Georgia has been counting a class of tests not included by most other states in its coronavirus screening numbers, artificially raising testing totals and lowering the state's percentage of positive results.
The test in question does not screen for active COVID-19 infection, instead checking to see whether a person has antibodies for the disease and therefore had it in the past.
By including the tests, Georgia — which has been criticized for a lagging testing regimen in fighting the glocal pandemic — appears to have performed more tests than it actually has.
But the numbers are also skewed because Georgia is not including positive results for people who test positive for COVID-19 antibodies. So the reported rate of confirmed cases among tests given is lower than it would be if those positives were included.
Georgia reports that it had conducted over 407,000 coronavirus tests as of Thursday afternoon. The Georgia Department of Public Health confirmed that 57,000, or a little more than 14%, of the state's total tests were the antibody variety, as of Wednesday. The state's inclusion of the antibody tests was first reported by the Ledger-Enquirer in Columbus.
According to Harvard researchers, Georgia is behind on needed testing. Researchers say Georgia needed to average 25,979 tests per day by May 15 but were at 15,375 as of Tuesday.
Nancy Nydam, spokeswoman for the Georgia Department of Public Health, said the department has been following federal methodology when including antibody tests in the total tests number. The Centers for Disease Control and Prevention was also leaving off positive results from antibody tests on its data site.
Other states such as Texas and Vermont have been reporting both tests in the same way. Virginia was also doing it until the Richmond Times-Dispatch reported on the practice. The governor of the state, Democrat Ralph Northam, then apologized for it and reversed course.
Pennsylvania also has said that it reports both kinds of tests, but no other states have.
Tennessee does not count antibody tests in its total test count, Shelley Walker with the Tennessee Department of Health confirmed Thursday.
Nydam said Georgia's health department has received antibody tests since early April.
She said in an email Wednesday her staff is "currently working diligently to provide greater transparency in the molecular and serologic testing data displayed on the Daily Status Report."
"One of our top priorities is to provide accurate and timely data to the public and we will continue to make every effort to do so," Nydam said.
Tennessee reporting delays
Although Tennessee does not include antibody testing in its state’s total, it has had some reporting issues.
Statewide, there is a difference between what local health departments are reporting as their daily test count and what state health departments are reporting.
By May 17, the Hamilton County Health Department reported 8,899 total tests while the Tennessee Department of Health said the county had completed 5,645 tests.
On Monday, the county health department said the difference of more than 3,200 tests was due to the Hamilton County Laboratory at Baylor School not having its reporting system fully online with the state’s reporting system. Throughout the pandemic, the Hamilton County Health Department has maintained that its daily COVID-19 report has the most up-to-date information.
Report by Wyatt Massey
Antibody and viral tests are not the same. The "rapid screen" antibody tests are not meant to serve as an official diagnosis of a COVID-19 infection but are designed to detect antibodies, the proteins that signal an immune response and are used to determine past infection. Viral tests are used to identify someone who is currently infected.
Including both tests in the total number of tests given but only including the positive cases from viral tests alters the denominator in the equation but doesn't change the numerator. This makes Georgia's positive case rate look lower than it actually is.
Rebecca Mitchell, an epidemiologist with a doctoral degree in infectious disease modeling from Cornell University, said the "lack of transparency erodes confidence in the system."
"I keep hoping this is all a result of people who are dedicated public health experts being overwhelmed by the scale of an epidemic as a result of chronic underfunding and insufficient staffing," Mitchell said. "These types of omissions, if true, make it harder to see reporting errors absent of politics."
Georgia Health Commissioner Dr. Kathleen Toomey told the Atlanta Journal-Constitution she was surprised and unaware the state was including the antibody tests.
The confusion is the state's latest mishap in COVID-19 data collection. Earlier this week, the state removed about 230 confirmed cases from the state's total. In a statement, the department said it mistakenly included antibody test results in the count.
As similar error was made in Northwest Georgia but the confirmed cases were ultimately not removed from the state's total.
In late April, after cases in Walker, Catoosa and other Northwest Georgia counties spiked and then leveled off, staff with the Northwest Health District notified top officials with the health department that positive cases from antibody tests had been incorrectly included in the totals.
Logan Boss, spokesman for the Northwest Health District, said the state told his office that it couldn't take out the positive cases because of how busy they were at the state level.
Between April 20 and 22, cases jumped by 44 in Walker County, 23 in Catoosa County and 11 in Dade County. Those were all positive cases from antibody testing. Other positives included two in Chattooga County, two in Gordon County and one in Floyd County.
Last week, three commissioners in Dade County announced they tested positive after taking an antibody test after feeling ill in February.
Boss said his office was told to keep the totals in and to move on.
"Which is kind of squirrelly but it was the only thing to do at the time," Boss said.
Dr. Gary Voccio, Health Director for the Georgia DPH Northwest Health District, said at the time some of the antibody positive cases "surely represent actual COVID-19 infections."
He added that "because so many COVID-19 cases are asymptomatic or mild, [some people] never seek medical attention, and thus are not tested, we know there are many more people in our communities who have been infected with the virus than the confirmed case count indicates."
But even as the state stopped counting positive cases through antibody tests, it didn't stop counting tests taken.
"I'll remain open to errors occurring as a result of work being done in haste and without intention as long as we see [the department of health] working to correct it rapidly," Mitchell said.
Contact Patrick Filbin at firstname.lastname@example.org or 423-757-6476. Follow him on Twitter @PatrickFilbin.