Analysis: As COVID-19 Outbreak Unfolds, N.H.'s Case Numbers Tell Just Part Of The Story

Mar 24, 2020

On March 23, 2020, New Hampshire announced its first death from coronavirus.
Credit CDC.gov

Almost daily, state public health officials have updated the total number of coronavirus cases identified in New Hampshire. On Monday, that number surpassed 100 — a grim milestone.

Local media outlets, including New Hampshire Public Radio, have reported on this growing number as a sign of the virus’ spread in the state.

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But as that number continues to rise, what should journalists and the public make of it? Arguably, less and less.

“In the United States the number of positives is probably a fraction of the true positives that exist out there,” said Dr. Edward Merrens, Chief Clinical Officer for Dartmouth-Hitchcock, in a call with reporters Monday.

We don’t know how many people have COVID-19 in New Hampshire. And experts are increasingly saying we probably never will. This is because there aren’t enough tests, or supplies to carry them out.

“You know, if we could be out there testing everybody, certainly we would do so. But that's not the reality of the situation that we're in right now,” Dr. Benjamin Chan, state epidemiologist, said on Monday’s The Exchange.

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In New Hampshire, as across the nation, health care providers lack the personal protective gear and specialized swabs to conduct widespread testing. Partly for that reason, state officials recently advised state residents to not seek testing, unless they are very sick, came in contact with someone with COVID-19, or work as a first responder or in the health care field.

Without widespread testing, the numbers of confirmed cases we have does not reflect the actual level of spread of COVID-19 in New Hampshire, and trends in the reported case count could create misleading impressions. For instance, a sudden spike in the number of confirmed cases may only indicate that a new batch of testing supplies arrived in the state, not that there was a surge in the number of actual infections.

The limited testing in New Hampshire has been valuable in at least establishing the fact that the virus is here and spreading.

“We know that this is a virus that's circulating in our communities,” said Chan, acknowledging the fact that many of the new cases being identified are not people who recently traveled or who were in close contact with a confirmed case of COVID-19.

Positive test results will also continue to be important in their specific and personal contexts: for doctors deciding on a treatment plan for a patient, or for public health officials looking to stop an outbreak at a sensitive site like a nursing home.

"In the U.S. the number of positives is probably a fraction of the true positives that exist out there." - Dr. Edward Merrens

“We’re trying to focus on testing in situations where we can make an intervention,” said Merrens, “where we can protect a healthcare worker or we can make the right decision for how to care for an in-patient.”

But for the wider public, other numbers will soon become more telling as to the overall state of the coronavirus outbreak in New Hampshire: How many people are being hospitalized due to COVID-19? How many people are dying because of it?

On Monday, New Hampshire began to keep count. After the state announced a Hillsborough County man had died of COVID-19, the public health department added a new row to the table of coronavirus data: “Deaths Attributed to COVID-19.”