Hospitals are likely seeing more COVID-19 patients than currently reported

San Antonio’s daily reports of patients hospitalized with COVID-19 don’t include dozens of people who have been admitted to local hospitals with symptoms of the disease, but are still awaiting test results.

The city reported that 88 patients with COVID-19, the disease caused by the coronavirus, were hospitalized on Tuesday. But at the same time, hospitals said they were caring for a total of 151 patients with COVID-19 symptoms — the group of 88 patients who had tested positive, plus an additional 63 “under investigation,” who were suspected to have the disease but had not yet tested positive, according County Judge Nelson Wolff.

The tally of confirmed and suspected COVID-19 hospitalized patients is important because it indicates the total demand on hospitals.

When the coronavirus began to spread across San Antonio, the number of unconfirmed cases in hospitals has sometimes been nearly double the number of patients diagnosed with it, according to data collected by STRAC, which oversees emergency medical response in Bexar County and 21 other nearby counties.

But as testing has ramped up over the last couple weeks, that number has shifted so that hospitals are now caring for more people who have been diagnosed with COVID-19 than those awaiting test results. Some of the patients included in the “suspected” tallies can also end up testing negative for the disease.

“It really relates to testing,” said Eric Epley, executive director of the Southwest Texas Regional Advisory Council. “If you have a test you can do in 15 minutes, versus a test that takes seven days, that number (of patients under investigation) can vary widely.”

Across the state, it has sometimes taken up to 10 days to get COVID-19 test results back from private labs, which combined with Texas’s slow start to testing, has meant local officials have been forced to navigate the pandemic with a limited understanding of the extent of coronavirus in their communities.

They’ve also received little guidance from the federal government or state about how they should be reporting the demand on hospitals to the public. There has been a wide variation in what government leaders decide to release — or hold back.

On Friday, for example, Gov. Greg Abbott said 827 patients were hospitalized with confirmed COVID-19 cases.

But when counting both confirmed and suspected cases, more than 700 patients with COVID-19 symptoms had been hospitalized in Harris County alone the day before, Hearst Newspapers reported. Officials in the Houston area have been reporting information on both confirmed and suspected cases for more than a week.

“Let’s say even half the (unconfirmed cases) are positive — that’s still a substantial number,” said Dr. Chris Amos, the director for the Institute of Clinical and Translational Medicine and interim chief of epidemiology and population sciences at Baylor College of Medicine.

In Houston, Amos is using numbers of both suspected and confirmed cases to predict how the coronavirus could spread and send a surge of sick patients to hospitals. Right now, one of the greatest challenges that he and other researchers face is there isn’t widespread data that shows how many of the suspected cases eventually turn up positive — or negative — for COVID-19.

The uncertainty has led some hospitals and government officials to be reluctant to release those figures. But when it comes to understanding how the coronavirus could affect hospitals the communities they care for, counting both the suspected and confirmed cases can be key, Amos said.

Counting patients who might not have COVID-19 potentially overestimates the demand on hospitals, Amos said, but he’d rather that than underestimating a potential influx.

“I think it’s better if it’s available,” Amos said. “I am in favor of that because it helps everybody understand how the epidemic is unfolding.”

Health officials in cities such as Seattle and New Orleans, both hotbeds for the disease, have also reported similar figures to the demand on their health care systems.

But many other communities, including San Antonio, are only reporting the information about confirmed COVID-19 cases. Some local officials are pushing to change.

“It’s more important for the community to be prepared for getting resources down to our hospitals and enlisting the help,” said Bexar County Commissioner Tommy Calvert. “I think we have to stop downplaying the pandemic.”

In San Antonio, hospitals aren’t anywhere close to running out of space, at least for now. As of Tuesday, more than 43 percent of hospital beds and 70 percent of ventilators were still available for patients.

Whether patients are confirmed to have COVID-19 or not, health care workers must treat them the same way once they arrive at the hospital with symptoms. Those patients still need nurses and doctors to care for them, intensive care beds and life-saving ventilators. In the most serious cases, people can become too sick to breathe on their own and can die if their lungs aren’t assisted by the oxygen-pumping machines.

If a test ends up showing that a patient doesn’t have COVID-19, that’s when health care workers can forgo suiting up coveted protective gear to care for them. Hospitals are currently trying to conserve protective equipment such as respirators masks, gowns and gloves, which are in short supply.

Of 151 patients who were hospitalized in San Antonio with both confirmed or suspected cases of COVID-19 on Monday, 45 percent of them were being cared for in the intensive care unit. More than one in five were relying on ventilators.

Are you a health care worker, hospital administrator or employee on the front lines of the pandemic? We want to hear from you. Marina Starleaf Riker is an investigative reporter for the San Antonio Express-News with extensive experience covering affordable housing, inequality and disaster recovery. To read more from Marina, become a subscriber. | Twitter: @MarinaStarleaf

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