Low levels of testing may be hiding a COVID wave in Texas: Experts

Looking at data from the Centers for Disease Control and Prevention would give the impression that COVID-19 is generally under control in Texas.

The federal agency's map of levels of COVID-19 spread in the community shows most counties in the state are classified as "low" or "medium."

But public health experts said this doesn't tell the true story and that case counts are artificially low in Texas due to low levels of testing reported to public health officials.

"There are limitations to this metric by the CDC," Dr. Luis Ostrosky-Zeichner, an infectious disease specialist at UTHealth Houston and Memorial Hermann Texas Medical Center, told ABC News. "The primary diver for the first part of the metric is the number of cases and then you get into hospitalizations and percentage of occupancy by COVID-19 patients."

He continued, "Until you see a high number of hospitalizations, you don't even get to the medium level. And we know that there has to be significant underreporting at this point for the number of cases."

According to the CDC, as of June 7 -- the latest date for which data is available -- Texas is currently performing 20,535 new COVID-19 tests per day with a seven-day rolling average of 24,352.

This is half as many as the average of 55,842 tests being performed three months ago.

Doctors told ABC News that testing is very different at this point in the pandemic, with fewer people testing at government-run sites and more people testing at home.

"Many people have access to testing through other means rather than going through one of the government screening centers," Dr. Robert Atmar, a professor of medicine and infectious diseases at Baylor College of Medicine in Houston, told ABC News. "People have access to home kits; they can buy them at the pharmacy."

This means some Americans are testing positive for COVID-19 on at-home rapid tests and not reporting their results to public health officials either because there is no mechanism to report results, or they just fail to do so.

Additionally, if people need treatments, such as antiviral pills like Paxlovid, they are getting prescriptions from their doctor rather than going to a hospital to receive them, doctors said.

"This is partly good news because people are not getting sick enough to require health care, but the downside is you cannot track the amount of disease in the community," Atmar said.

This means the CDC data on COVID-19 community levels is somewhat unreliable.

"The current national risk map may provide a false sense of relief," said Dr. John Brownstein, an epidemiologist at Boston Children's Hospital and an ABC News contributor. "Many areas with high rates of transmission are deemed to be low risk only because of data reporting gaps and lags."

He added, "The shift to home testing compounds these issues as that data is unlikely to make it into public health surveillance systems."

Experts said this is one reason why wastewater data, which shows virus levels in wastewater samples, may be a more accurate representation of levels of COVID-19 in a community.

Although wastewater data is not representative of the entire U.S. -- with many areas not even having treatment plants -- it does give an idea of hidden waves across the country.

According to data from a Houston wastewater monitoring dashboard -- run jointly by the Houston Health Department and Rice University -- levels of COVID-19 in wastewater samples in the city, as of June 6, are 502% compared to baseline in July 2020.

This is similar to levels seen during the delta surge, which peaked at 539% compared to levels in July 2020.

Dr. Wesley Long, medical director of microbiology at Houston Methodist Hospital, told ABC News that because transmission levels are high -- not low or medium as indicated by the CDC in most Texas counties -- it's important for more people to get tested.

"What I would like to see change is for people to still be mindful," he said. "Certainly, if they have symptoms, even if they're mild symptoms, to get tested so that they know they're negative or so that they can take the proper precautions and don't continue to spread the virus."

Dr. James Cutrell, an infectious disease physician at UT Southwestern Medical Center in Dallas, told ABC News he recommends people not just look at the CDC transmission map but also data on trends to see if cases are rising or falling and assess their personal risk.

"People who are fully vaccinated and boosted may be able to be more liberal in terms of what they feel comfortable whereas others who may have medical conditions or live with those who are more medically vulnerable need to consider being a bit more cautious," Cutrell said.