HARTFORD, Conn. — According to official state numbers, Connecticut has recorded 3,939 positive COVID-19 tests in the past week, most in a seven-day period since early March.
In reality, experts say the true number is larger. Maybe much larger.
At previous stages of the pandemic, the vast majority of positive COVID-19 results came from tests administered by medical professionals and then reported to the Department of Public Health. But now Connecticut residents can purchase a test at a pharmacy and take it in their living room with no requirement that they report positive results anywhere or confirm their results with a medical provider.
That is good news when it comes to convenient testing access but bad news when it comes to tracking results.
“We have to be mindful of the data we are receiving and not receiving,” said Dr. David Banach, hospital epidemiologist at UConn Health. “Relying on [cases] as a primary way to gauge what’s circulating in the community is not as applicable right now.”
A sign outside of Charter Oak Health Center, which is administering vaccines and boosters daily. (Jessica Hill / Special to the Courant)
Official COVID-19 case counts have always underrepresented the true spread of the disease to some degree — as not everyone who gets infected develops symptoms or seeks a test — but experts say this has become especially true during the at-home testing era. Dr. Scott Gottlieb, a former FDA commissioner who has advised Gov. Ned Lamont during the pandemic, said recently he thinks the U.S. is “dramatically undercounting” COVID-19 cases, particularly in the Northeast.
“We’re probably only picking up one in seven or one in eight infections,” Gottlieb told CBS. “And that’s because a lot of people are testing at home. They’re not presenting for definitive PCR tests, so they’re not getting counted.”
This dynamic is apparent in looking at the number of COVID-19 tests Connecticut has reported in recent weeks. Whereas during previous stages of the pandemic an uptick in transmission had led to an increase in how many tests (both positive and negative) the state reports, this time has been different.
COVID-19 testing, as reported by the state, recently reached its lowest level since widespread testing began nearly two years ago, despite widespread evidence of increased transmission.
Though the Connecticut Department of Health provides an online form through which health care providers can report COVID-19 cases among their patients, there is no way for an ordinary person to report a positive at-home test. On an FAQ page posted in January, DPH instructs those with COVID-19 that they don’t have to report their positive result and should merely inform close contacts.
DPH spokesperson Chris Boyle said Friday that while case counts are less precise than previously, other metrics remain reliable.
“The data we have are still informative about what is going on with the pandemic, especially as we focus on more severe outcomes such as hospitalizations and deaths,” Boyle said in an email.
Even with the undercounting, Connecticut has seen a seen a notable increase in COVID-19 cases amid the recent spread of the BA.2 omicron subvariant, from about 300 a day in late March to more than 550 a day currently. This is nowhere near the nearly 10,000 cases a day the state recorded during the height of its winter surge but far more than during the truly quiet days of last summer.
By other metrics, the uptick looks even more concerning. Connecticut’s seven-day COVID-19 positivity rate has risen from about 2.5% throughout much of March to 6.5% as of Friday. Meanwhile, the number of patients hospitalized with COVID-19 has doubled in just the past two weeks.
Whereas case counts have been a key (though perhaps rough) measure throughout much of the pandemic, these metrics, as well as wastewater surveillance, now appear to more accurately convey the state’s level of transmission.
“We have to look at other metrics, including hospitalizations as well as things like wastewater tracking,” Banach said. “In many ways that’s going to be more useful than simply looking at recorded cases.”
The 14 coronavirus-linked deaths Connecticut reported Thursday were the fewest in a single week since last October, before the state’s winter surge. COVID-19 deaths, which typically lag other metrics by several weeks, have dipped in recent months, returning to pre-omicron levels.
Dr. Ulysses Wu, chief epidemiologist at Hartford HealthCare, said that while hospitalizations and deaths remain the most important measures of COVID-19′s impact, cases have functioned as a “canary in a coalmine” warning when a wave of severe illness was on its way.
When most testing occurs at home, that warning sign disappears.
“The at-home testing is very important for our fight against COVID,” Wu said. “But from an epidemiologic, predictive standpoint, it doesn’t help me.”
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