Alabama currently has the highest coronavirus positivity rate in the nation.
Data from the Alabama Department of Public Health shows the percent of reported COVID-19 diagnostic tests that come back positive currently sits at 35 percent. The next closest state, Iowa, sits at 31 percent.
Alabama’s positivity rate has been high for much of the pandemic, reaching nearly 50 percent as recently as this month. But as cases here and throughout the country declined following the post-holiday surge, Alabama’s rate has stayed the highest.
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Alabama’s 7-day average for new virus cases has ticked up slightly over the past few days after falling dramatically in the middle of January, but a rise in cases doesn’t explain the state’s positivity rate.
There are two components that make up positivity rate – new cases and the number of tests reported. In Alabama, and in many of the other state with high rates, a lack of testing is helping to drive up the numbers.
Through Jan. 27 – the last day for which state-level data was available for all states – Alabama was averaging 2,776 new virus cases per day, and testing just 7,914 people per day. This year so far, Alabama reported 232,035 new tests – or roughly 5 percent of the state’s population. That’s the fifth lowest percentage in the nation.
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Each of the bottom six states by testing as a percent of population are in the top six for positivity rate. Those states are Alabama, Idaho, South Dakota, Iowa, Kansas and Pennsylvania. It’s no coincidence – a lack of testing leads directly to a higher positivity rate.
But there’s another reason those states might be high, or low, on those lists.
In Alabama, testing is counted by how many individuals get tested, rather than by counting each test used. It’s one of four states to do it this way, according to data compiled by the COVID Tracking Project. The other three are South Dakota, Idaho and Kansas – each also near the top in positivity rate. Several other states – including Pennsylvania and Iowa, partially report testing data by individuals.
For example, a healthcare worker in Birmingham could get tested once a week, but that data would only enter Alabama’s system once. That difference in reporting could mean those states’ testing numbers are being undercounted.
Early in the pandemic, the World Health Organization recommended that governments aim for less than 5 percent positivity rate in order to lift some restrictions.
ADPH on Thursday said it doesn’t expect its numbers to be overly affected by people getting repeat tests.
“As repeat testing has not been recommended since July, 2020, patients should not be having more than one test,” Assistant State Health Officer Dr. Karen Landers said in an email to AL.com. “Thus, ADPH reports the number of unique individuals tested.”
And there are other potential problems with Alabama’s testing data. All labs throughout the state that perform virus testing are required to report their data – both positive and negative test results – to ADPH. It’s possible, and perhaps even likely, that some aren’t doing so.
In Fayette County, a small county in northwest Alabama, the positivity rate, as calculated with reported tests and reported cases over the last seven days, is 72.7 percent – the highest in Alabama. There have been an average of 18.9 people tested per day reported over the last week in Fayette, and ADPH has reported 13.7 cases per day there over that time. But on some of those days, the state reported more new cases than tests performed.
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Because of the various issues with Alabama’s testing numbers, it’s difficult to say what the actual positivity rate is. Page 10 of ADPH’s coronavirus dashboard lists positivity rate by week, and limits data to labs that report both positive and negative tests. For the week ending Jan. 23, that chart shows Alabama performed 142,000 tests, with a positivity rate of 13.1 percent.
But many national organizations – including Johns Hopkins and Becker’s Hospital Review – cite the 35 percent positivity rate number. The difference can be troublesome, since positivity rate has been used as a key statistic when determining things like when to ease social distancing restrictions and when to institute travel advisories.
Do you have an idea for a data story about Alabama? Email Ramsey Archibald at rarchibald@al.com, and follow him on Twitter @RamseyArchibald. Read more Alabama data stories here.