Happy Nice Mall

Millions of rapid-fire Covid tests at home are flying off pharmacy shelves across the country, giving Americans the opportunity to instantly read if they have been infected with the coronavirus, though sometimes flawed.

But the infrequent reporting of results to public health departments exacerbates the longstanding challenges of maintaining the correct number of cases at a time when the number of infections due to the Omicron variant is increasing.

At a minimum, the widespread availability of home tests undermines the accuracy of official positivity rates and case numbers. At the other extreme, there is a factor that has caused some public health experts to raise the once unthinkable question: Does the number of coronavirus cases serve a useful purpose, and if not, should they continue?

The chief medical officer of the Association of State and Regional Health Officials at the national level, Dr. “Our whole approach to the outbreak has been case-based surveillance: We have to count every case, and that’s not true anymore,” said Marcus Plescia. Nonprofit organization representing public health agencies in the United States. “It becomes a time when we have to think about doing things differently.”

There is no comprehensive data on how many rapid tests are used each day, but experts say this is likely far higher than the number of polymerase chain reaction or PCR tests completed in the lab, which require more time to produce results. are generally reported as aggregated totals.

At least one home testing company has implemented a system for reporting results directly to health authorities. And some local health departments have set up systems for people to report the results of home rapid tests. But Mara Aspinall, a biomedical diagnostician at Arizona State University and OraSure’s board of directors, estimates that with such a voluntary system, it’s possible that millions of tests a day go unreported. rapid Covid tests.

“We certainly don’t want to stop testing, but at the same time, we can’t blindly blind public health officials,” said Ms Aspinall. “They rely on this information to take proactive and reactive measures. It’s a very fine balance.”

The rapid increase in home testing could be a tipping point for public health experts in a conversation that began months ago. The problem is the feasibility of moving to less frequent case reporting or a system of “on-duty surveillance” similar to what public health officials currently use to monitor other illnesses such as flu. virus. Overall case numbers are estimated based on these case numbers.

Concerns have also emerged about the accuracy of the tests. Antigen tests detect the Omicron variant, but not as effectively as they detect other variants, the Food and Drug Administration said on Tuesday.

Throughout the pandemic, daily case numbers have played a central role in shaping policy responses to the pandemic. Cities imposed mask requirements and closed schools or businesses in response to positivity rates based on daily case numbers. public school system in New York it is closed at some point when the positivity rate reaches 3 percent.

Public health officials and news organizations like The New York Times continue to use daily case numbers to paint an up-to-date picture of the pandemic.

However, due to limited access to testing and the prevalence of asymptomatic cases, case numbers have long been found to be artificially low. And compiling these numbers is a labor-intensive task for already strained public health departments.

As a result, many states began reporting fewer per week than daily case counts as cases fell over the summer. Some have turned to more frequent reporting as the number of cases has risen again. But as the Omicron variant is causing a rapid increase in positive cases, states are seeing that they can’t keep up. And with so many more cases not reported already through home testing, there’s little incentive to try.

Chief medical officer of the State Council and Regional Epidemiologists, Dr. Marcelle Layton said she talked to members of her organization about moving away from daily case numbers, and that many of them still report daily and are eager to make that change. next months. His organization is also in touch with the Centers for Disease Control and Prevention for possible guidance that could move states to limit daily case reporting. A CDC spokesperson said the agency has no plans to change its reporting guidance for states.

Tennessee announced last week that it will begin reporting Covid case data on a weekly basis, consistent with other infectious diseases. The state’s health commissioner, Dr. Lisa Piercey said at a news conference last week that delays in home testing and notifications from healthcare organizations are making the state’s daily case counts inaccurate.

“It’s not a sustainable way to do this permanently,” he said. He added: “The daily reporting of numbers is no longer so relevant. It’s about trends, but the real number isn’t all that accurate when you don’t know what you don’t know.”

The government will also begin to report the rate of test positivity based solely on PCR tests, rather than including the limited number of rapid tests it reports on.

From the council of epidemiologists, Dr. “Everyone knew this time had come,” Layton said, adding that this shift is part of a movement to approach Covid-19 as an endemic disease that the country will have to live with indefinitely. flu.

Other experts say daily reporting isn’t necessary in the long run, but the rapid rollout of Omicron requires health authorities to maintain daily reporting.

“The reason we’re here is because the virus is moving so fast — if you’re five days behind, you’re already in the contagious period for a lot of people,” said Stefanie Friedhoff, a professor at Brown University’s School of Public Health. “As long as we’re on this Omicron wave, we need to understand our daily numbers as well as we can.”

He argued that paramedics should report the number of cases on a daily basis, but said the available data should be clearer about its limitations.

As local public health officials realized the limitations of daily case numbers, they turned to a variety of other sources to track the spread of the virus, such as hospitalization trends and direct reports from community leaders.

D., director of health for the Multnomah County Department of Public Health in Oregon, which encompasses Portland and the surrounding area. Jessica Guernsey said that in light of both home testing and the rapid spread of Omicron, these other measurements are becoming more useful. emphasis on tracking the total number of cases.

Dr. “With the situation we are facing with something as aggressive as Omicron, testing, isolation and contact tracing are becoming much less relevant,” Guernsey said. “At one point, it’s kind of a constant drumming to understand that there’s so much Covid out there – it just doesn’t help us understand things any more.”

However, senior health officer with the Cook County Department of Public Health in Illinois, Dr. Rachel Rubin said masking Covid cases with home testing comes with some challenges for local health departments. If positive test results of people infected in schools or nursing homes are not reported, this prevents the county from advising these agencies on isolation procedures or identifying other cluster-related cases.

Dr. “It’s like a double-edged sword,” Rubin said. On the one hand, he said, the increase in home testing is a positive development, allowing people to isolate when necessary. On the other hand, it leaves public health officials in the dark. “I think we’re only catching the tip of the iceberg of positive tests,” he said.