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UPDATED July 15 to include new information about case reporting in Bexar County.

Is Texas inflating its count of Chinese coronavirus cases by combining unconfirmed “probable” cases with “confirmed” positive cases?

According to state and local officials, the answer is “no.”

In fact, the Texas Department of State Health Services says so right on their case-reporting website: “Probable cases are not included in the total case numbers.”

Yet confusion about whether total case counts are artificially inflated by including probable cases has persisted.

On Monday, local DFW media outlet Fox 4 News asked Texas Gov. Greg Abbott about the case-counting question (at the 4:00 mark):

Fox 4 News: “Has there been a reporting change on confirmed positive cases? Do those numbers now include probable cases?”

 

Abbott: “The way the data is provided by the state department of health services, it provides one column and one single category for those who test positive for COVID-19. It provides a separate column and a separate category for probable cases. The two are not intermixed at all.”

Questions began back in May, after DSHS advised county health officials they were changing how the state counts and reports cases of COVID-19 by adding a “probable” case category, as well as loosening the definition of COVID-related deaths.

Collin County Judge Chris Hill raised the issue at the May 18 commissioners court meeting, saying the changes could “significantly and artificially” spike case and death totals.

“This has the potential to be a very significant event for us here in Texas and Collin County,” Hill said, adding it could also lead to more residents being quarantined and stress health department resources by inflating the number of people being monitored—a key factor as the county considered whether to continue tracking COVID patients locally or hand off the responsibility to the state.

A presentation by Aisha Souri, an epidemiologist with Collin County Health Care Services, explained the state’s new case definitions.

Souri said the definition of a confirmed case—requiring a positive PCR lab result for COVID-19—was remaining the same.

“But now they’ve added a ‘probable’ case definition,” Souri said. “So, that still gets counted toward the case count. It’s different—it’s not confirmed, but it’s still a case.”

“Why they chose last week to release this formal definition, I don’t know,” she added.

Collin County Commissioner Darrell Hale asked Souri if the state would report probable cases separately.

“They said that they would like to report it that way,” she said. “The states that already implemented this, they do report it that way.”

“The state has assured us that they’re going to be reporting positive confirmed tests and probable tests—probable cases and confirmed cases—separately,” Hill said. “So, we take them on their word that from now on, they’re going to be separating those into two categories as they report on how many COVID infections they have.”

At a special commissioners court meeting on May 29 to decide on transferring the county’s COVID case tracking and reporting duties to DSHS, Hill addressed the case-count question again.

He said the governor’s team had since told him the new probable case definition directive came from the CDC, but “neither DSHS nor the state will include probable cases in any reports specific to Collin County.”

Collin County Administrator Bill Bilyeu followed up at a commissioners court meeting on June 22:

“The positives that you’re seeing [in the state’s reports] are true positives. Those aren’t self-reported; those aren’t antibody tests. … The numbers you see … have nothing to do with the change in the state’s counting.

 

“What we understand from the state’s counting is those numbers are being reported to the CDC. That’s not something that’s being included in their public releases.”

 

“I have verified with my health director in writing that this is the case,” Hale told Texas Scorecard the following week. “No antibody tests, no presumed cases. Only positive swab tests.”

The bottom line: Texas is counting “probable” coronavirus cases but is not including those counts in the total number of “confirmed” cases reported to the public—with at least one exception.

San Antonio Metropolitan Health District, which tracks and reports COVID-19 cases for Bexar County, states on its website that their case totals “include both confirmed and probable cases,” and those combined case totals match numbers reported on the DSHS COVID-19 dashboard.

Days after this original report, Metro Health changed its online data reporting site to add a definition of “probable cases” as “symptomatic cases that have a positive antigen (FIA) test result” and also added a breakdown of the number of confirmed and probable cases included in its total case count. On July 14, such probable cases accounted for 17 percent of Bexar County’s total cases reported by Metro Health and DSHS.


Texas Scorecard is awaiting clarification from DSHS about its public reporting of case data from Metro Health and other local health departments that track and report their own COVID-19 cases.