Millions of rapid at- home Covid tests are flying off pharmacy shelves across the country, giving Americans an instant, if sometimes imperfect, read on whether or not they have the coronaviruses.
The results are rarely reported to public health departments, which makes it difficult to maintain an accurate count of cases at a time when the number of infections is increasing.
At the minimum, the availability of at- home tests is making it hard to know if a patient is positive or negative. It is one factor that makes some public health experts raise a question that would have been unthinkable in the past: Do counts of coronaviruses cases serve a useful purpose, and if not, should they be stopped?
The approach to the Pandemic has been case-based, and that is no longer accurate, according to Dr. Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials. We have to think about doing things differently now.
It is not known how many rapid tests are used every day, but experts say it is more than the number of P.C.R. tests, which are completed in a lab and require more time to deliver results.
One at- home test company has implemented a system to report results directly to the health authorities. People can report results from rapid at- home tests from some local health departments. Mara Aspinall, an expert in biomedical diagnostics at Arizona State University who is also on the board of directors of OraSure, estimates that millions of tests are going unreported with a voluntary system.
Ms. Aspinall said that they don't want to discourage testing, but they can't leave public health authorities blind. They rely on this information to take precautions. It is a very fine balance.
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In parts of the country that have been hit hard by the Omicron variant, at- home Covid-19 tests have been flying off the shelves.
Public health experts have been talking about the rise of at- home testing for months. The feasibility of shifting to less frequent case reporting or a system like the one that public health officials use to track other diseases like the flu is at issue. The case numbers are used to derive the overall case numbers.
Concerns have been raised about the accuracy of the tests. The Omicron variant is detected by the Omicron variant test but not as effectively as other variant tests.
The policy responses to the Pandemic have been shaped by daily case counts. Schools and businesses have been closed in cities due to positive case counts. The public school system in New York City was shut down when the positivity rate reached 3 percent.
The New York Times and public health officials continue to use daily case counts to paint an up-to-date picture of the Pandemic.
The artificially low case numbers are due to limited access to testing and the prevalence of asymptomatic cases. It's a labor-intensive task for public health departments.
As a result, many states began shifting away from daily case counts to reporting less often. As case numbers went back up, some returned to more frequent reporting. With the Omicron variant fueling a rapid surge in positive cases, states are finding that they can't keep up. There is little incentive to try because there are so many unreported cases.
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A man in Washington got his nose tested with a rapid antigen Covid test kit.
The Council of State and Territorial Epidemiologists has been talking with its members about shifting away from daily case counts and many are eager to do so in the coming months. The Centers for Disease Control and Prevention has been in contact with her organization about possible guidance that would limit the amount of case reporting. The agency did not have plans to change reporting guidance for states, according to a C.D.C. spokesman.
Tennessee announced last week that it would begin reporting Covid case data weekly. The state's health commissioner said at a news conference last week that at- home testing and lags in reporting have made the state's daily case counts inaccurate.
She said that it was not a sustainable way to do it. Daily reporting of numbers is not relevant anymore. The actual number is not accurate when you don't know what you don't know.
The state will start reporting its test positivity rate based on P.C.R. tests, rather than the limited number of rapid tests it receives.
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The U.S. record for daily coronaviruses cases has been broken as two highly contagious versions have spread across the country. On Tuesday, the seven-day average of U.S. cases topped 267,000.
The C.D.C. reduced the time that certain Americans must stay home from 10 to five days. The change only applies to those without symptoms or who have other symptoms improving.
The shift was part of a move toward Covid-19 being an endemic disease that the country would have to live with indefinitely.
The health authorities maintain daily reporting in order to keep up with Omicron's rapid spread.
If you are five days behind, you are already in the infectious period for many people. As long as we are in the Omicron wave, we need to understand our daily numbers.
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In New York this month, people are handing out at- home test kits.
She said that health officials should report case numbers daily, but that they should be more clear about the limitations of the data.
Local public health officials have realized the limitations of daily case counts and have turned to a variety of other sources to track the virus's spread.
In light of the rapid spread of Omicron, the health director for the Multnomah County Public Health Department in Oregon said that the other metrics had become more useful than the emphasis on total numbers of cases.
Testing, isolation and contact tracing become less relevant with the situation we are in with Omicron. It doesn't help us understand things that much more if we keep hearing about a lot of Covid.
Dr. Rachel Rubin is the senior medical officer for the Cook County Department of Public Health in Illinois. If the positive test results of people at schools or nursing homes are not reported, the county will not be able to advise those institutions on isolation procedures or identify other cases connected to the cluster.
Dr. Rubin said it was like a double-edged sword. She said that the rise of at- home testing is a positive development that allows people to be isolated. It leaves public health officials in the dark. She thinks we are only capturing the tip of the bigger picture.
