Most at-home COVID tests in Massachusetts cannot be formally reported to public health authorities, sparking concerns about how virus cases are being undercounted in the Commonwealth and beyond.
A spokesperson for the Massachusetts Department of Public Health told the Globe in an e-mail that there is no avenue for residents to alert the state of positive results from antigen tests.
The majority of at-home tests “are not reportable,” the spokesperson wrote.
“The exceptions are those that are observed during telehealth visits or those where collection occurs at home and the sample is mailed into a laboratory for testing.”
Select states, including Ohio and Washington D.C., have created online forms for people to self-report positive results. When asked if Massachusetts plans to launch a similar program, the Department of Public Health did not immediately respond.
Instead, the spokesperson said that people using at-home tests who test positive should isolate and notify their close contacts — anyone within six feet of them for 15 minutes or more. Instructions on the Mass.gov website about self-testing encourage residents with positive test results to stay home for 10 days. (It also includes a graphic on how to self-test.)
Omicron has led to widespread transmission of COVID nationwide and driven up case counts to record-breaking levels in New England. But the already-high official numbers are probably undercounting actual cases, experts say, since they do not include many results from antigen tests.
Dr. Howard Koh, a professor at the Harvard T. H. Chan School of Public Health, said he expects Massachusetts is substantially underreporting cases because of the discrepancy. That skews the statewide positivity rate and the calculus for public health officials responsible for hospital capacity and staffing, Koh said.
What is desperately needed, he added, is a way to automatically connect rapid tests with the health department, for the sake of the community and the individual. Some antigen tests, like the BinaxNOW home test, already have an option for trained telehealth providers to proctor the test and send results to public health authorities.
But the issue is just “the latest example of the overwhelming need for better public health systems in a time of crisis,” Koh said.
“Accurate data is essential.”
Because the case count is likely higher than recorded, the proportion of hospitalizations and deaths should be smaller, too, said Dr. Paul Sax, a professor of medicine at Brigham and Women’s Hospital and Harvard Medical School.
He added that tracking the number of rapid tests sold could partly solve the “information vacuum.” But not everyone who buys a kit uses it immediately.
“It would be a wild approximation,” Sax said.
The at-home tests have been lauded by public health experts as an easy and efficient way to detect the virus. Though after skyrocketing in popularity this holiday season, the swabs have quickly become scarce online and at pharmacies. Receiving a professionally administered PCR test also often requires a hunt for appointments or an hours-long wait.
Dr. Georges Benjamin, the executive director of the American Public Health Association, told CNN that he recommends people report positive at-home test results to their health care provider and local health department. They should include the type of test a person took and when, a summary of their symptoms, and details about vaccine status, close contacts, and any medications taken to mitigate symptoms, Benjamin said.
Doing so helps track the spread of the virus but also benefits the patient, since their provider may choose to intervene with treatments like monoclonal antibodies or antiviral medication, he added.
Sax said alerting a healthcare provider could be a key step for patients who develop long COVID symptoms down the line, those who have symptoms for weeks — or months — after the isolation period ends.
Some Massachusetts cities have set up methods to report self-tests of their own. Chelsea encourages those who test positive with an antigen test to call 311. Residents will be connected with a public health official to discuss next steps. (It is unclear whether the at-home testing reports are added to the city’s case count.)