“Slow Down the Testing”
The pandemic in mid-July, 2020, most agree, was the worst of times in the Sun Belt. But by late August, the Trump campaign is trying desperately to convince the American public and media that, if not now quite the best of times, things are improving.
Some states are supporting this narrative with deceptive reporting of critical COVID statistics. Unfortunately, it’s working, providing a misleading picture of progress against this disease while endangering lives in the process.
As an example of a misleadingly optimistic report, see this extended analysis published by Will Feuer on CNBC News website on August 25. A brief excerpt:
“Fauci’s worst fears have not come to pass as daily new cases have steadily fallen across much of the U.S….
In Florida, the daily average number of new cases has fallen from about 11,100 [per day] on July 22 to about 3,900 [per day] this week. Cindy Prins, an epidemiologist at the University of Florida, attributed much of the drop to changing behavior across the state, prompted by news coverage and effective public health messaging.”CNBC News, August 25, 2020
Feuer is at least somewhat aware that “Confirmed Cases” can be manipulated. But, along with most of the MSM, he doesn’t do the work to tease apart the official truth-bending, even in a heavily reported piece. As we’ll see, according to the numbers, changing behavior in Florida actually had very little to do with the reduction in Confirmed Cases.
To be clear, I am not an epidemiologist. But I am a former management consultant, who spent a fair number of years working with highly dysfunctional large corporations that in some cases institutionalized misleading reporting (Note 1). The skills I developed then are useful here in ferreting out what’s going on with states like Florida, which is, in my opinion, publishing politically-motivated, official misinformation about the status of the pandemic.
What is a Confirmed Case?
Trump was widely ridiculed for saying the “more testing leads to more cases”. In point of fact, it’s an accurate statement if you add one word: “more testing leads to more reported cases”. This subtle difference seems lost on many reporters covering this story. It’s not lost on Red governors looking to support the President’s campaign narrative.
In the situation the US finds itself today, a “Confirmed Case” is an artificial construct. Recognize that a Confirmed Case means something far different from the common-sense meaning of the words, which would be someone sick with an “infection”. The number of infections, estimated by the CDC and others, is likely 10x higher than the current confirmed case count. So, of course, more testing leads to more cases.
When states are acting in good faith to attack the problem, and reporting consistently, Confirmed Cases are an OK barometer for the status of the pandemic. But, because (as we’ll see) the numbers are so easy to manipulate, it’s highly problematic if the state is acting in bad faith.
To illustrate how this works, I’m going to do a deep dive on Florida in two parts. Part 1 will look at testing numbers. Part 2 (which I’ll publish later this week) will take a close look at positivity (the percentage of tests confirming an infection) and how this is being manipulated.
The Undisputed Facts
In mid-July, Florida was reeling from the Pandemic. It had assumed the mantle as COVID’s epicenter in the US from New York. The press narrative was all about how out-of-control things were, and particularly focused on DeSantis’ mishandling of the pandemic.
By the end of August, the narrative is switching to Florida getting things under control.
Here are the “top-line” numbers. The week ending July 17 is arguably Florida’s worst week; while the week ending August 27 appears to show substantial, continuing improvement:
|Week ending||New Cases|
Yes, it’s true that New Cases fell by 74% between these two periods, from 10,000/day to less than 2,700 . Most reporting goes no deeper than this. What’s wrong with that?
A Plan to Hide the Truth?
What’s wrong is it points to a story that isn’t true. Florida is showing slight signs of improvement, perhaps, but the pandemic is far from under control. However, the state’s top line reporting paints a far rosier picture. To get to the truth, you need to dig deeper and calculate some numbers yourself (something few reporters seem to do).
In Florida’s case, you’ll want to download the daily Florida DOH County Report (Note 2). This is the source document for the official case count, and therefore deserves close examination. The document was originally designed so that, the number of positive tests = confirmed cases, based on the number of people tested. Put another way, you can think of the report as driving a formula calculating Confirmed Cases as follows:
(a) [Confirmed Cases] = [People Tested] x [% positive] Note: “% positive” is often referred to as “Positivity”, a term we’ll adopt for the rest of this post. (a) is simply a label.
You need to dig this deep because the State of Florida plays games with its top-line positivity reporting (and publishes alternative testing counts that we’ll discuss in detail in Part 2).
For example, for the week ending July 19, the DOH Dashboard was reporting positivity as 12.73%. However, based on the people-based testing counts provided on the County Report, the positivity was 17.89% for the week ending July 17. We’ve adopted these County Report variables because they are the source for the underlying DOH case count. They were also designed consistent with the methodology for case and test reporting that was recommended by the pre-politicized CDC, and which can be compared to most other states (Note 3).
By this calculation, the County Report tells you that Total People Tested fell from 406,435 during the Week ending 7/17, to 150,259 for the week of 8/27, a 63% drop!
Feuer, in his article, is aware that Case Count is influenced by testing counts. As he states:
While testing has declined in recent weeks, the number of new cases is falling faster than testing rates, indicating that at least some of the drop is real….
When you dive into the numbers, new cases fell by 54,025 for the weeks ending July 17 to August 27. But, based on the formula (a), Cases would have fallen by 45,849 simply due to reduced testing numbers, even if Positivity had stayed flat. By this reckoning, 85% of the reduction is due directly to reduced test counts!
|Week ending||Positivity||Total Tests|
|July 17||17.89%||406,435 (1,973)||72,730|
|August 27||12.45%||150,259 (729)||18,705|
Feuer doesn’t run the Florida numbers himself, and seems to accept Cindy Prins’ explanation (quoted at top) at face value, that “much of the drop” was due to changing behavior. However, behavior impacts positivity, explaining only 15% of the drop. The other 85% is due to the State of Florida’s testing levels. I note that Feuer quotes Dr. Prins, an Epidemiologist at the University of Florida, indirectly, so the quote may not be accurate. She is, however, an employee of the State of Florida.
Is there a benign explanation for cutting testing?
A positivity rate of 17.89% is dangerously high. To be experiencing this rate and be cutting back on testing suggests either gross incompetence or callous disregard for human life (or both).
For example, see this graph which contrasts New York’s testing history to Florida’s. Note these are both large states (population nearly the same); both have been hit hard by the Pandemic. New York was hit earlier, but has been the most successful state in terms of reducing new infections and caseloads. Florida was hit later, and has done a much worse job in controlling the infection.
Once Florida’s case rate started to climb in mid-June, Florida appeared to follow the New York model, increasing testing dramatically until July 17. However, New York has continued to increase its testing rate even as positivity has fallen to under 1%.
By contrast, Florida began cutting the number of tests week by week starting July 18, so that by the week ending August 27th it was testing at less than half of its peak level, falling to to 44th out of 51 states (including DC).
Even the rate of 1,973/100k that Florida was testing at the mid-July peak isn’t particularly high. It would have ranked 8th during the week of August 27th. The rate of 729 seems shockingly low: CA @ 5.64% tested at 1,489.
Most of the states you see with high positivity (>10%) and low testing rates (<1,000/100k) are other states presumably supporting the “Pandemic is Over” narrative of the Trump campaign. Texas, struggling with a similar positivity rate to Florida’s is at 14.1% positivity and is testing at 745/100k. Others, starting with the lowest testing levels, are SC @ 28.44%/292; ID @ 12.88%/735; MO @ 14.09%/766; SD @ 17.45%/851; MS @ 16.29%/899; IA @ 16.77%/903; and KS @ 10.70%/989. The only “blue” state meeting the same criteria (positivity> 10%, testing < 1,000/100k) is NV @ 15.55%/592.
We also took a close look at Florida’s testing rate by county. We’ll have a LOT more to say about this in Part II of this post, but we think it’s worth introducing here. The maps show the level of testing from the County Report, expressed in Tests-per-Person / per 100,000 population for the weeks ending 7/17 and 8/27, respectively.
On average across the entire state, the testing level fell by 63%. However, the two counties with the highest rate in the state are:
- Leon County, where the State Capital is located, testing at 1,980/100k. The testing rate actually rose during this interval, the only county where this happened, from 1,535 during the week of July 17.
- Alachua County, home of the University of Florida, at a rate of 1,562/100k, a reduction of less than 20% period-to-period.
It would seem the state government, while willing to endanger its citizens in support of a narrative, is taking care of itself!
Note 1: From 1986 to 1993, I was a consultant with the New York office of McKinsey & Company. My first engagement was with the computer division of a major company that by the accounting of the McKinsey team was losing $2 billion/year, and by the company’s books, about $300 million. Playing games with numbers is not restricted to states.
Note 2: The sources for most of this analysis are the Cases by County dataset published by the Florida Department of Health. This allowed me to calculate case and test reporting at a granular level for the weeks ending 7/17 and 8/27. Not precisely the dates quoted by Feuer, but close enough. This data is archived on the University of Florida’s Florida COVID-19 Hub, which you can find here. For the purposes of weekly totals, I downloaded tables for 7/11, 7/17, 8/21, and 8/27, to allow me to calculate the difference in cumulative totals.
Note 3: The CDC’s original, non-political guidelines recommended reporting by people tested rather than samples, recognizing that an individual can receive multiple tests prior to testing positive. When health practitioners talk about Positivity, the percentages they quote usually assume tests reported this way. Reporting based on samples will always show a lower percentage than reporting based on people. We’ll explain this in more detail in Part II (Florida’s alternative approach actually mixes the two methods, making it even more confusing).