Georgia is back in COVID-19 red zone. It’s worse if rapid tests are included, experts say
Georgia is back in the coronavirus red zone, and rapid testing data suggests more people are infected than confirmed case data shows.
The state’s new case rate remained below the levels seen in the midwestern United States and below Georgia’s summer peak, according to the weekly White House coronavirus task force report dated Nov. 8. However, Georgia’s case data doesn’t include positive, rapid tests while many other states do. Georgia, following guidance from the Centers for Disease Control and Prevention, treats these as probable cases.
More recent data shows a continued increase in infections. Data from Nov. 7-13 shows rapid tests have accounted for almost 24% of Georgia’s total laboratory positives. State health officials have said daily reporting of rapid tests has been “bumpy.”
These rapid tests — also called antigen tests — are more likely to miss COVID-19 infection than viral/PCR tests. But false positives are also unlikely, according to the CDC.
Public health experts who spoke with McClatchy, the parent company of the Telegraph and Ledger-Enquirer, complimented state health officials for reporting these rapid tests separately but also recommended Georgia include a category on its dashboard listing the total number of all positive coronavirus tests that check for active infections.
A spokesperson for the Georgia Department of Public Health did not respond to McClatchy’s questions about the state’s rapid testing data. A new task force report will be made publicly available later this week.
“I think Georgia is doing a good job at being transparent as much as possible by providing them separately,” said Dr. Amber Schmidtke, a member of the Georgia COVID-19 data advisory task force. “We just need one more piece of data on the daily report that (shows) the combined total.”
Georgia’s White House report
The state reported 11,901 new COVID-19 cases for the week ending Nov. 6. The rate of 112 cases per 100,000 people was the 40th highest-rate in the nation. It was a 14% increase from the prior week, but below the national average of 209 cases per 100,000 people. Test positivity rates also increased to 7.4% for the week ending Nov. 4, up 0.2% from the prior week.
According to the report, 67% of Georgia’s counties have moderate or high levels of community transmission with 25% landing in the red zone. About half of the state’s hospitals reported having three or fewer days of PPE stockpiled.
“Georgia has seen an increase in new cases and stability in test positivity,” the report reads. “Triangulation of data suggests there is increasing community spread, especially silent asymptomatic spread that will result in further increases in cases and hospitalizations.”
In addition to mask-wearing and distancing recommendations, the task force has asked Georgia health officials to use “proactive and increased testing and surveillance” to get a handle on community spread.
The report recommends all red and orange counties begin proactive testing of 18 to 40-year-old residents.
What is rapid testing and why is it important?
The use of rapid tests will be key in expanding the state’s testing efforts, task force officials said.
Guidance from the CDC states the “gold standard” for COVID-19 detection remains the PCR/viral test, but those results can take up to a week.
Antigen tests, while more likely to miss a positive case, can deliver results between 15 and 30 minutes. The task force states the tests “perform well” but not 8 to 10 days post-infection. The tests could find asymptomatic and pre-symptomatic COVID-19 cases.
The rapid tests also allow doctors, urgent care facilities and long-term care facilities to make quick decisions about patient care. Testing can be extended to people where care may not be readily available, the CDC and the Food and Drug Administration reports.
Guidance from the CDC states positive rapid tests should be treated as a “presumptive” or probable COVID-19 case. Georgia added probable case data to its public dashboard on Nov. 3.
As of early November, Georgia is one of only six states to report positive rapid tests but not include it in total case data, the New York Times reports. However, the White House coronavirus task force recommends positive rapid tests be reported as cases. It makes no distinction between confirmed or probable.
Dr. Harry Heiman, a clinical associate professor at Georgia State University’s School of Public Health, said he thinks the state should include positive rapid tests as a part of its total case count.
“(We’d) have a more accurate visualization of what’s going on,” he said. “Even without those, we’ve had a dramatic increase in the number of cases over the last five weeks. But if you add those to it, it’s even more dramatic.”
How many rapid positives has Georgia reported?
From Nov. 7-13, Georgia reported a total of 13,393 new COVID-19 cases and 5,125 positive antigen tests. Rapid tests account for nearly 28% of the total lab positives, according to a McClatchy analysis of raw state health department data.
That data was skewed by a data dump on Nov. 10 of about 1,000 older rapid tests from mid-October, and reporting of antigen positives has been “bumpy,” state health department spokesperson Nancy Nydam told the Atlanta Journal-Constitution.
When adjusted for the dump, nearly 24% of the state’s positive COVID-19 tests came from rapid testing during that week.
It’s unclear how many total rapid coronavirus tests have been conducted in Georgia. The state health department doesn’t publish that data. Gov. Brian Kemp’s office previously said that Georgia would receive 3 million tests by year’s end.
“It’s harder for them to wrap their hands around,” Schmidtke said of antigen testing numbers. “It’s a point of care test. It’s not controlled by a lab, so the accounting of how many tests have been performed and how many were negative and how many were positive is a lot harder to manage.”
Georgia reported 1,962 new confirmed cases and 206 rapid positive tests Sunday. Since the start of the pandemic, 386,949 cases and 8,462 deaths have been confirmed. An additional 495 probable COVID-19 deaths have been reported statewide.
This story was originally published November 16, 2020 at 3:06 PM with the headline "Georgia is back in COVID-19 red zone. It’s worse if rapid tests are included, experts say."