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CDC: Possibly up to 10 unreported COVID cases for each known case

Ohatchee testing

Karen Cobb goes over some instructions before giving a driver in Ohatchee Wednesday a coronavirus test. A group of nurses from the Calhoun County Health Department conducted testing Wednesday morning at Town Hall. 

If a test hadn’t told her so, Jane Gonzalez might never have known she’d contracted COVID-19. 

The 58-year-old Weaver resident is a breast cancer patient who regularly travels to UAB Hospital in Birmingham, so her health is always on her mind. But in late March, when the novel coronavirus had yet only briefly been a mainstream topic of discussion, she thought her persistent headache, weariness and fever were unrelated to the then-unfamiliar virus. Her body normally runs a slightly cool 97.8 degrees that kicked up to 103 over a few days, prompting her doctor to insist on a screening test, in spite of their rarity at the time. 

By the time the results came back a few days later, she said, Gonzalez felt close to normal. 

“I was hardly coughing, I had no fever, though I did have a mild headache and I kept that probably for two weeks,” Gonzalez said by phone Thursday. “You could have knocked me over with a feather when they called me back and said I had COVID.” 

Gonzalez was one of thousands to test positive for the virus in Alabama, among many more in the nation. But how many people actually have or have had the illness — but weren’t diagnosed or were asymptomatic — is uncertain. Robert Redfield, director of the Centers for Disease Control and Prevention, said the number of unidentified cases may be much larger than those known.

“Our best estimate right now is that for every case that’s reported, there actually are 10 other infections,” Redfield said, according to a Washington Post story

Gonzalez said her brush with the virus had been mild. A friend of hers had pneumonia earlier this year and contracted the virus afterward, she explained; even though she survived a difficult battle with the infection, her friend still has problems with breathing and heart palpitations. 

“You really don’t know how COVID is going to affect you until you get it,” Gonzalez said. “It seems to really overwhelm people who have special circumstances.” 

Some people, though, are asymptomatic; they carry the virus without presenting any of its symptoms, but can still infect others. Identifying that part of the population has been difficult, at best. 

Dr. Raul Magadia, who works on the coronavirus unit at Regional Medical Center in Anniston and with the Calhoun County COVID command system, said studies of South Korea’s clash with the pandemic showed that as much as 40 percent of the nation’s COVID-19 patients were asymptomatic. Magadia said health care workers understood that was likely also the case in the United States as early as April, but a lack of testing supplies prevented much investigation. 

“Now that we’ve ramped up testing, even if you think you didn’t get exposed or don't have symptoms, we can still test you,” Magadia said. 

Testing supplies are less scarce now, and people going to hospitals for elective procedures are being tested as a matter of course, making it easier to catch asymptomatic cases. That’s still only a small part of the overall population, however. By Magadia’s reasoning, the CDC estimate seems believable, though maybe a bit low. 

“The average person has maybe an average of three or four people in their household. If one patient is positive, whether they know it or not or have been tested or not, they’re essentially contaminating, or giving that to their two or three other household members,” Magadia said. “And those three or four people will have friends.” 

An asymptomatic person working in a grocery store might interact with hundreds of people per day, he said. 

“Some people may not be as busy, but imagine how many people you have been in contact with since this morning,” said Magadia. 

Assistant Metro Editor Ben Nunnally: 256-235-3560.