Source: U.S. Medical News  Sep 16, 2020  2 years ago
U.S. Medical News: Sudden Decrease In COVID-19 Infection Rates In America Is Due To Bureaucratic Mess Not Because Infection Rates Are Going Down!
U.S. Medical News: Sudden Decrease In COVID-19 Infection Rates In America Is Due To Bureaucratic Mess Not Because Infection Rates Are Going Down!
Source: U.S. Medical News  Sep 16, 2020  2 years ago
U.S. Medical News: It simply frightening what’s happening in America at the moment. Literally every agency from the FDA, NIH, CDC to the State Health Departments is being manipulated by the White House and supported by certain media and social media platforms including Twitter (it might come as a shock to many but Twitter is actually pro-Trump despite the farce about labeling some of his tweets etc, they did so under pressure from medical entities but they never suspended his account!).

With the introduction of rapid antigen testing kits in the country, and some counties and states are even replacing the PCR test but with guidelines on reporting still saying that PCR test are required, the reporting of infection rates in the country is in a mess not to mention other factors also influencing reporting protocols etc.
The lack of antigen test reporting leaves America ‘blind to the pandemic’. More than 20 states either don't release or have incomplete data on the rapid antigen tests now considered key to containing the coronavirus, which has sickened more than 6.5 million Americans. The lapses leave officials and the public in the dark about the true scope of the pandemic as untold numbers of cases go uncounted.
Daily, the gap will is widening as tens of millions of antigen tests sweep the country. Federal officials on White House orders are prioritizing the tests to quickly detect COVID-19's spread over slower, but more accurate, PCR tests.
However relying on patchy data on COVID testing carries enormous consequences as officials decide whether to reopen schools and businesses: Go back to normal too quickly and risk even greater outbreaks of disease. Keep people at home too long and risk an even greater economic crisis. (however this is the strategy of the White House)
Dr Janet Hamilton, executive director of the Council for State and Territorial Epidemiologists, which represents public health officials said, "The absence of information is a very dangerous thing. We will be blind to the pandemic. It will be happening around us and we will have no data."
It has been reported that the states that do not report antigen test results or do not count antigen positives as COVID cases are California, Colorado, Georgia, Illinois, Maryland, Minnesota, Missouri, Montana, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Pennsylvania, South Dakota, Tennessee, Texas, Vermont, Virginia, Washington, Wisconsin and Wyoming, as well as the District of Columbia.
To date, most of the COVID tests given in the U.S. have been PCR tests, which are processed in medical labs and can take days to return results. By contrast, antigen tests offer results in minutes outside of labs, appealing to everyone from medical clinics to sports teams and universities.
Unlike the labs running the PCR tests, any providers using antigen tests don't have an easy way to send data electronically to public health authorities.
It was reported that since July, though, the federal government has pushed roughly 5 million antigen tests into nearly 14,000 nursing homes to contain outbreaks among staff members and residents.
The Department of Health and Human Services also awarded a US$760 million contract to b uy 150 million rapid antigen tests from Abbott, (One of Trumps favourite pharma/biotech company) the Illinois-based diagnostics behemoth. It plans to send 750,000 of those to nursing homes starting this week, Brett Giroir, the HHS official heading the Trump administration's testing efforts, told industry executives on Sept. 8.
Federal officials have not elaborated on how many tests will be sent elsewhere but have suggested many will go to governors to distribute as schools reopen.
However the rush of antigen tests, however, won't be particularly useful to officials if the results are not publicly and uniformly reported.
In a survey of 50 states and the District of Columbia on their collection of antigen test results and what is reported publicly. Forty-eight responded between Sept. 3 and 10, revealing significant variation over whether individuals who test positive for COVID-19 with an antigen test are counted as cases and whether states even publicly report antigen data in their testing numbers:
-21 states and D.C. do not report all antigen test results.
-15 states and D.C. do not count positive results from antigen tests as COVID cases.
-Two states do not require antigen test providers to report results, and five others require only positive results to be reported.
-Nearly half of states believe their antigen test results are underreported.
Alarmingly, many state counts of infected individuals could be artificially low.
For example, the lack of reporting could imply infection rates are declining because the virus isn't spreading as widely when really more antigen tests are being used and not counted, public health officials and experts say.
Dr Jeffrey Morris, a biostatistics professor at the University of Pennsylvania said, "It's going to look like your cases are coming down when they're not."
However an agency spokesperson said that HHS recognizes that antigen tests are underreported but maintained that officials are not missing the full scale of the pandemic,
HHS spokesperson Mia Heck added, "There is sufficient testing to achieve all objectives outlined in the testing strategy, including identifying newly emergent outbreaks, supporting public health isolation and contact tracing, protecting the vulnerable, supporting safe reopening of schools and businesses, and enabling state testing plans."
One of the major part of the problem on antigen test reporting stems from what counts as a COVID case. Guidance from the Centers for Disease Control and Prevention defines a "confirmed" COVID case as one that is determined from a PCR test. Positive results from antigen tests are considered "probable" cases because the tests can be less accurate.
However months after the first COVID antigen test received emergency authorization from the Food and Drug Administration, the CDC revised its COVID case definition in early August to allow a positive antigen test to count as a probable case without assessing whether a person had clinical symptoms or was in close contact with a confirmed infected person.
This change prompted many states including Arkansas, starting Sept. 2 to adjust how they report cases.
Dr Jennifer Dillaha, medical director for the Arkansas Department of Health said, "It's easy for people to think since we use the word 'probable' that maybe it's a case, maybe it isn't. But that's not how we think of it," "It is a real case in the same way that a PCR is a real case."
An assistant state health officer for the Alabama Department of Public Health, Dr Karen Landers, said her biggest concern was the potential undercounting of antigen test results as they continue to grow in popularity. While the state has been trying to work with each urgent care or other medical provider, some struggle to submit the results.
She added, "We can't afford to miss a case.”
Congress passed the CARES Act in March which requires a broad range of health care providers to report any COVID test result to state or local health departments. Nonetheless, two states Montana and New Jersey said they weren't requiring antigen test providers to report results, positive or negative.
Mississippi, Colorado, Maine, New Hampshire and Wyoming require only positive results to be reported, which can distort the positivity rate.
The support services manager for the Brazos County Health Department in Texas, Sara Mendez, said the department saw an increase of antigen tests being administered as Texas A&M University students returned. Even though the state health department was not including positive COVID cases from antigen tests in its public reports, the local health department felt obligated to do so.
She said"A lot of the college students will just go and get those done as opposed to the PCR tests,so we felt like we were missing out."
Interestingly Indiana University undertook a massive antigen testing operation for students living on campus in August, administering 14,870 antigen tests across four campuses through drive-thrus, according to Dr Graham McKeen, an assistant university director for public health.
The test results were delivered while students waited in cars for about 30 minutes, with 159 coming back positive. Each night, a university staff member would manually download the spreadsheet off each of the test machines and securely email it to the state health department.
However Indiana began reporting antigen testing only on Aug. 24, adding over 16,000 antigen tests into its public dashboard that day and saying in a news release that it plans to retroactively add in earlier antigen testing figures.
Dr McKeen said that, even though the state is now reporting some antigen data, tests are still missed under the cumbersome reporting system. The state said some of the data is being sent by fax.
Dr McKeen added, "It doesn't give the community a good handle on the infection in the community."
The HHS spokesperson said that federal agencies are working to improve the reporting of results and that problems were likely to be eased in the future, citing that Abbott's antigen test includes an electronic reader for automated reporting.
By October, 48 million of those tests will be in circulation each month, she said.
Scott Becker, executive director of the Association of Public Health Laboratories said, "What this is exposing is the antiquated systems that public health agencies have had for years. So much of the data we've gotten is incomplete."
The same data barrier is playing out in nursing homes as well.
The White House administration is pushing for nursing homes to use the tests for required screenings at least once a month and as often as twice a week. Under new federal regulations, nursing homes that don't comply with regular testing and reporting requirements are subject to citations or fines.
Some nursing home owners are saying, "We have no technology today to submit this information which leaves us in a vulnerable position."
In the last few days, nationwide infection rates for the United States has seen drastic decreases however in counties, states and at campuses, actual testing rates are showing extremely high rates of infections!
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