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Problems between labs and DHEC cause an undercount in SC COVID-19 tests

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Students at the University of South Carolina line up to take COVID-19 test on Davis Field outside of Thomas Cooper Library on Sept. 2, 2020. Reporting inconsistencies between the S.C. Department of Health and Environmental Control and labs across the state mean the number of COVID-19 tests reported to the public is lower than reality. File/John A. Carlos II/ Special to The Post and Courier

Miscommunication and a confusing reporting system have left thousands of COVID-19 tests missing from the S.C. Department of Health and Environmental Control reports to the public.

Though the undercount that has come to light in recent weeks is small enough that agency leaders say it doesn't affect how the state responds to the pandemic, the missing entries could impede DHEC's efforts to investigate cases and measure tests each day. 

DHEC says it has been telling labs and health care groups for months to report their results. Some providers say communication from state and national officials has been uneven.

Just a few parties run the majority of COVID-19 tests in South Carolina: the state's public health lab, major out-of-state labs Quest Diagnostics and LabCorp, and the Medical University of South Carolina. No major issues have been reported from those labs. 

But on Sept. 22, DHEC said it got word of 15,000 previously unreported tests from Augusta University Healthcare in Georgia. Three days later, the agency said it received another 7,000 results from Doctors Care, an urgent care chain. 

"We do want people to understand that the overwhelming majority of labs and facilities are reporting their positive and negative results to DHEC as required," state epidemiologist Dr. Linda Bell said.

Labs and health care providers have never had to report such vast amounts of information, and to multiple agencies, Bell said. DHEC has also never had to track this volume of reports. The number of missing tests is likely a small portion of the 1.4 million total tests between March 1 and the end of September, Bell added.

DHEC is still crunching the numbers, but the agency doesn't believe the missing tests significantly affect the state's percent positive — a key metric that indicates how fast the virus is spreading. But if the agency isn't hearing of positive test results, it can't conduct contact tracing.

"We don't have a good way of knowing what we're not getting," Bell said.

Missing negatives

For months, a number of labs and hospitals were not reporting COVID-19 tests if they came back negative. During normal times, that is standard practice. But given the crisis, public health officials want to track how many tests are being done in total. 

Diatherix, a laboratory in Alabama that has been running some South Carolinians' tests, was among those not reporting negative results. The lab is owned by Eurofins Scientific, a publicly traded, Luxembourg-based conglomerate. Diatherix is now working with South Carolina officials to report all of its results, retroactively.

Eurofins said in a statement it was only notified of the need to report both positive and negative tests in the last month. Federal health authorities passed a rule Aug. 25 that required all labs to report both positive and negative results. Companies that failed to comply by mid-September are subject to sanctions and fines

"Most state agencies have had varying reporting requirements during the course of the current pandemic," the company's investor relations team said in a statement. State health agencies are "heavily taxed" with shifting reporting requirements, "and all have done their best to respond to the public need for accurate data," the company added.

Contacted by The Post and Courier, two South Carolina hospitals declined to say why they weren't reporting all results to DHEC.

The state agency instructed Bon Secours St. Francis in Greenville to report both negative and positive tests, according to emails to the hospital provided by DHEC. The hospital failed to do so. Bon Secours did not respond to repeated requests for comment. 

A spokeswoman for Anmed Health in Anderson did not answer a question about why the hospital system was not reporting negative results to the state health agency. As a result of the problem, thousands of the hospital's test results didn't appear in DHEC counts. The spokeswoman did say between March and the end of August, Anmed Health's negative tests totaled about 6,600. 

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Inconsistencies

Even as thousands of tests went unreported, state leaders say they are reaching for a goal of testing 500,000 South Carolinians per month. A state ranking by Johns Hopkins University puts South Carolina 31st in testing efforts.

Marshall Taylor, acting director at DHEC, told state senators last week the agency reminded labs of the need to report their numbers in early September, not long after WYFF-TV reported thousands of missing results.

Taylor said the issue was "everybody is not on an electronic system tied directly to their state health department."

Whatever the exact problem, labs and providers say they have received mixed messages. 

DHEC reported the 15,000 missing test results from Augusta University Healthcare, just over the state border in Georgia, on Sept. 22. A spokeswoman for the hospital said they had been submitting test results to DHEC for the past six months but only heard in mid-September that the agency wasn't receiving them. 

DHEC provided a list of each lab's number of COVID-19 tests to The Post and Courier. The information, which reflects data between March 1 and …

A spokeswoman for Doctors Care said the urgent care chain had a process in place to report some of its tests, but not others, resulting the delayed reporting of thousands of tests. Requirements for reporting tests have also shifted during the pandemic, the spokewoman said.

"We have a longstanding relationship with DHEC and respect the work they are doing to serve our state’s public health needs," she said. "Our organization continues to make every effort to respond to reporting changes."

The quick clinics are now automatically reporting all tests on a daily basis. 

Other labs said they have conducted more tests than a DHEC report provided to The Post and Courier reflects. A founder of Vikor Scientific, a lab in Charleston, said the company has run an average 3,773 tests per month — the DHEC report shows just 379 between March 1 and July 16.

Palmetto Primary Care Physicians, which began offering a rapid COVID-19 test in Charleston in mid-June, initially reported all results to DHEC, a spokeswoman for the practice said. But then word came from DHEC that it was only necessary to report positive results, which they did for two months this summer. The spokeswoman said DHEC reversed course in late August, again instructing Palmetto Primary Care Physicians to report both positive and negative results.

The health agency recorded 22 positive tests in one month from the practice. The reality was 703.

In an announcement Wednesday, DHEC said it is improving its electronic reporting system. In the meantime, whether more labs' information could be missing is difficult to say. 

Seanna Adcox contributed to this report. 

Reach Mary Katherine Wildeman at 843-607-4312. Follow her on Twitter @mkwildeman.

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