Alabama currently has the highest coronavirus positivity in the country.
Data from the Department of Public Health in Alabama shows the percentage of COVID-19 diagnostic tests that are positive is currently 35 percent. The next nearest state, Iowa, sits at 31 percent.
Alabama’s positivity rate was high for much of the pandemic and recently reached nearly 50 percent this month. But as cases here and across the country declined after the boom after the holidays, the rate in Alabama remained the highest.
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Alabama’s 7-day average for new virus cases has risen slightly over the past few days after falling dramatically in mid-January, but an increase in cases does not explain the positive percentage of the state.
There are two components that make up the positivity rate – new cases and the number of tests reported. In Alabama, and in many other high-rate states, a lack of testing helps increase numbers.
As of January 27 – the last day on which state-level data was available to all states – Alabama averaged 2,776 new virus cases per day and tested only 7,914 people per day. So far this year, Alabama has reported 232,035 new tests – or about 5 percent of the state’s population. This is the fifth lowest percentage in the country.
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Each of the bottom six states by testing if a percentage of the population is in the top six for positivity. These states are Alabama, Idaho, South Dakota, Iowa, Kansas and Pennsylvania. This is not a coincidence – a lack of testing directly leads to a higher positivity rate.
But there is another reason why these states may be high or low on the lists.
In Alabama, the test is counted by how many individuals are tested, rather than by each test used. It is 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 of which is also positive toward the summit. Several other states – including Pennsylvania and Iowa – report partial test data by individuals.
A health care worker in Birmingham, for example, can be tested once a week, but the data will only come into Alabama’s system once. The difference in reporting could mean that the countries’ test numbers are undernumbered.
Early in the pandemic, the World Health Organization recommended that governments strive for less than 5 percent positivity rate to lift certain restrictions.
ADPH said on Thursday it does not expect its numbers to be overly influenced by people getting repeat tests.
“Since repeated tests have not been recommended since July 2020, patients should not undergo more than one test,” said Dr. Karen Landers, assistant state health officer, said in an email to AL.com. “ADPH therefore reports the number of unique individuals tested.”
And there are other possible problems with Alabama’s test data. All laboratories throughout the state that perform virus tests must report their data – both positive and negative test results – to ADPH. It is possible, and perhaps even probable, that some do not.
In Fayette County, a small province in northwest Alabama, the positivity rate, calculated with reported tests and reported cases over the past seven days, is 72.7 percent – the highest in Alabama. An average of 18.9 people a day were tested in Fayette over the past week, and ADPH reported 13.7 cases a day there. But on some of those days, the state reported more new cases than tests conducted.
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Because of the various problems with Alabama’s test numbers, it’s hard to say what the real positivity rate is. Page 10 of ADPH’s coronavirus dashboard lists weekly positivity, limiting data to laboratories reporting positive and negative tests. For the week ending January 23, the chart shows that Alabama did 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 positive figure of 35 percent. The difference can be tricky, as positivity rate is used as an important statistic to determine things, such as when to facilitate social distance restrictions and when to set travel advice.
Do you have an idea for a data story about Alabama? Send an email to Ramsey Archibald at [email protected], and follow him on Twitter @RamseyArchibald. Read more information stories about Alabama here.