County health authorities across Texas are still sorting through a backlog of previously unreported coronavirus test results, shaking some local officials confidence in the numbers and leaving them to wonder whether they missed chances to slow the illness.
A statewide data dump led to giant daily case counts in some North Texas counties over the weekend, including Dallas County, where officials had to contend with more than 7,600 previously unknown positive cases in four days the majority of them backlogged from June and July.
Because local health officials didnt know about the cases until now, contact tracing hasnt been done on them. That could have serious implications, said Dr. Matt Richardson, Denton Countys director of public health.
We missed that opportunity because of the late report, which just allows the pandemic to grow, he said. Thats why we have a pandemic. Weve missed opportunities for containment and unfortunately that was out of our control.
Richardson said the county was uncomfortable with statewide data on tests and said it was frustrating that some inherent flaws with the states database are being exacerbated by the delays.
That just renders it less valuable, he said, adding that the data are still useful because they show what happened and provide demographic information.
The backlogged cases came to light after the state upgraded its reporting system Aug. 1 to better handle the high volume of daily test results.
Before the coronavirus pandemic, the state health department took in fewer than 2,000 lab test results a day for a long list of conditions including measles, meningitis and some STDs. But as COVID-19 testing expanded and the state had to track positive and negative results the tracking system couldn't keep up, said Lara Anton, a spokeswoman for the Department of State Health Services.
After the upgrade, which allowed the state to process more than 100,000 test results a day, the state cleared the backlog in the first week of August, Anton said.
But once those results were processed, the state spotted coding problems with test results the commercial Quest Diagnostics labs reported that prevented the state from importing its data.
That led to a backlog of 354,000 tests from Quest, Anton said.
Quest Diagnostics told KTVT-TV (Channel 11) that the state had changed servers without letting it know, so it didnt realize its results werent being received.
Coding issues also led to problems getting data from CHRISTUS Meditech, a lab for several hospitals, which had a backlog of about 95,000 test results, and then a backlog of about 59,000 test results from Walgreens pharmacies, Anton said.
By Sunday, each of the backlogs was resolved and test results were available to counties, she said. Now, the case sorting is in the hands of county health officials, who will have to determine whether the results are for cases they previously knew about or whether they are new, Anton said.
The perspective you need to have is that with COVID, there are hundreds of labs reporting now that were not previously reporting to public health, she said. For instance, Walgreens is not typically testing for infectious diseases, but for COVID, theyre doing testing. So they had a longer road ... to get set up to process the tests and then to have a report and then to get them into a format where they could send it to us.
The backlogs didn't cause delays in notifying patients of their test results.
However, they could breed skepticism in the numbers for people who already doubts about them, said Timothy Bray, director of the Institute for Urban Policy Research at UT Dallas. And for people, including business owners and school leaders, who rely on local daily case counts among other data to make decisions about operating safely, they may feel theyre flying blind, Bray said.
Collin County officials havent specified how many of their cases were part of the backlog, but after reporting more than 1,100 cases Friday and none Sunday, officials warned residents they had no confidence in the states data in a message posted on the countys dashboard Tuesday.
The Commissioners Court is 100% certain that the COVID-19 data being reported for Collin County is inaccurate, Collin County Judge Chris Hill wrote on Facebook.
Anton, the State Health Services Department spokeswoman, said that since Collin County chose to have the state take over its case management in June, the state has been providing the most complete data available each day.
As with all COVID-19 data, it is subject to change as more information comes in, she said.
Gov. Greg Abbott stood by the states data in an interview Wednesday with KXAS-TV (NBC 5).
We used a very robust system team that came in, that corrected all of the data metrics and now we have good accurate information flow, he said. There may be still another day or two while that information is leveled out. But by the time this week ends, we should have pretty accurate data.
He also stressed that the backlog issue affected only test result data.
The most important and accurate information that exists is the information about the people who are hospitalized because of COVID-19. That information has never been questioned, the governor told KXAS. That information is both the most accurate, and the most important information that we have.
In Dallas County, officials indicated that most of the more than 7,600 previously unknown cases came from tests done in July.
In Tarrant County, health officials said many of the 1,487 cases it reported Saturday were part of the backlog.
Within the last five days, Denton County received more than 7,000 previously unreported test results, and 893 were positive. Some of the lab results were performed a few days ago, but some come from May and June, officials said.
Richardson, Denton Countys public health director, said the county is investigating the backlogged cases to see whether there are duplicates and having contact tracers verify them.
He said the backlogged cases will be added to new daily case counts after theyre investigated and designated as active or recovered cases.
Candy Blair, Collin Countys public health director, said officials noticed the problem when they saw a sudden spike in the data last week. They reported 1,175 new cases Aug. 14 nearly 10 times the daily average in cases.
Public health directors in the region asked the state about the problem, and thats when they learned about the backlog, she said.
Now she wants to make sure people understand that cases havent spiked suddenly.
You dont want them to panic, she said. Thats the last thing we want to do is to look like our numbers have quadrupled or are 10 times the amount that they normally are.
Officials in other counties also expressed a need for calm.
People need to be patient and understanding, Tarrant County public health director Vinny Taneja said at Tuesdays county commissioners court. We are worried that what we dont know might come back and bite us, and [the backlog is] a prime example of things that have gone on and we had no idea that this was an issue.
Diana Cervantes, an infectious disease epidemiologist and an assistant professor at the University of North Texas Health Science Center, said public health authorities have to put their emphasis on stopping transmission of the disease.
"That's your one goal; you want to focus on that," she said.
So health departments may make investigating new cases a priority over tracing old ones. Cervantes said that when departments have to sift through backlogged cases, theyre trying to determine whether any might be people in high-transmission settings and whether theres a chance to prevent an infectious person from spreading the virus.
"You need to be able to figure out is it even possible at this point to intervene?" she said.
Bray, the director of UT Dallas Institute for Urban Policy Research, said the backlog is a matter of critical public health and public policy concern, but it shouldnt change peoples behaviors in response to the pandemic.
We need to get to the bottom of it, he said. We need to make sure it doesnt happen again, but it doesnt reduce the need to be vigilant in public health and public safety measures.
And despite the unexpected jump in case counts, experts still see encouraging trends in the virus spread.
Dallas County has seen a significant drop in confirmed cases recently, in spite of the backlog, County Judge Clay Jenkins said Tuesday.
He also has noted less demand for tests in recent weeks.
It is quite understandable at this point that people would have concerns about computer programs, coding errors, contractors who did not mail things timely and other human errors around testing and reporting, Jenkins said in a written statement. However, the underlying science and the medical recommendations to you and the public are sound.
Dr. Philip Huang, the countys public health director, reported Tuesday that emergency-room visits have leveled off since their peak in June. The rate of positive tests from hospitals, though still high at 14%, also has declined recently.
He said people need to continue good public health practices.
We need to keep the physical distancing, washing of hands, staying home when you can, Huang said. All of these things are important, and they are showing to work. So just everyone needs to be vigilant. Dont let up.
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