Column: Lack of standardization in COVID reporting is obscuring real risk

In a recent article, The Herald-Times described the current, local incidence of COVID-19. The article stated Indiana ranked 42nd among states where COVID-19 is most rapidly spreading. It is important to note that these data probably do not reflect the actual burden of COVID-19 in Indiana.

The latest:Monroe County's COVID cases fall 25.1%; Indiana cases holding steady

Most experts agree COVID-19 incidence rates and test positivity data are biased toward lower numbers as many tests are not reported. It is, perhaps, even harder to confidently compare COVID-19 data between states.

Currently, there is an apples-and-oranges approach to both COVID-19 testing and reporting test positivity. This is because there are no current federal requirements guiding states’ reporting. Federal guidelines to standardize state testing and reporting would help increase the accuracy of comparisons between states. The proportion of true cases reported might always be lower than actual cases due to underreporting, especially of home tests. However, if the degree of underreporting were more similar between states, as they likely would be with nationwide guidelines, comparisons would be more accurate.

For example, some states report only the number of positive tests among total tests performed. They may not differentiate between unique individuals and repeat tests in the same individual. In other words, if 100 tests were performed in a week for unique individuals and 15 were positive, this is a 15% positivity rate. But, if 100 tests were performed, 15 were positive, and 10 of those positives occurred in a one-week period among the same five people, the 7-day positivity rate is closer to 10%. Also, serology tests should not be reported with PCR tests as they diagnose historical but not active infection. Nevertheless, some states combine serology and PCR data.

For various reasons, including political issues and nationwide personnel shortages, standardized federal COVID-19 reporting requirements are unlikely to occur soon. Even if there were federal guidelines, we know that obtaining a test is harder for some individuals and in some places than others, providing another source of bias. According to the Indiana government coronavirus website, there are no longer freely available SARS-CoV-2 PCR tests available in Monroe County. However, a 07/02/2022 online search for free PCR tests in Bloomington revealed that The Covid Clinic offers no-cost tests following successful completion of a scholarship application. Also, as of 07/02/2022, Bloomington’s Morton Street COVID-19 testing site offers no-cost testing.

More on The Covid Clinic:COVID testing outside College Mall is unlike other options. Here's what's different.

How can people find the most accurate data possible? One way is to track local wastewater data. These data are freely available from the City of Bloomington at: https://bloomington.data.socrata.com/Utilities-Water/City-of-Bloomington-Sars-CoV-2-COVID-19-Wastewater/yv82-z42g/data. When counts are higher in the “gene copies per 100mL” column, it is probable there is a higher burden of COVID-19 in the area. Nevertheless, even seemingly unbiased data such as wastewater viral load can be influenced by changes in weather and variations in sample analytical technique.

For now, it is probably prudent for those concerned about the accuracy of available COVID-19 testing data to remain vigilant and aware of discrepancies in data reporting. A helpful resource is the Johns Hopkins University Pandemic Data Initiative (PDI) website found at: https://coronavirus.jhu.edu/ Individuals can also write their Congressional representatives and senators (Rep. Trey Hollingsworth, and Sens. Todd Young and Mike Braun) asking them to encourage the CDC and the U.S. Census Bureau to standardize testing and reporting until we are well into an endemic phase. Lastly, the PDI data suggest that Monroe County’s 7-day average positivity rate is 15.3% on 07/02/2022. While this number may not be accurate, it is high enough that those who wish to avoid COVID-19 may want to continue masking.

Katharine Watson is a veterinarian and epidemiology PhD candidate at Indiana University.

This article originally appeared on The Herald-Times: Column: Reported COVID-19 data doesn't reflect Indiana's actual burden