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Nevada became the first state to report rapid antigen testing as part of its coronavirus counts this week. Experts said that the move could give a better picture of the pandemic and also help to improve metrics to measure how it is spreading.

According to an Associated Press review, Maryland is the only U.S. state that does not include rapid tests in its online dashboard, or include them in virus statistics. This was based on a review of policies and dashboards for all 50 states.

Nevada was among the hardest hit states by the pandemic. The state’s hospitals are at capacity, the unemployment rate has broken all national records and 435,000 people have tested positive to COVID-19. Nevada health officials admit that the lack of rapid tests in their tally has limited the public’s understanding about the spread of the pandemic.

In September 2020, officials told the AP that they were working on separate reports for antigen and molecular testing. They claimed Monday that delays were due to the fact that they had to manage competing priorities and limited resources in order for them to report on their dashboard.

Rapid antigen tests detect viral proteins and return results in minutes. This is in contrast to traditional molecular tests that can take days but which are more accurate. They are widely used in schools, prisons and nursing homes due to their quick turnaround time.

President Joe Biden was kind enough to praise rapid testing last month. However, the continuing absence of a national strategy for testing and supply problems as well as the variety of ways states report them show the lack of a national testing strategy. While some states report their antigen testing separately with positive results being considered “probable”, others combine them with molecular test to get an overall count.

Nevada added over 600,000 tests to its online dashboard, which shows coronavirus cases and deaths, vaccination rates, and positivity rates. The infusion increased the number of COVID-19-related cases by 9.700 and reduced the positivity rate by one-sixth from 10.1% to 8.8%.

Brian Labus, University of Nevada Las Vegas epidemiologist, said that scientists did not assume that testing data would provide a complete picture of COVID-19’s trajectory. Instead, they used it to identify trends. He said that it is easier to see when COVID-19 spikes and falls if all cases are counted in the same way. This is especially true for statistics that help determine the need to implement preventive measures such as mask mandates.

A 8% positive rate is one of the criteria for triggering county mask mandates in public spaces. The CDC defines this as “substantial transmission”.

Labus stated that “changing now will likely cause some disruption to this system.”

Nevada is a bit more skeptical than other states about antigen testing, also known as point-of-care tests. Federal officials criticised Nevada for stopping the use of antigen tests a year ago because they were inaccurate.

Nevada was the only state that had stopped using the tests. The ban was then reversed.

In December, Nevada began to report rapid tests from its prisons towards its cumulative case count. They also approved them for use as school reopening plans and for the protocols for large events such as last month’s Life is Beautiful Music Festival with 60,000 attendees. However, the state didn’t have to include all of the tests in its calculations of infection rates after those approvals.

According to Melissa Peek-Bullock, state epidemiologist, Nevada Department of Health and Human Services, the department made the decision that it would direct its resources and staffing towards distributing vaccines and contact tracer. At the height of the pandemic there was not enough capacity to examine every positive result from a rapid antibody test.

She said that although it was not consistent to report rapid test results only from state prisons she believed that counting them would have denied guards, inmates and their families crucial information about the spread of the pandemic in prisons.

Peek-Bullock stated that Nevada has now been able to conduct positive antigen testing as a means of investigating possible coronavirus cases after a decrease in the number of cases.

“The antigen testing reports really help us to see the state’s disease burden. She said that schools, correctional facilities and employers are using antigen testing in large numbers. “We’ve reached a point where we must take these positive results into consideration during the pandemic.”

According to state data, Nevada health officials received an average of 17.700 antigen test results per week in August and the first three months of September.

Janet Hamilton, executive director of Council of State and Territorial Epidemiologists, stated that Nevada was not the only state having trouble processing hundreds of thousands of test results. The test results are not sent electronically from the providers to the health departments. This forces them to deal with large amounts of paper. She said that these time-consuming tasks are caused by a lack of funding for infrastructure and public health systems nationwide.

“We should have electronic cases reporting. But public health was not funded until very recently to support it.” Hamilton stated that providers were not incentivized to take part in the process, or to ensure their electronic medical records systems sent data to public health.

Nevada is a particularly affected area because of the lack of infrastructure. Officials began the pandemic transmitting test information via fax to the federal government.

Maryland reports molecular tests only. Requests for comment were not answered by state health officials.

Although 49 states have now made public reports of rapid test positives being probable cases, epidemiologists are concerned that this doesn’t give a complete picture.

Consumers can order at-home antigen tests online or in their local drugstores. They do not need to report to the health department. Nevada encourages anyone whose at-home antigen test results are positive to have molecular testing done to confirm the results. This gives Nevada more detailed data that allows them to contact trace.

“As epidemiologists, we are very conscious of this. Hamilton stated that the data you have tells a story in either incomplete or complete ways. “We are not telling the whole story about COVID-19.