As public officials and health experts continually refer to new coronavirus cases and deaths to find clues to when restrictions on daily life can be lifted safely, many people are eager for news on another, more reassuring metric: coronavirus recoveries.
Health departments across North Texas report COVID-19 statistics daily, and Tarrant, Collin and Denton counties regularly report new recoveries alongside the new infections.
But other places, including Dallas County, don’t. The state provides recovery numbers, but the figures aren’t reported at the national level.
So why aren’t recovery data always reported? Here’s what you need to know.
Recovery numbers aren’t always reliable
Health experts say that during outbreaks like COVID-19, recovery data are scarce and isn’t always accurate.
Most COVID-19 cases are mild, and because many places in the United States, including Texas, lack significant testing capacity, it’s possible many people have had the virus and not known it and aren’t included in the totals.
There’s no reporting requirement for health-care providers or patients in Texas, so numbers are only estimates, health experts say.
Just as when people often visit the doctor when they have the flu, but they call back or return only if their symptoms get worse. If they go home and get better, they typically don’t update the doctor.
Even if peple with COVID-19 do report ack, there’s no way for the information to be included in county or state data because there’s no requirement or method for health-care providers to document it, said Dr. Beth Kassanoff, an internal medicine physician with North Texas Preferred Health Partners and the 2021 president-elect of the Dallas County Medical Society.
“In my practice, we’re in contact very frequently with our patients who are sick, whether it’s COVID or not,” she said. “We can tell you from our own practice from our own patients how people are faring with the disease and when we think they’ve recovered, but there’s no way for us to get that individual patient data matched up with the testing data to be able to report those numbers.”
Even Texas, which chooses to report statewide recovery data, includes an important caveat on its novel coronavirus dashboard: the numbers are estimates based on assumptions about hospitalizations and recovery times, and can change as more information becomes available.
Without the ability to accurately retest the entire population for the virus or the virus’s antibodies, the only way to get a true recovery number would be to follow up with all the patients to see how they’re doing. That would require significant resources that are being directed toward contact-tracing, health experts say.
“People are recovering from this, absolutely,” Casey Kelley of Northwestern University’s Feinberg School of Medicine told U.S. News & World Report. “They absolutely are, and most people will. We just don’t have the data because we don’t have the manpower to monitor that right now.”
There are varying definitions of “recovery”
Although Texas reports statewide recovery numbers, many health departments don’t.
The Centers for Disease Control and Prevention don’t report such data at the national level. And though a count is included on a popularly cited sebsite created by Johns Hopkins University, the number is an estimate created using available media reports, county and state data. The result is probably “substantially lower than the true number,” the site’s creators say.
A key reason recoveries aren’t reported at the state level is that there isn’t a clear definition of what recovery from the novel coronavirus is, health experts say. The CDC has standards for discontinuing self-isolation, which it sometimes refers to as “recovery” on its site, but that definition also says some people may need longer to stop being contagious.
By the CDC’s definition, someone can stop self-isolating after three consecutive days without a fever (without using fever reducing medicine), improvements in respiratory symptoms if it has been at least 10 days since symptoms appeared, or two negative COVID-19 test results taken at least 24 hours apart.
Some states are using that definition as a metric for recovery, but others are using different measures, including the length of time after a diagnosis or hospital admission, Kassanoff said.
Texas calculates its recovery rates by assuming that 20% of people require hospitalization, The Texas Tribune reported. Those who are hospitalized are considered recovered after 32 days, and those who are not are considered recovered after 14 days.
“It’s working with the tools you have and the knowledge that you have,” Angela Clendenin, an epidemiologist and biostatistician at Texas A&M University School of Public Health, told The Texas Tribune. “The formulas are sound. They make logical sense. But at the same time, knowing that that’s probably the closest we can get to an estimate doesn’t always mean it’s going to be highly accurate.”
Even for states using the CDC’s definition, it’s important to note that no longer being contagious isn’t necessarily the same as being recovered, Kassanoff said.
“When you think of someone as having recovered from something, to most people, that means that they’re well,” Kassanoff said. “And there can be some long-term significant health consequences from COVID, especially from people that have been hospitalized. Lung issues, kidney issues, some of those things can happen with COVID-19 and they might not be recovered from those at the time those 30 days are up, if that’s what the measure is.”
In Dallas County, recovery data aren’t reported because it’s not a measurement the CDC uses, said Lauren Trimble, chief of staff for Dallas County Judge Clay Jenkins.
“What we can say is that currently the number of persons who have not been hospitalized [as presented in the county’s Tuesday/Friday report], are the number who can be presumed to have either recovered, or on their road to recovery,” Trimble said in an email. “The exact number of patients who have been released from area hospitals to continue their recovery at home is not available at this time.”
It’s not the most important way to chart the course of an outbreak
Although recovery numbers help reassure the public, they don’t tell public health experts much about making recommendations for how to move forward during an outbreak.
“It’s probably the most ignored of the public metrics that are out there,” Jeffrey Martin, professor of epidemiology and biostatistics at the University of California San Francisco, told the San Francisco Chronicle. “In short, it isn’t telling us that much.”
In Tarrant County, public health officials chose to report recoveries to help calm residents’ fears, said Richard Hill, senior public information officer for Tarrant County Public Health, adding that the data aren’t absolute and can’t be used to draw inferences about the outbreak.
“Showing that people are recovering helps calm fears and provides some perspective to media coverage of devastating outbreaks and deaths around the world,” Hill said in an email. “And the fact is that most of the people who get COVID-19 will recover.”
Kassanoff said accurate recovery numbers, besides being reassuring, could help health experts model the curve of the pandemic more accurately. But she said it’s more important to use resources to determine accurate counts of new cases.
Accurate recovery data “would really remind us that most patients who get COVID-19 do recover,” she said. “But that number isn’t as important to scientists because it really doesn’t help us make decisions about what precautions communities need to take, or really how prevalent in the community COVID is.”