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Why Coronavirus Cases In Missouri Are Down But Hospitalizations Are At Record Highs

Carlos Moreno/KCUR.org
COVID-19 testing has slowed in Missouri during the same period that new cases have appeared to decline.

Testing data suggests that Missouri has been missing many cases in its counts.

Missouri appears to be among the few states where COVID-19 cases are declining, but hospital data suggests the coronavirus has, in fact, been surging again.

Though coronavirus hospitalizations have reached all-time highs in Missouri, low testing rates could explain why fewer cases are being reported.

Infectious disease specialist Dr. Mary Anne Jackson, dean of the University of Missouri – Kansas City School of Medicine, said that even though more companies are offering testing and a wider varieties of tests are available, testing still remains an obstacle in Missouri.

“It is still hard to find access to a COVID test if you’re someone who’s developed symptoms,” Jackson said.

Some national news outlets that track COVID-19 cases have reported Missouri as one of three or four states with declining cases. Republican Gov. Mike Parson tweeted one of those stories this week as evidence that Missouri is on the right track.

An average of 1,313 people in Missouri are newly diagnosed with COVID-19 each day, the Missouri Department of Health and Senior Services reported on Wednesday. It’s a decline from the peak of 1,500 average new cases in mid-September.

During the same period, however, Missouri’s daily average testing rate has declined from a high of 17,854 in mid-September to 16,246 on Oct. 3.

Case counts can often rise and fall with testing rates, and Missouri’s percentage of COVID-19 tests coming back positive suggests that the state is missing many cases in its testing.

The White House Coronavirus Task Force and other health organizations recommend a positivity rate of less than 10%, and 5% or lower is preferred. Low positivity rates indicate that enough people are being tested to yield an accurate assessment of the spread of the virus.

Missouri’s positivity rate stands at 13.7%, while the rate in the Kansas City metro area reached 16.2% on Wednesday, the highest since mid-April.

Current COVID-19 testing for the Kansas City metro area is at roughly two-thirds of the recommended 3,150 tests, according to the Mid-America Regional Council.

Hospitalizations can also indicate high levels of transmission.

A record high 1,176 people were hospitalized with COVID-19 in Missouri on Tuesday, according to the Department of Health and Senior Services.

Hospitalizations may show trends of transmission that have already occurred, according to a spokesman for the Missouri Hospital Association.

“Hospitalizations are a lagging indicator,” Dave Dillon said in an email.

Missouri’s data also shows concerning trends relative to other states.

Missouri’s seven-day case rate currently averages just over 10,000, higher than many more populous states, including New York, Massachusetts and Pennsylvania, according to data from the New York Times.

And unlike many states, which have had sustained levels of low cases following early spikes, Missouri’s rate of new cases has not dropped significantly after ramping up in July.

Dillon says the high rate of transmission could threaten the capacity of the state’s health care system, particularly outside of Kansas City and St. Louis.

“Missouri needs to reduce the positive rates/reproductive rate of the virus to maintain our health care system’s ability to provide care,” Dillon said.

Jackson said Missouri’s unusual curve is largely due to resistance in many parts of the state to wearing masks, social distancing and limiting large gatherings.

She said she’s been urging fellow health care providers to push even harder for people to adopt these measures, but she worries the state’s COVID-19 situation is becoming even further complicated by the appearance of seasonal respiratory viruses.

“There are individuals out there with symptoms that haven’t been directly exposed to COVID that they know, clearly are symptomatic, and have not been able to access a test and are continuing to go out into society,” Jackson said.

As a health care reporter, I aim to empower my audience to take steps to improve health care and make informed decisions as consumers and voters. I tell human stories augmented with research and data to explain how our health care system works and sometimes fails us. Email me at alexs@kcur.org.
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