The Midwest, also known as America’s Heartland, is home to small towns, rural farmland, and friendly people. This region has certainly felt the burden of the COVID-19 pandemic; however, Missouri and Iowa have both had recent one-day COVID-19 case spikes – a 64,674 (Figure 4) and 27,277 (Figure 5) new cases respectively – that have raised the eyebrows of data scientists. In sum, both states have changed the way they have been reporting COVID-19 cases which have caused these spikes. Even though there have been one-day spikes in Alabama (Figure 1), Arkansas (Figure 2), and New York (Figure 3), most states have had consistent new case numbers since the beginning of February 2021.

 

Figure 1: Alabama New Daily COVID Cases between 2/5/2021 and 3/28/2021.

 

 

 

 

Figure 2: Arkansas New Daily COVID Cases between 2/5/2021 and 3/28/2021.

 

Figure 3: New York New Daily COVID Cases between 2/5/2021 and 3/28/2021.

Case Corrections in Missouri

On March 11th, 2021, Missouri’s (MO) total COVID-19 case count increased by 16.9%.² Upon investigation of this increase, an article titled: “Missouri adds 81,206 ‘probable’ COVID-19 cases to pandemic report” revealed that the state’s previous COVID-19 case reports omitted the probable cases, which were identified by antigen or rapid tests, and missed many rural infections.² On March 11th, the new confirmed cases as reported by Johns Hopkins stood at 64,674 (Figure 4). The change in reporting contributed to over 81,000 probable cases. However, in the Johns Hopkins data, 64,674 of those 81,000 cases were confirmed COVID-19 cases.

Figure 4: Missouri New Daily COVID Cases between 12/03/2020 and 3/28/2021.

 

Prior to March 8th, MO only reported total and county-level data for COVID-19 cases confirmed with a PCR test.² However, the post-3/11 new case reports includes those testing positive by either a PCR test or an antigen or rapid test, as opposed to the more accurate PCR test alone.² Why are these cases considered probable and not confirmed, and why were they not reported from the get-go? These are good questions to consider.

Change in Test Positivity Reporting in Iowa

On February 19th, 2021, the Iowa Department of Public Health (IDPH) changed their reporting of positive COVID-19 test results.¹ “Previously on the homepage of coronavirus.iowa.gov, the state showed individuals tested and individuals who tested positive. Now, they will show the total tests the state has administered and the total number of tests that have come back positive. The difference in these numbers is caused by individuals getting tested more than once.” ¹ The rationale for this change in reporting was because state health officials stated that “at home tests are becoming more available.” ¹  As a potential result of this change in reporting, the new COVID-19 cases for that day was 27,277 (Figure 5) which was a 4600% increase in new cases since the previous day.¹ This one day spike in cases can be considered a correction to the data as a result of the change in the way that they are reporting new cases. However, it could also have been an error as on the 1st of March 2021 the new daily cases were reported as -26,726 (Figure 5) which would be the correction for the irregular 27,277 cases on the 19th of February.

Figure 5: Iowa New Daily COVID Cases between 12/03/2020 and 3/28/2021.

A Tale of Two Tests

The antigen or rapid tests are considered to be less reliable when compared to PCR tests.² Antigen/rapid tests are able to generate a test result in fifteen minutes or less, and are known for generating false negatives. Therefore, MO initially omitted these results and deemed them as “probable” instead. There are numerous issues associated with omitting antigen/rapid test results from the total case count. The main issue is that this can give residents a false sense of security. Individuals may see the data for only PCR confirmed cases and believe that it encapsulates all of the risk – versus only the risk relative to the portion of the state’s overall population that can access a PCR test. This may lead more people to socialize, let down their guard, and engage in group activities. Thus, potentially increasing the spread of COVID-19 and placing even more lives at risk.

So how come we are still using antigen/rapid tests, despite their lack of reliability? In addition to the speed of the test, they are also a less expensive alternative. The state of Missouri was able to purchase a large amount of antigen/rapid tests with CARES Act funding.² In addition, given the rural landscape of MO, many MO residents had to drive 30-40 minutes away to receive a PCR test.² Therefore, making the antigen/rapid test Cheaper, Faster, and More Accessible – a hard to resist trifecta.

A Commitment to Consistency

Undoubtedly, it is critical for states to accurately report COVID-19 cases in a consistent manner. There are a number of reasons why this is important. One, it allows the public to be accurately informed of the risk (or as accurately as possible) and to take effective risk management measures such as social distancing, wearing masks, and self-isolation when necessary. Two, it builds trust within the community and gives residents more assurance that they can trust the reported case counts. It is not a good feeling to suddenly realize your state has started changing the way they report the number of cases. There is inconsistent information floating around about the pandemic as a whole, let’s at least get the case counts correct and consistent. As seen in Missouri’s case, the state was previously omitting all antigen/rapid test cases. Once they began to report them on March 11th, increasing their one-day new case count, why not go back and update the reporting from the beginning? In Iowa’s case, they changed their reporting of positive COVID-19 cases. Both of these changes in case reporting skewed the overall case counts and could have left individuals feeling uneasy. Would you?

 

References

  1. KTIV (2021) Iowa changing how it reports COVID-19 results [Online] Available from: https://ktiv.com/2021/02/19/iowa-changing-how-it-reports-covid-19-results/ (Last Accessed: 3/31/2021)
  2. Keller, R. (2021, March 8). Missouri adds 81,206 ‘probable’ COVID-19 cases to pandemic report. Missouri Independent. [Online] Available From: https://missouriindependent.com/2021/03/08/missouri-adds-81206-probable-covid-19-cases-to-pandemic-report/ (Last Accessed: 4/6/2021)
  3. Unsplash (2021) America’s Heartland [Online] Available From: https://unsplash.com/s/photos/america’s-heartland(Last Accessed: 4/6/2021)
  4. Iowa Department of Health (2021) COVID-19 in Iowa [Online] Available From: https://coronavirus.iowa.gov/(Last Accessed: 4/2/2021)