SAN ANTONIO — San Antonio health officials have responded to widespread confusion caused by a change in the way Texas is reporting coronavirus cases from Bexar County.
On Wednesday, state health officials removed 3,484 coronavirus cases from the state's total coronavirus count due to how Bexar County reports the area's total coronavirus cases. Metro Health includes both positive test results as confirmed by molecular and antigen testing.
Up until Wednesday, Texas Department of State Health Services had included the total number of cases for Bexar County, but now has amended their count to exclude the county's antigen testing numbers.
City health leaders said this was not a mistake on their part. They said the antigen tests are recommended by the Centers for Disease Control and accurately detect positive cases.
“To be clear, this is not an ‘error’ in Metro Health’s reporting,” Dr. Colleen Bridger said. “This is a disagreement over what should be reported in total counts. We will continue to align our definitions with those from the CDC and the Texas Department of State Health Services, while honoring the state’s request to separate probable cases.”
During Thursday night's coronavirus briefing, Mayor Ron Nirenberg emphasized the discrepancy isn't a mistake, but rather a difference in how Texas and Bexar County considers in their respective COVID-19 case totals. He says Metro Health's practice allows them to be thorough in their testing.
"We're trying to make sure that people have the data to so they can make informed decisions to protect themselves, their businesses and their families," Nirenberg said.
Nirenberg added he believes the people who received positive antigen tests should be included in the total for the state, as the CDC does in its national count.
"The fact that we have some folks at the state and federal level who are questioning whether to or not we should count that test, makes it seem like some people at the state and federal level are trying to suppress just how bad this COVID pandemic is," Nirenberg said.
The city's explanation is below in full:
San Antonio Metro Health separates “confirmed” COVID-19 cases from “probable” cases at the request of the state Probable cases based on FDA-approved test results of symptomatic patients continue to be reflected in both federal and local counts SAN ANTONIO, TX (July 16, 2020) At the request of the Texas Department of State Health Services (DSHS), Metro Health is now separating COVID cases that were confirmed by a positive molecular test (PCR) from those that were detected by a positive antigen test combined with COVID-19 symptoms, otherwise known as “probable cases.” Antigen tests were approved by the FDA for emergency use on May 8 and July 2, 2020, and they are considered very accurate in detecting the presence of COVID-19 in people with symptoms. The CDC includes positive antigen test results in its national count of COVID-19 cases, as does Metro Health in Bexar County counts.
However, the State of Texas does not include antigen test results in its COVID-19 dashboard counts, despite collecting this data from local health departments and reporting it to the federal government.
“Probable cases do not mean ‘maybe’ cases of COVID-19,” said Dr. Colleen Bridger. “Antigen tests are FDA approved, and positive tests are highly accurate. San Antonio is one of only three Texas cities collecting and reporting this data per the CDC guidelines, but the State of Texas wants apples-to-apples comparisons between Texas cities.”
Antigen tests quickly identify people who are currently infected with the coronavirus by detecting proteins from the virus in nose and throat secretions. This is the same technology used in your doctor's office for rapid strep testing. By contrast, a PCR test, looks for genetic material.
When the FDA authorized the emergency use of antigen tests in the detection of COVID-19, it stated the following:
"This latest FDA authorization is for an antigen test, which is a new type of diagnostic test designed for rapid detection of the virus that causes COVID-19. Each category of diagnostic test has its own unique role in the fight against this virus. PCR tests can be incredibly accurate, but running the tests and analyzing the results can take time. One of the main advantages of an antigen test is the speed of the test, which can provide results in minutes. However, antigen tests may not detect all active infections, as they do not work the same way as a PCR test. Antigen tests are very specific for the virus, but are not as sensitive as molecular PCR tests. This means that positive results from antigen tests are highly accurate, but there is a higher chance of false negatives, so negative results do not rule out infection. With this in mind, negative results from an antigen test may need to be confirmed with a PCR test prior to making treatment decisions or to prevent the possible spread of the virus due to a false negative."
Antigen tests should not be confused with antibody tests, which detect a specific antibody in the blood that indicates the body’s response to a new or recent infection of COVID-19. Antibody tests, which are considered much less reliable that molecular and antigen tests, are not reported in San Antonio Metro Health’s case counts.
In response to the request from DSHS, Metro Health has separated confirmed and probable case counts in the data posted daily to the City’s COVID-19 website.
COVID-19 Cases by Case Type (As of 7/15/2020):
Confirmed: 17,912
Probable: 3,634
Total: 21,546
Given the validity of antigen testing, San Antonio Metro Health will continue to report probable cases in its total case counts. Metro Health also conducts case investigations and contact tracing for probable cases.
“To be clear, this is not an ‘error’ in Metro Health’s reporting,” said Dr. Bridger. “This is a disagreement over what should be reported in total counts. We will continue to align our definitions with those from the CDC and the Texas Department of State Health Services, while honoring the state’s request to separate probable cases.”