When you look at the COVID-19 case numbers from the state and county health departments, you feel like youβre getting something firm and reliable.
As of Saturday morning, for example, the state reported there have been 104 confirmed cases in Arizona, 12 of them in Pima County.
Until this weekend, you could count the local number of known cases on two hands β as long as you keep them away from your face.
But those numbers are about as helpful as a twice-used face mask.
For weeks now the virus has quietly spread in Arizona, and hardly anyone has known whether they have it, because they couldnβt get tested and because some carriers donβt have significant symptoms.
Even if you had a fever, a cough and all the other symptoms of COVID-19, and even if you tested negative for other viruses like the flu, you generally could not get tested for this new coronavirus. Unless you needed to be hospitalized, or you had traveled to China, doctors and emergency-room staff usually told you to self-quarantine and act as if you have COVID-19. You were βpresumptive.β
Medical offices arenβt testing widely simply because there arenβt enough materials available.
Debbie Rupp of Marana has been facing this frustrating phenomenon. She got sick March 11 and it came on pretty strong, she said, βwith the headache, the tiredness, the body aches, the cough, the fever.β On Monday, she said, she called her doctor.
"They got back to me that day and said, βWe just want you to quarantine.β I asked, βAre we going to test?β She said, βThe doctor has tests, but sheβs saving them for more extreme cases.ββ
The illness has spread to other members of Ruppβs family.
She thinks itβs likely to be COVID-19, but she canβt find out.
βTheyβre not taking count from the people like me or my son or my grandson, and Iβm pretty sure we all would have tested positive,β she said.
We donβt know for sure, of course, about the cause of their illnesses. But there are many other people like Rupp in Southern Arizona. And together they make those state and county figures pretty useless. Unfortunately, we in the news media, too, are focusing on those figures and sometimes forgetting even to qualify that they represent βknownβ cases, not the actual total.
I spoke with my friend Michael Worobey, a UA professor of ecology and evolutionary biology who is a renowned expert on viral epidemics, and asked him about this reporting of cases.
βIt could give a lot of people a false sense of security,β he said. βIf youβre being told itβs still low risk, that thereβs not much around, then people will behave differently.β
Indeed, the state health department was classifying the risk of transmission in Arizona all last week, until late Friday, as βminimal.β On Friday evening, they raised the risk to βmoderate.β
Now, the health authoritiesβ assessment is not just a function of confirmed cases.
Epidemiologists are also monitoring hospital admissions, intensive-care cases and reports of flu-like illness, among other factors.
But unfortunately, these minimizing reports of confirmed cases have become the basis for at least one state health policy. On Thursday, Gov. Doug Ducey announced he was ordering the closure of restaurants and bars, gyms, movie theaters and other gathering places, but not in counties where no cases of COVID-19 had been confirmed.
This represented a misguided reliance on flimsy figures.
How flimsy? Santa Cruz and Cochise counties had zero confirmed cases the day Ducey made the order, but the next day they each had confirmed cases. Yuma County had none the day of the announcement but its first two days later.
The governorβs spokesman, Patrick Ptak, told me the governor is following expert guidance.
βThe new actions we took yesterday reflect the CDC guidance,β he said Friday. βWe acknowledge that events change quickly.β
In this situation, far from watching the virus like a stock ticker, we have to assume COVID-19 is circulating widely and act accordingly.
Just consider my story from Thursday: At least one bridge player was apparently infected while attending a tournament March 2-March 8 in Tucson along with hundreds of others, but we only know that because the playerβs brother is a doctor who worried about the public health risk and got him tested.
When I told Pima Countyβs health director, Dr. Bob England, that I planned to write about the uselessness of the testing numbers that his own department was publishing, his response surprised me.
βThank you,β he said.
βIf we had more testing available, weβd have a much more realistic picture of whatβs going on,β England explained.
βThe fact that our testing has been so limited, for one thing skews the people who are tested to be overwhelmingly the sickest. Weβre missing the mild disease that could have been spread within the community.β
That mild disease, the type that Rupp may have caught or even less serious, is what is most insidious, because weβre passing it to each other wherever we meet, unless we keep our social distance.
βA lot of the transmission of this virus is occurring among people who are not even sick enough to go to the doctor,β Worobey said.
Worobey, who has traced the genetic evolution of HIV and the emergence of the Spanish flu, explained more testing would be extremely helpful to encourage isolation of infected people, to know how the virus is moving in the population and to isolate the illness.
βIf a large number of people are tested, even people who are asymptomatic, itβs not too late to snuff this out in the U.S. But every day that goes past without really aggressively doing that is going to make it much harder.β
We donβt seem to be headed in that direction. Health departments in New York City and Los Angeles are advising doctors to stop testing all but the most seriously ill patients because there arenβt enough testing supplies.
βWe still have an opportunity, if weβre careful about social distancing, to slow the spread down,β he said. If we fail to rise to the challenge, he said, βthe world is going to look a lot like a disaster movie.β
That outlook is not something you could tell by looking at the governmentsβ meager, misleading testing figures.
