COLUMBUS - Ohio just started to report "probable" cases of COVID-19, the respiratory disease caused by the novel coronavirus.
For everyone without a degree in epidemiology or public health, this new definition might be a little confusing.
But the concept isn't new to disease tracking. The U.S. Centers for Disease Control and Prevention tracks both "confirmed" and "probable" cases of the avian flu. Confirmed and probable cases of the measles are treated similarly by the CDC.
The Enquirer explains what is a probable COVID-19 case, why Ohio is reporting that number now and what it can tell us going forward about the virus' spread in the state.
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What is a probable case?
Let's start with what a probable case isn't, and that's a confirmed case.
A confirmed case is someone who received a positive test for COVID-19 using a polymerase chain reaction (PCR) test. Those are the tests involving a nasal swab that the CDC, Ohio Department of Health and most hospitals have been using. They've been in short supply.
Now, there are new tests for COVID-19. One is serological testing – sometimes called antibody tests or blood tests – that determines whether someone had COVID-19 and has since recovered.
Another is a rapid diagnostic test, which detects viral proteins called antigens in a patient's respiratory tract that's been swabbed.
A patient who tested positive for COVID-19 using an antibody test or a rapid diagnostic test wouldn't count as a "confirmed" case under the CDC's definition. The World Health Organization has been wary of using either test for clinical decisions until more research is done.
Anyone who tests positive for COVID-19 using one of those tests would be considered a probable case if the person also had symptoms that couldn't be explained in another way, the patient had close contact with someone who had COVID-19 or both.
Without any testing, a patient could be labeled a probable case if he had symptoms such as fever, chills, headaches, sore throat, pneumonia or acute respiratory distress syndrome without another explanation and close contact with someone with a confirmed or probable case of COVID-19 within 14 days of symptoms.
Probable cases would also include anyone whose death certificate lists COVID-19 as the cause of death or a significant condition contributing to death – even without a test.
Put simply, the CDC and Ohio Department of Health aren't reporting everyone with a cough as a probable COVID-19 case.
Why is Ohio reporting probable cases now?
On April 5, the Council of State and Territorial Epidemiologists' executive board recommended including probable cases in COVID-19 counts. CSTE works with local and federal health officials to define infectious diseases.
The CDC agreed and started to report both confirmed and probable cases in their totals. The CDC recommended that states report probable cases, too, Ohio Gov. Mike DeWine said.
On Friday, the Ohio Department of Health started to report probable cases along with confirmed cases daily. As of Tuesday, 127 cases and 15 deaths were reported as probable cases of COVID-19, which amounts to 1.7% of cases and 4.6% of deaths.
Are probable cases a new concept?
No. The 1996 case definition for measles includes definitions for suspected, probable and confirmed cases. In some circumstances, running lab tests on everyone is impractical.
Here's what the CDC shared: "In the midst of a large outbreak of a disease caused by a known agent, some cases may be permanently classified as suspected or probable because officials may feel that running laboratory tests on every patient with a consistent clinical picture and a history of exposure (e.g., chickenpox) is unnecessary and even wasteful."
Is this just a scheme to inflate Ohio's numbers and make COVID-19 seem like a bigger problem than it is?
No. Ohio has continued to list both confirmed cases and probable cases on the Ohio Department of Health's website, so those who trust the confirmed case total can still find it.
DeWine said the new numbers will give Ohio's leaders a better picture of the problem, which has been difficult to grasp with limited testing and delays in data.
“Using this guidance will be instrumental in helping us trace the spread of the disease and eventually isolate it to small pockets or areas so we could open things up again,” DeWine said Friday. “At the same time, it will allow us to target limited resources for a better public health response.”
Does Ohio have to report these numbers? What are other states doing?
No. The CDC recommended that states share probable cases, but some states are not.
Kentucky is reporting confirmed cases only. Pennsylvania is reporting probable cases.
When New York City included probable cases, the number of deaths soared above 10,000.
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