This article is from the source 'nytimes' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.

You can find the current article at its original source at https://www.nytimes.com/2020/05/22/us/politics/coronavirus-tests-cdc.html

The article has changed 30 times. There is an RSS feed of changes available.

Version 12 Version 13
C.D.C. Test Counting Error Leaves Epidemiologists ‘Really Baffled’ C.D.C. Test Counting Error Leaves Epidemiologists ‘Really Baffled’
(about 1 hour later)
WASHINGTON — As it tracks the coronavirus’s spread, the Centers for Disease Control and Prevention is combining tests that detect active infection with those that detect recovery from Covid-19 — a system that muddies the picture of the pandemic but raises the percentage of Americans tested as President Trump boasts about testing.WASHINGTON — As it tracks the coronavirus’s spread, the Centers for Disease Control and Prevention is combining tests that detect active infection with those that detect recovery from Covid-19 — a system that muddies the picture of the pandemic but raises the percentage of Americans tested as President Trump boasts about testing.
Now that serology tests, which look for antibodies in the blood of people who have recovered, are more widespread, C.D.C. officials said Friday they would work to separate them from the results of diagnostic tests, which detect active infection. One of the agency’s data tracker websites has been lumping them together.Now that serology tests, which look for antibodies in the blood of people who have recovered, are more widespread, C.D.C. officials said Friday they would work to separate them from the results of diagnostic tests, which detect active infection. One of the agency’s data tracker websites has been lumping them together.
Stunned epidemiologists say data from antibody tests and active virus tests should never be mixed because diagnostic testing seeks to quantify the amount of active disease in the population. Serological testing can also be unreliable. And patients who have had both diagnostic and serology tests would be counted twice in the totals.Stunned epidemiologists say data from antibody tests and active virus tests should never be mixed because diagnostic testing seeks to quantify the amount of active disease in the population. Serological testing can also be unreliable. And patients who have had both diagnostic and serology tests would be counted twice in the totals.
“It just doesn’t make any sense; all of us are really baffled,” said Natalie Dean, a biostatistician at the University of Florida.“It just doesn’t make any sense; all of us are really baffled,” said Natalie Dean, a biostatistician at the University of Florida.
Epidemiologists, state health officials and a spokeswoman for the C.D.C. said there was no ill intent; they attributed the flawed reporting system to confusion and fatigue in overworked state and local health departments that typically track infections — not tests — during outbreaks. The C.D.C. relies on states to report their data.Epidemiologists, state health officials and a spokeswoman for the C.D.C. said there was no ill intent; they attributed the flawed reporting system to confusion and fatigue in overworked state and local health departments that typically track infections — not tests — during outbreaks. The C.D.C. relies on states to report their data.
If the agency intended to bolster the testing numbers for political purposes, the advantage to Mr. Trump would be minimal. The Atlantic reported that on Monday, one of the C.D.C.’s trackers reported that 10.2 million viral tests had been conducted nationwide since the pandemic began. On Wednesday, after the C.D.C. stopped differentiating virus tests, the number went to 10.8 million.If the agency intended to bolster the testing numbers for political purposes, the advantage to Mr. Trump would be minimal. The Atlantic reported that on Monday, one of the C.D.C.’s trackers reported that 10.2 million viral tests had been conducted nationwide since the pandemic began. On Wednesday, after the C.D.C. stopped differentiating virus tests, the number went to 10.8 million.
A spokeswoman for the C.D.C., Kristen Nordlund, said viral testing was much more common than antibody testing in the pandemic’s early days, and some states combined the virus tests together with the few antibody results they had.A spokeswoman for the C.D.C., Kristen Nordlund, said viral testing was much more common than antibody testing in the pandemic’s early days, and some states combined the virus tests together with the few antibody results they had.
“Now that serology testing is more widely available, C.D.C. is working to differentiate those tests from the viral tests and will report this information, differentiated by test type, publicly on our Covid Data Tracker website in the coming weeks,” Ms. Nordlund said.“Now that serology testing is more widely available, C.D.C. is working to differentiate those tests from the viral tests and will report this information, differentiated by test type, publicly on our Covid Data Tracker website in the coming weeks,” Ms. Nordlund said.
State health officials in Virginia, Texas, Georgia and Vermont also said they were beginning to disaggregate their testing data.State health officials in Virginia, Texas, Georgia and Vermont also said they were beginning to disaggregate their testing data.
“This is not an intentional misuse of information — it’s part of the fog of the infectious disease war,” said Michael T. Osterholm, a University of Minnesota professor and former state epidemiologist who was sharply critical of the disease control centers early in the pandemic. “We’ve done surveillance for cases, and now we’re all trying to do testing, and it presents unique challenges.”“This is not an intentional misuse of information — it’s part of the fog of the infectious disease war,” said Michael T. Osterholm, a University of Minnesota professor and former state epidemiologist who was sharply critical of the disease control centers early in the pandemic. “We’ve done surveillance for cases, and now we’re all trying to do testing, and it presents unique challenges.”
Whatever the reason, the numbers are fueling Mr. Trump’s frequent — and inaccurate — boasts that the United States is doing more testing “than all other countries combined,” a claim that the fact-checking website PolitiFact has declared “pants on fire wrong.” Governors rely on testing in deciding how far to go in reopening their economies. With all 50 states moving to reopen, accurate tracking is essential.Whatever the reason, the numbers are fueling Mr. Trump’s frequent — and inaccurate — boasts that the United States is doing more testing “than all other countries combined,” a claim that the fact-checking website PolitiFact has declared “pants on fire wrong.” Governors rely on testing in deciding how far to go in reopening their economies. With all 50 states moving to reopen, accurate tracking is essential.
“We’re like the blind epidemiologists trying to understand the elephant,” said Michael Levy, a professor of epidemiology at the University of Pennsylvania. Health officials, he said, need good reporting to “understand the relationship between the epidemic that we can’t see, and the data that we can see.”“We’re like the blind epidemiologists trying to understand the elephant,” said Michael Levy, a professor of epidemiology at the University of Pennsylvania. Health officials, he said, need good reporting to “understand the relationship between the epidemic that we can’t see, and the data that we can see.”
Scott J. Becker, the executive director of the Association of Public Health Laboratories, said there was another reason states were tracking testing: Mr. Trump wants the numbers.Scott J. Becker, the executive director of the Association of Public Health Laboratories, said there was another reason states were tracking testing: Mr. Trump wants the numbers.
“We’ve never needed to capture test volume. That is what the White House wanted to know, how many tests were being done,” Mr. Becker said, adding, “Ordinarily this all works through the public health system, but in this response, there’s been a drive to have data numbers, at multiple levels.”“We’ve never needed to capture test volume. That is what the White House wanted to know, how many tests were being done,” Mr. Becker said, adding, “Ordinarily this all works through the public health system, but in this response, there’s been a drive to have data numbers, at multiple levels.”
Like Ms. Nordlund at the C.D.C., health officials around the country say diagnostic tests, which detect the presence of the virus, had initially far outpaced antibody tests, so agencies grouped them together. While both numbers are helpful in assessing the scale of the outbreak, only viral test numbers can indicate a state’s ability to identify people who currently have the virus.Like Ms. Nordlund at the C.D.C., health officials around the country say diagnostic tests, which detect the presence of the virus, had initially far outpaced antibody tests, so agencies grouped them together. While both numbers are helpful in assessing the scale of the outbreak, only viral test numbers can indicate a state’s ability to identify people who currently have the virus.
Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health, said mixing the two numbers would distort the picture of the coronavirus outbreak in various parts of the country. In most places outside of New York City, the center of the outbreak in the United States, the proportion of people who have been exposed to the virus, and who would produce a positive result on an antibody test, is likely to be lower than 10 percent.Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health, said mixing the two numbers would distort the picture of the coronavirus outbreak in various parts of the country. In most places outside of New York City, the center of the outbreak in the United States, the proportion of people who have been exposed to the virus, and who would produce a positive result on an antibody test, is likely to be lower than 10 percent.
“What that means is that those tests are more likely to come back negative, which means that you could end up with a misleading picture overall,” he said. “You’ll think there is less disease there than there actually is. That is not something that is going to be helpful, to say the least.”“What that means is that those tests are more likely to come back negative, which means that you could end up with a misleading picture overall,” he said. “You’ll think there is less disease there than there actually is. That is not something that is going to be helpful, to say the least.”
The mixing of the results was first reported by The Atlantic and local news outlets, like The Richmond Times-Dispatch, The Texas Observer, The Columbus Ledger-Enquirer and WLRN, a radio station in Miami. Virginia first faced criticism for combining its test results this month, but has since stopped the practice, effective May 14, the state’s health department said on Friday.The mixing of the results was first reported by The Atlantic and local news outlets, like The Richmond Times-Dispatch, The Texas Observer, The Columbus Ledger-Enquirer and WLRN, a radio station in Miami. Virginia first faced criticism for combining its test results this month, but has since stopped the practice, effective May 14, the state’s health department said on Friday.
Updated June 22, 2020 Updated June 24, 2020
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Clark Mercer, the chief of staff for Gov. Ralph Northam of Virginia, a Democrat, initially defended the strategy last week at a news conference, saying that it was important for the state to report totals that included antibody tests in order to be ranked properly compared with other states.Clark Mercer, the chief of staff for Gov. Ralph Northam of Virginia, a Democrat, initially defended the strategy last week at a news conference, saying that it was important for the state to report totals that included antibody tests in order to be ranked properly compared with other states.
“If we are going to be compared to all 50 states,” he said, “I want to make sure it is apples to apples.”“If we are going to be compared to all 50 states,” he said, “I want to make sure it is apples to apples.”
But a few days later, Mr. Northam, who is a physician, said he had only recently learned that the data was being combined and had since directed the health department to disaggregate the results. Serology, or antibody, tests accounted for 9 percent of tests in Virginia, Mr. Northam said — a figure that Dr. Lilian Peake, the Virginia state epidemiologist, said would not have drastically changed the state’s overall results.But a few days later, Mr. Northam, who is a physician, said he had only recently learned that the data was being combined and had since directed the health department to disaggregate the results. Serology, or antibody, tests accounted for 9 percent of tests in Virginia, Mr. Northam said — a figure that Dr. Lilian Peake, the Virginia state epidemiologist, said would not have drastically changed the state’s overall results.
“For the 20 years that I’ve been a public health leader, we’ve never focused on testing, and this is a new virus, so we are still learning about it,” Dr. Peake said Friday. “The tests are being developed, and we are still learning how to interpret them.”“For the 20 years that I’ve been a public health leader, we’ve never focused on testing, and this is a new virus, so we are still learning about it,” Dr. Peake said Friday. “The tests are being developed, and we are still learning how to interpret them.”
Health officials in Texas also announced this week that they had made changes to exclude antibody tests from its tally of total tests, and Vermont previously removed tests for antibodies from the numbers on its website.Health officials in Texas also announced this week that they had made changes to exclude antibody tests from its tally of total tests, and Vermont previously removed tests for antibodies from the numbers on its website.
“If we include serology, we inflate the denominator,” Erik W. Filkorn, a spokesman for Vermont’s health operations center, said in a statement on Friday, adding that the effect had been minimal. Serology tests accounted for 4 percent of all tests in Vermont, he said, and including them may have increased the percent positive rate by “a fraction of one percentage point.”“If we include serology, we inflate the denominator,” Erik W. Filkorn, a spokesman for Vermont’s health operations center, said in a statement on Friday, adding that the effect had been minimal. Serology tests accounted for 4 percent of all tests in Vermont, he said, and including them may have increased the percent positive rate by “a fraction of one percentage point.”
In Georgia, a state that is being closely watched after it became one of the first to reopen businesses last month, officials said they were working to improve transparency after reports that up to 15 percent of the state’s tests were antibody tests. While Georgia’s coronavirus caseload has remained more or less the same in recent weeks, the latest developments raised questions about the accuracy of the numbers.In Georgia, a state that is being closely watched after it became one of the first to reopen businesses last month, officials said they were working to improve transparency after reports that up to 15 percent of the state’s tests were antibody tests. While Georgia’s coronavirus caseload has remained more or less the same in recent weeks, the latest developments raised questions about the accuracy of the numbers.
“The integrity of our data is absolutely our No. 1 priority,” Dr. Kathleen Toomey, the commissioner of the Georgia Department of Public Health, said at a news conference on Thursday.“The integrity of our data is absolutely our No. 1 priority,” Dr. Kathleen Toomey, the commissioner of the Georgia Department of Public Health, said at a news conference on Thursday.
The Pennsylvania Department of Health is still using a small number of positive antibody tests to inform the state’s total case numbers, a spokesman, Nate Wardle, said on Friday. But he said those antibody tests were not skewing results — they represent less than 1 percent of total cases in the state, he said — and were not being used to decide whether regions should reopen.The Pennsylvania Department of Health is still using a small number of positive antibody tests to inform the state’s total case numbers, a spokesman, Nate Wardle, said on Friday. But he said those antibody tests were not skewing results — they represent less than 1 percent of total cases in the state, he said — and were not being used to decide whether regions should reopen.
Mr. Wardle said patients who had a positive antibody test as well as symptoms or a high-risk exposure had been included in the state’s “probable” test count, based on guidance from the C.D.C., which allowed the state to track whether patients who had symptoms early on may have had the virus.Mr. Wardle said patients who had a positive antibody test as well as symptoms or a high-risk exposure had been included in the state’s “probable” test count, based on guidance from the C.D.C., which allowed the state to track whether patients who had symptoms early on may have had the virus.
“We think the way we are reporting the data is correct,” he said, adding that the probable cause cases were broken out and kept separately from confirmed cases. “We are not using our probable cases in any of our decision-making.”“We think the way we are reporting the data is correct,” he said, adding that the probable cause cases were broken out and kept separately from confirmed cases. “We are not using our probable cases in any of our decision-making.”
Sheryl Gay Stolberg reported from Washington, Sheila Kaplan from New York and Sarah Mervosh from Canton, Ohio. Apoorva Mandavilli contributed reporting from New York.Sheryl Gay Stolberg reported from Washington, Sheila Kaplan from New York and Sarah Mervosh from Canton, Ohio. Apoorva Mandavilli contributed reporting from New York.