Is COVID-19 being underreported?

You may have heard some of the back and forth on COVID-19 and whether it is being over, or underreported. There are several things to consider when trying to make sense of this daily count of cases, and mortality rates. First, in the early days of the outbreak of this disease, there were no tests available in the United States to adequately detect the Corona virus. The World Health Organization started using an accurate test manufactured by a company in Germany but the United States did not ask for those tests, and instead, developed its own. As those tests have hit the market they have been found to be unreliable in detecting people with positive cases of COVID-19. They also have a high false negative rate which indicates they have an issue with something called “specificity.” That is, the ability for a test to correctly identify someone who does not have the disease. That’s one problem that may be leading to underreporting of COVID-19 cases.

Early on, there were deaths that were regarded as coming from a viral pneumonia that was not influenza. Those could have been from COVID-19 as well, and some states adjusted their mortality tables to indicate a higher number of cases deaths from Corona virus as they more closely examined the diagnostic criteria for a “case” of COVID. While this may have increased some of the numbers in some states, additional cases could have been missed due to failure to classify them as related to the virus. In addition, some people do not want to be tested and have simply stayed home until they felt better. In the early months of the outbreak, recall we were being told if you don’t have the primary symptoms of the virus, stay home so as not to overwhelm the hospital system. For those that did want a test, in some cases, they couldn’t get one.

Finally, a large number of people either have had no symptoms at all or have had mild symptoms from the disease. Those people are not likely being tested since there is also no basic treatment for mild cases that present to medical clinics or hospitals. Keep in mind, as better testing is developed more positive cases will be detected and so the “incidence” of the cases will increase. That is the term for new cases. In addition, with time the percent of people with existing cases the disease may increase as well. That is called prevalence. Once we have reliable antibody tests we can also know who has been exposed to the virus. That will give us better answers as to how we have done with the virus. But for now, a short answer to the question is, we have likely underestimated the cases of COVID-19 in the United States. Getting this right will be critical to getting a handle on who has it, who needs quarantining and who needs treatment. Only then will we really be able to manage the disease appropriately. Adequate testing is critical to that process and to us getting back to semi-normal.