Popular rapid COVID-19 tests don't count in Austin's case numbers

Rapid COVID-19 tests are becoming increasingly available and popular in Austin, but the results are not counted toward the area's confirmed-case totals, raising questions among health officials about whether they are underestimating the disease's spread.

"That's something that we're looking at right now, as to what kind of impact that's having on our numbers," Austin-Travis County Interim Health Authority Dr. Mark Escott said.

The results of the rapid antigen tests, which return results in as little as 15 minutes, are slightly less accurate than the slower genetic tests and aren't reported in the county's daily confirmed cases because they are considered "probable" instead of "confirmed" in state and CDC guidelines.

While local health officials study the issue - and even consider offering the antigen tests for free to residents - some in the medical community say the impact of the omission on daily totals is clear.

"I think we're seeing an undercount by not including the rapid antigen tests," said Dr. David Gude, Chief Operating Officer of Texas MedClinic, which offers the tests at its 19 Central Texas locations.

Red tape

The number of people seeking out free COVID-19 genetic testing through Austin Public Health has declined in the wake of the recent surge. Local officials attribute this to both a lower transmission rate and the increasing availability of the rapid antigen tests, which detect active COVID infections.

The U.S. Food and Drug Administration issued its first emergency use authorization to a rapid antigen test in May, acknowledging that the model is marginally less sensitive than the genetic—or polymerase chain reaction tests—already in use.

But the antigen tests offer the benefits of being cheaper to produce, less invasive to conduct and much faster results—in around 15 minutes.

Patients who receive genetic tests, on the other hand, may wait more than a week for results because the tests must be sent out to labs for processing, and many national labs are overwhelmed.

The Texas Department of State Health Services recently began reporting the number of antigen tests and positive results as probable cases, although an agency spokesperson told the Houston Chronicle earlier this month that the policy may change given the growing reliance on antigen tests.

Since Aug. 6, 16,409 antigen tests have been conducted in Texas compared to around 100,000 genetic tests in that same period.

Texas recently began reporting the number of rapid antigen tests conducted across the state.

The state dashboard shows the recent addition of antigen test numbers.

(Department of State Health Services)

APH would not provide the number of positive results reported from rapid antigen tests conducted in Travis County. Austonia has filed a public records request for the information.

"I think it's very unfortunate that some decision-makers have decided to not include the rapid antigen tests in the case counts," Gude said.

A clear preference

Although genetic tests continue to outnumber rapid antigen tests overall, at the private testing sites that offer rapid antigen tests—which require certain on-site equipment to process—this is not the case.

At Total Men's Primary Care, which has 16 locations in and around Austin, demand for genetic tests is down because of the long wait times for results, CEO Robert Sek said.

Similarly, Texas MedClinic is seeing decreased demand for both rapid antigen testing and genetic testing compared to the surge period. But the level of interest for each type of test is not the same.

For patients not traveling abroad or awaiting surgery, two instances that might require a negative genetic test result, antigen tests are the clear favorite because of their rapid response time, Gude said.

"The only patients that I see that have any preference for a [genetic test] is because there's some agency or entity that is requiring [it]," Gude told Austonia.