NH Coronavirus: 91% Negative: False Tests, Flaws, Something Else?

CONCORD, NH — New Hampshire is more than five weeks into the new coronavirus pandemic and nearly four weeks since the state launched its first emergency orders, and during the tracking of data of cases by the New Hampshire Department of Health and Human Services, one nagging, rather large question hanging in the air like a shed COVID-19 droplet is why the state has so many negative tests? A specific answer, like the virus itself, is elusive. During the course of tracking the data released by the state, negative COVID-19 tests have hovered around 90 percent.

Currently, the state of New Hampshire is only testing two sets of people deemed "high-risk" — individuals with symptoms similar to the flu only more severe like high fever; aches, pains, and tiredness; and a dry cough, often with difficult breathing; and travelers from hot spots like China, Italy, Japan, and South Korea. Later, after people were found to be infected by other travelers, individuals who traveled domestically were added to the list, and the state is also recommending that first responders and health care workers get tested, too, in order to not spread the virus and also self-isolate to heal if they get sick.

Not everyone with symptoms gets tested in New Hampshire — despite advocates and activists requesting expanded testing, monitoring, and tracing. When individuals see they have symptoms, they are supposed to avoid interacting with others, watch their symptoms to see if they worsen, and contact their health care provider for screening. After that, the provider makes a test recommendation (read the state's self-observation guide here).

For weeks, there have been media headlines with pundits clamoring about the lack of tests, as if 320 million tests were supposed to be available for a new virus no one even had a hint of existing six months ago. At the same time as all the clamoring, states like New Hampshire ramped up testing. As an example, between March 23, the day the state announced its first COVID-19 death and March 27, the day the state announced its second death, testing more than doubled — from 1,548 to 3,843. On March 23, 93.5 percent of tests came back negative; on March 27, it was 95.2 percent.

In other words, even with ramped up testing of individuals who were in the high-risk group, COVID-19 does not appear to be widespread in the state with high-risk people.

Since the state started testing and reporting negative tests, test results showing a negative result have consistently been between 90 and 95 percent range.

Patch raised the question of high negative testing to Dr. Benjamin Chan, the state epidemiologist Monday, and specifically asked about the negative tests. Here are his answers.

Chan said people with symptoms were getting tested based on Centers for Disease Control and Prevention guidelines and what was occurring in nearby states. The decision on whether or not someone was tested was based on the recommendation of the health care provider after assessing symptoms and medical conditions, ability to isolate at home, and other reasons. Chan said if there are supplies of tests on the local level, the tests can be expanded, especially for health care workers.

As far as the accuracy of the tests go, Chan said because the state was gathering genetic data from patients with swabs, the tests were "very sensitive for picking up the virus." The tests, he said, were PCR — polymerase chain reaction tests. Catching patients with symptoms early, with the possibility that they may shed to others by coughing, sneezing, and not cleaning their hands, the test should be finding the virus, if it is there.

Chan said there were many other viruses currently being spread publicly like the flu — although the level of flu had been dropping — but given the spread of the new coronavirus, providers may not recommend testing because a patient can self-isolate at home and not spread whatever sickness they have.

Don't miss updates about coronavirus precautions and information in New Hampshire as they are announced. Sign up for Patch news alerts and newsletters.

Chan said he couldn't speak to why so many people were testing negative. But someone who has the symptoms and tests negative, "that indicates the person is not infected with COVID-19." He added that the state was not recommending the testing of people who were asymptomatic.

"Testing (people) that don't have symptoms doesn't necessarily mean that they won't then go on and develop infection," Chan said. "Negative tests and people who are asymptomatic, meaning without symptoms, can be interpreted with caution but if someone is symptomatic and a negative test, we really believe that is a pretty good indication they don't have COVID-19."

Patch submitted a number of questions to the health department nearly two weeks ago including questions about the investigatory process and possibility human error or faulty memory of patients that brings into question community-based transmission; whether or not the state should collect or has collected foreign travel records to interview people who visited hot spots between November 2019 and late February when the first COVID-19 case was discovered in New Hampshire; whether or not people could have had the virus between November 2019 and February; whether or not people with negatives tests were to be re-tested; and other questions but did not receive a response.

The state did begin reposting negative results and posting recovery results after being requested to by Patch and other news organizations.

Patch takes community journalism seriously and we want to be as much service to our readers as possible at this very uncertain time. If you are a public health worker, medical provider, elected official, patient, or other coronavirus expert — or you simply have a news tip you'd like to share — please fill out this form. We'll keep names and personal information private.

Others Disagree, Call For Expanded Testing, Digital Tracing Of Positives

Earlier this week, a number of medical professionals, however, called on Gov. Chris Sununu to not only expand testing of people who were asymptomatic but also require everyone to wear masks, perform antibody testing, and also positive tracing — a form of digital spying, in a sense, while protecting patient privacy.

The activists and advocates said this process, not unlike how it was done in South Korea, would ensure positive cases were adhering to the guidelines — something they found "highly suspect, frankly," the letter stated.

Kevin Landrigan of the New Hampshire Union Leader asked Chan about the recommendations and the requirement to wear makes (see below).

Dr. Richard Dipentima, one of the letters signers, is a former state representative who called on the governor a week ago to close New Hampshire Liquor and Wine Outlets in order to ensure the health of those workers. He also has the distinction of being the director of a district health department in Connecticut, the assistant director of New Hampshire NH Public Health, the chief Communicable Disease Epidemiology at NH Public Health, a public health director in Manchester, and U.S. Air Force and New Hampshire Air National Guard Public Health Officer. In other words, he knows a bit about all of this.

Dipentima said as many as 30 percent of the negative tests in New Hampshire could be false negatives based on other COVID-19 studies. He added that there could be issues in the way genetic materials were being gathered — including common or simple mistakes by health care professionals.

"My data is from a study published in the Journal Radiology from a study done in China," Dipentima said. "They compared the COVID-19 PCR test with symptomatic patents with CT scans. The regular test showed incorrect negative results in 71 percent of the cases, while the CT scans were 98 percent accurate. I am not suggesting the use of CT scans, but it simply shows that in that study the PCR test was 71 percent sensitive. This may explain some of why we are seeing so many negative tests here."

Dipentima said though it could be possible that the new coronavirus is not yet widely circulating in New Hampshire — which is why more testing needs to be done, on more lower risk people, who are willing to come forward and be tested.

"They may be the worried well, people with symptoms of other circulating respiratory diseases, or a combination of all these factors," he said. "Over time, if strong social distancing measures and other public health measures are employed, this will change. The virus will be more widely spread and the percentage of positive tests will increase."

Dipentima said the health investigation process by the state had "limitations" due to "individual memory, honesty, and openness of the person being interviewed and the experience and expertise of the person conducting the interview," which means that many of the cases that are presumed to be community-based transmission might not be because they may not remember correctly or had second or third person contact with a high risk group person.

"These interviews require some skills, similar to a police detective investigating a crime," he said. "That is why we epidemiologists are called 'disease detectives.' Of course, there could be information that is missed, that is part of being human. You do the best you can to try and get the person being interviewed to feel comfortable, safe and secure that what you are doing is for the benefit of their family, friends and the community. It may take more than one interview, to give people time to recall things they failed to disclose on the initial interview."

Some asymptomatic people, Dipentima said, could have had the virus in January and February and not known it. He suspected people from New Hampshire who traveled domestically to Seattle, some parts of California, and/or New York City and other areas, could have "very well could have been infected, brought the virus home, and developed no or very mild symptoms that were self-limiting … that is how epidemics spread."

But requesting travel records for those periods of time, at this point in time, would have limited value, because they were "infected long before now, developed symptoms, recovered, died, or never got sick, and are no longer infectious," he said. The information might be useful when interviewing cases or for antibody testing, for evidence of past infection, but testing them now, to keep them from spreading the virus, which they probably don't have, "would be much too late."

Dipentima said, "Now, that horse has already left the barn."

Dipentima was also asked about how much the Murray Models being used by the Institute for Health Metrics and Evaluation, which have been wildly fluctuating could be trusted.

Conservative political activist Ed Mosca has been tracking them on GraniteGrok.com and was the first person in the state to note that the model was way off with hospitalization and death predictions — suggesting there would be around 351 COVID-19 deaths in New Hampshire by August. Two days later, that prediction dropped by more than 900 percent to 32. It is up to 66 as of April 8. Death counts by the model have also been way off and have dropped substantially during the past few weeks.

Despite the flaws, Dipentima said the models were still "useful tools to help guide public health decisions, resource allocation, and planning on how to prepare for best to worst case possibilities."

Dipentima said, "They are not exact, and have limitations."

There is no question that COVID-19 is mysterious and deadly; a silent enemy, as some have called it, with many unknowns. One of those unknowns may or will continue to be the high number of people in New Hampshire with symptoms who are testing negative — until the data is collected from those people who were in high-risk groups and had symptoms but somehow didn't catch it as well as other who potentially infected people for two months when the virus first left China and no one knew.

Stop The Spread Of COVID-19!

COVID-19, not unlike the flu and other respiratory illnesses, is spread through respiratory droplets, usually through coughing and sneezing, and exposure to others who are sick or might be showing symptoms.

Health officials emphasize residents should follow these recommendations:

• Avoid any domestic and international travel, especially on public transportation such as buses, trains, and airplanes.
• Practice social distancing. Stay at least 6 feet from other people, including distancing while in waiting areas or lines.
• Anybody who is told to self-quarantine and stay at home due to exposure to a person with confirmed or suspect COVID-19 needs to stay home and not go out into public places.
• If you are 60 years or older or have chronic medical conditions, you need to stay home and not go out.
• Avoid gatherings of 10 people or more.
• Employers need to move to telework as much as possible.
• There is increasing evidence that this virus can survive for hours or possibly even a few days on surfaces, so people should clean frequently touched surfaces, including door handles, grocery carts and grocery basket handles, etc.

Take the same precautions as you would if you were sick:

• Stay home and avoid public places when sick (i.e., social distancing).
• Cover mouth and nose when coughing and sneezing.
• Wash hands frequently.
• Disinfect frequently touched surfaces.

More information from the New Hampshire Department of Health and Human Services about coronavirus can be found here on the department's website.

• Guidance to schools can be found can be found here.
• Instructions for returning travelers to self-observe for symptoms of COVID-19 are available are available here.
• For more information on COVID-19 in NH, visit its site here.
• For the latest information from the CDC, visit its site here.

ALSO READ:

• NH Coronavirus Update: 4 More Deaths, 32 New Cases Announced
• Concord Coronavirus: Testing Site Closed Due To 'Lack Of Volume'
• NH Experts To Governor: Increase Coronavirus Testing, Treatment, Tracking
• State Prison Worker Tests Positive For Coronavirus
• NH Coronavirus Update: 4 More Children Infected; 715 Now Positive

Got a news tip? Send it to tony.schinella@patch.com. View videos on Tony Schinella's YouTube channel