Do at-home COVID test kits obscure true number of COVID cases in Alabama?

First, the numbers.

After a stunning peak of more than 6,000 COVID-19 cases per day in late August, new daily case numbers are on the decline in Alabama.

The seven-day rolling average of new cases fell below 2,000 this week for this first time since late July, and all but three Alabama counties had high community transmission of the virus in the past week, according to state data.

But state data most likely undercounts the true number of active COVID-19 infections at any one time. Some sick people may not seek testing, while others may be asymptomatic and not realize they're contagious.

Then there's the availability of at-home testing. 

Alabama Department of Public Health says it does not track the distribution of at-home tests and that COVID-19 cases identified through at-home testing typically aren't reflected in Alabama case data. The exceptions would include a positive test that is "medically attended," meaning it was self administered but witnessed by a provider in person or via telehealth. In such a case, the provider would be mandated to report it through proper channels. 

The use of at-home tests could increase in popularity in the U.S. as President Joe Biden ramped up production of affordable testing kits earlier this month amid a raging COVID-19 wave across the country. 

The ADPH said Wednesday at-home COVID-19 tests should not be relied upon in all cases, but the tests could be a useful tool in mitigation efforts. ADPH follows CDC guidance in recommending people get tested after a known exposure to COVID-19, before travel and frequent regular testing in environments like schools and healthcare facilities. 

"ADPH wouldn't necessarily recommend an at-home test over a test conducted at a facility," the department said in a statement. "However, since at-home tests may help keep ill persons safely at home and are readily available, they are a useful test option."

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Other countries, such as Britain, frequently use rapid testing as a mitigation measure similar to masking, but the U.S. has been slower to adopt the practice, to the frustration of some experts. USA Today reports Dr. Michael Mina, a Harvard epidemiologist, believes the federal government should purchase enough rapid tests to allow Americans to self-test two to three times a week. The at-home tests, though less sensitive than lab tests, are effective at catching the contagious cases that need to isolate, Mina said. 

Colorado this week acquired 2 million at-home tests to give away free for residents as a mitigation effort. 

“We know that testing is one of the key areas to keep people safe," Colorado Gov. Jared Polis said. "The sooner that somebody knows that they have COVID and they're contagious, the sooner they can take the steps to self-isolate, protecting even their close family members from contracting the deadly virus."

Though improving, the current wave of COVID-19 cases continues to tax Alabama's health care system. At least 1,766 people were hospitalized with COVID-19 on Wednesday, including 35 pediatric patients. 

Contact Montgomery Advertiser reporter Melissa Brown at 334-240-0132 or mabrown@gannett.com.