test can be performed more rapidly, is less expensive, and can be mass-produced more easily. At this time it appears these antibody tests could be the way doctors determine a person’s immunity to COVID-19. Which could be used to help determine when a person can safely come out of quarantine or return to work.

However, there has been some debate over the accuracy of the antibody quick test. This has added more confusion to the discussion of COVID-19 testing and whether these tests should be relied on for official positive test counts. According to officials at MCHD, the Texas State Department of Health is accepting positive quick test results as positive test results.

MCHD Chief of Staff Dr. Justin Corbin discussed the antibody testing on Facebook on April 14 saying “We have increased our positive case count in Moore County by 900% in the last week. Now that the state has started accepting our rapid testing results as accurate, we are starting to see a more accurate picture of the local effect of this pandemic. With better testing ability comes better information with which to make decisions”

https://www.facebook.com/photo.php?fbid=10102150770166582&set=a.711722505672&type=3&theater

Some are skeptical of the quick test because of possible false negative results. The Hospital District told the Moore County Journal on Tuesday that “The quick test is known to produce a false negative if the patient is tested within the first three days of infection, before the antibody builds in the system.” In those cases, MCHD is quarantining the patient until a follow-up test can be run. Hospital officials also say that the quick test has not been determined to produce false positives.

The antibody quick test was recommended to be purchased by MCHD Medical Staff, consisting of both employed physicians and those in private practice. Once MCHD acquired the quick test they first used it to verify results on multiple patients, both who tested positive and negative on the traditional PCR tests. This was done before testing unknown patients.

MCHD says their verification tests proved to have a 100% accuracy rate. In addition, the Department of Health is verifying quick test positives the District has run, also with a 100% accuracy rate.

At this time it is anticipated that the positive count will continue to rise in Moore County. In fact, the whole state of Texas will continue to have a rise in positive cases for a week or more. According to projections (as of April 14th on the IHME healthdata.org website) COVID-19 related deaths in Texas will continue to rise until April 30th. These projections have varied widely in the past and are only one source of information.

It’s difficult at this time to tell exactly how long the numbers will rise in Moore County. There will be times when the information will be confusing. Even the professionals are learning as they go through this. These are unprecedented times we are living in. The best we can do is educate ourselves continually.

The phrase “Knowledge is Power” comes to mind. The more you can learn the better prepared you can be as you navigate this new world we are living in. Below are some articles I have read as I have been educating myself on this topic.

Blood testing articles
https://www.usatoday.com/story/news/2020/04/02/fda-oks-first-coronavirus-blood-test-track-immunity-test-vaccines/5116281002/

https://www.dispatch.com/news/20200413/coronavirus-antibody-blood-tests-arrive-in-wild-west-marketplace

In-Depth immunity testing article
https://www.reuters.com/article/us-health-coronavirus-immune-test-insigh-idUSKBN21C1KK

Info on false positives and negatives
https://www.al.com/news/2020/04/blood-tests-for-coronavirus-cant-replace-nasal-swabs-experts-say.html

A recent interview with CDC Director about antibody testing
https://www.nbcnews.com/health/health-news/antibody-tests-need-be-place-2nd-coronavirus-wave-cdc-director-n1182621

COVID-19 antibody test
https://premierbiotech.com/innovation/covid-19/?fbclid=IwAR1G4DZGA_VuXPvJKUIU6L0GyDam1XBb3c3xgZstJLscoFBneuCpb098v_c

Why Did The World World Shut Down for COVID-19 but not Ebola, SARS, or Swine Flu?
https://fivethirtyeight.com/features/why-did-the-world-shut-down-for-covid-19-but-not-ebola-sars-or-swine-flu/