The Unreported Cases

March 7, 2020 11:38 a.m.

I am always very cautious about drawing conclusions based even on a significant number of reader reports. But having reviewed numerous accounts and combined those with many more from other published accounts, the following is clear: a substantial number of people are seeking medical care for respiratory illnesses (usually not severe) and being presumptively diagnosed with COVID-19 but sent home to take care of themselves and not being recorded in any registry or being contact-traced in any way.

When I say presumptively diagnosed let me be clear what I mean: patient presents with COVID-19 type symptoms, tests negative for the flu and other possible infections and may or may not have travel or contact histories that indicate a risk. Certainly many of these will be other things beside COVID-19. These are by definition not confirmed. But they aren’t just ‘seems sick and isn’t the flu.’ In many of these cases I’m talking to frontline clinicians who say based on experience, differential diagnoses, etc that they think these are likely COVID-19 cases. The issue is there are no tests. Where there are tests they’re being (understandably) rationed for people at high risk, presenting with severe disease, coming up in contact trace investigations etc.

In most cases these people are being told they might have it, how to self-treat at home and to self-isolate. In cases that appear to be mild that is likely the best medical and public health advice. But many of these people are not able to skip work. And again, critically, these presumptive diagnoses are not being reported on any registries.

Again, to be clear, they can’t and shouldn’t be reported as COVID-19 cases since they’re not confirmed. They haven’t been tested. My point is that there’s a significant population of these people and probably a substantial number of them have the disease. At least a non-trivial number do not have the financial ability to miss work, especially without proof that they have the illness.

It’s a really bad situation when the illness seems to be spreading over a broad geographic scope within the country. The continuing lack of testing capacity is a huge, huge problem.

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