COVID Positivity Rate: State Epidemiologist Says There's "Not A Very Good Way" To Calculate

State Health Official Says COVID-19 Positivity Rate Is "Just An Estimate," Local Numbers Not Available

Darren Doyle, story:
In case you needed more confusion about the coronavirus numbers, data, and percentages, a new number has popped up on the COVID-19 radar, which is "positivity rate." 

Governor Andy Beshear continues to stress this number in his regular press conferences, which recently has remained over 5% in KY. He reported yesterday this rate stood at 5.67%. The positivity rate is calculated by dividing the total number of confirmed positive cases by the total amount of tests administered; however, that number is only accurate if the total number of tests administered is also accurate. 

During last Friday's Edmonson Voice update on coronavirus cases in both Edmonson County and the Barren River Health District, (which serves 8 counties), we wanted to calculate the positivity rate for Edmonson County and compare it to state numbers. We reached out to A Plus Family Healthcare, a local clinic and a current area hot spot for COVID testing. CEO Patrick Merritt confirmed that their clinic has not been reporting total number of tests administered to any local or state entity, as there has been no requirement from the clinic to do so; however, they are required to report the total number of positive cases to the Barren River District Health Department. 

We asked BRDHD if they could provide us with the amount of tests that have been administered in Edmonson County, as well as the amount of tests administered district wide, a population of more than 276,000 people. 

We received an emailed response from Kim Flora, listed as Human Resources Manager for Barren River District Health Department. In the email she said, "BRDHD is not tracking the total number of tests being administered so we cannot give that number for our region."

After reaching out to the Governor's Office, we were directed to Susan Dunlap, Executive Director of the Office of Public Affairs for the Kentucky Cabinet for Health and Family Services. She gave us some general information how administered tests are reported but our specific question was what is the exact process that ensures all testing facilities, (and those can be everything to large hospitals, all the way down to small localized clinics), are reporting the total number of tests that they are administering. Our entire mission was to provide a localized positivity number to compare to statewide numbers. The Edmonson Voice has consistently seen lower numbers in Edmonson County for both active coronavirus cases and deaths than many other surrounding counties, as well as lower than statewide numbers. ​

She said she was not certain she could give me a comprehensive answer, so she directed us to Dr. Doug Thoroughman, Epidemiologist for the Commonwealth of Kentucky. He oversees the infectious disease operation in KY and is tasked to ensure KY follows national guidelines. We spoke with him on the phone on Tuesday.

"Even at the state level, we don't have a good way of accounting in a given county what tests have been given, or how many tests have been given," he said. 

He then described the Kentucky Health Information Exchange, which is an electronic data collection system that gathers data from most hospitals and some providers that allows clinicians to share information. If a doctor sees a patient, he or she can access this information portal and see patient information, where COVID data can be seen and shared, but because all medical facilities don't use this, problems occur.

"In the case of COVID-19, there's a whole boatload of new labs that have started testing that have never done public health testing before. A lot of them are labs that traditionally test for drug levels in people for places of employment, and a lot of them say, 'hey look I can do some COVID testing and make some extra money,' and now they're doing COVID-19 testing and a lot of them are unfamiliar in public health reporting and surveillance, and they've never reported to state health departments or local health departments."

He said those labs are unaware they're supposed to report this information and no one knows how many of them are out there; however, every facility is required to report their positive cases.

"By law, labs only have to report positive tests, they don't have to report all their tests--they only have to report positives, so if they're aware they're supposed to be reporting, and we try to make sure people are aware--but like I said, not all are--but by law, they're only required to report their positive tests."

​We then asked how can KY's positivity rate be accurate if these hurdles exist for gathering the necessary data.

"So the way we're getting positivity rates, and it's only a statewide rate-we don't get a per-county, it's by a different mechanism because of that very issue. We don't have a very good way of getting all these numbers together--and I will just say---the positivity rate is just an estimate because it's definitely not complete with all the testing that's been done."

He then described a process where all labs are asked to enter information into a daily survey, which is both total number of positives and tests, and break that down into what type of tests they are, but he described that process as "not very good because a lot of those people are repeat-tested so they can be in those numbers more than once." 

"Nothing's perfect, I'll tell you right now, there's no good way to get positivity rate in any state, unless the state health department is the only testing body in the state, there's no good way of getting that."

Some argue it is unfair to claim Kentucky's positivity rate is accurate if all lab facilities are not tracking the total amount of tests administered. Others say the process of data collection is accurate enough to give Kentuckians a fair assessment of the situation; however, the fewer administered tests that are reported compared to the same number of positive cases, which all testing sites are reporting, will result in a positivity rate that could potentially be much higher than the correct rate. What does that mean?

According to the World Health Organization, before a region can relax restrictions or begin reopening, the test positivity rate from a comprehensive testing program should be at or below 5% for at least 14 days. If KY's positivity rate remains above 5%, restrictions will likely remain in place as they've been.

Beshear has recently made what he described as a "recommendation" to push in-person school back to September 28th; however, he has come under fire from school officials all across the state claiming that while it's being labeled as a recommendation, it is much more serious than that. 

Edmonson County Schools voted to delay in-person classes until September 28th; however, all students will begin virtual classes on September 8th.

Barren County unanimously voted to start in-person classes on August 24th, going against the Governor's recommendation. They also offer virtual classes for those that choose not to attend in-person. Bowling Green City Schools are holding a special called meeting tonight to make their decision. Warren County Schools still plan to open in-person classes on the same date, August 24th. ​