In San Antonio – as is the case across much of Texas – it’s currently impossible to know how many people have been tested for coronavirus, according to interviews with local health officials.

That’s mainly due to a lack of data from private laboratories, which have been reporting positive tests but have not until recently been required to report the total number of test results, according to officials with the City and the San Antonio Metropolitan Health District. Metro Health also so far has not shared the total number of tests its lab has conducted on a county-by-county basis, citing privacy concerns.

“It’s going to be weeks I think before we have a clear understanding of how many tests have been done in Bexar County,” said San Antonio Assistant City Manager Colleen Bridger, a former Metro Health director.

Health experts worldwide are urging authorities to test as many people as possible for coronavirus, with many pointing to South Korea’s swift roll-out of testing as an example of how it effectively managed the crisis.

Knowing the total number of people who had been tested would help residents better understand how fast the virus is spreading in San Antonio and what the rate of infection might be among those whose symptoms are severe enough to seek medical care. It also might potentially shed more light on how governments and health care providers are responding.

However, the full picture of the virus’s spread still would not be complete because not everyone who’s sick would be tested, including those whose symptoms aren’t severe enough to seek medical care or those who don’t even know they’re sick.

Bridger said that San Antonio residents likely would soon see an “explosion in the number of tests” as more medical providers begin offering them.

On Monday, Texas MedClinic announced it’s offering coronavirus testing at its 19 urgent care clinics in the San Antonio area. University Health System and UT Health San Antonio also are offering testing for their patients through the University Health System lab, public relations manager Elizabeth Allen said.

“There’s so much change around this and so many different places are now starting to do tests,” Bridger said. “And none of them are used to having to report negative tests to the health department.”

Assistant City Manager and former Metro Health Director Colleen Bridger. Credit: Scott Ball / San Antonio Report

Texas Gov. Greg Abbott on Tuesday sought to fix the lack of complete private lab data by issuing an executive order requiring all laboratories in the state to provide comprehensive coronavirus test results to the Texas Department of State Health Services (DSHS).

“That, I think, will solve the problem permanently for all the counties,” Bridger said.

As of late Wednesday, 84 people in Bexar County had tested positive for the virus, and three people have died, according to Metro Health. Across Texas, 974 people had tested positive, out of more than 13,200 total tests, according to the DSHS. The state agency reported 1,758 coronavirus tests at public labs and 11,477 at private labs.

In San Antonio, private labs have been required to submit all of their coronavirus testing data to Metro Health since Mayor Ron Nirenberg issued a March 18 emergency declaration compelling “all public, private, and commercial laboratories” operating in the city to provide results.

But when Metro Health officials met with representatives of multiple private labs on Monday, they found the message had not gotten through, Metro Health Director Dawn Emerick said.

“They didn’t even know anything about the declaration,” Emerick said. “That was the first time they had even seen that there was a requirement, and that was on Monday.” As of Wednesday evening, none of the private labs in San Antonio had submitted the additional information.

So far, Metro Health has been posting the number of both positive and negative results from its own lab. However, those results do not show the number of results by county. Instead, the results are for an entire 28-county public health region known as Region 8. As of Tuesday, that number is 467. The Rivard Report also sought numbers of total tests Metro Health has processed for Bexar County but did not receive them by late Wednesday.

Emerick said the main reason they don’t release the total number on a county-by-county basis is because of privacy concerns. They don’t want to inadvertently identify someone who might have coronavirus, though she didn’t explain how revealing a total number of people tested for the disease would identify them.

Other health departments have chosen to release more detailed data about positive test results. For example, Dallas County’s health department lists the number of people who have tested positive by their city of residence. Metro Health’s decision not to release that kind of information is also based on respecting patients’ privacy, Emerick said.

“It’s a hard thing, but it all comes down to how we protect the privacy of the people behind the numbers,” Emerick said. “And that’s where we’re going to lean 100 percent all the time.”

San Antonio Metropolitan Health District Director Dawn Emerick. Credit: Scott Ball / San Antonio Report

Some smaller health departments within Region 8 have decided to release their own numbers. Examples include Comal County Public Health, which as of Wednesday morning had 92 total tests administered, seven positive results, 57 negative, and 28 pending.

“In some of those other counties that you might only have one or two results in,” said Emerick said, “from an ethics perspective, that really challenges us. Some folks might choose to [release the data]. There’s a lot of health departments around the country.”

However, San Antonio officials might soon begin offering more data about where coronavirus is showing up in Bexar County. Metro Health staff are working with the City’s Office of Innovation to create a map to display the geographic locations of those who have tested positive, the City’s Chief Innovation Officer Brian Dillard said. The map would show results on the zip code or Census tract level to avoid revealing patients’ identities.

Dallas County’s health department also is releasing data about whether those who tested positive have been hospitalized or required a ventilator. Metro Health is not releasing such information, though Emerick said they plan to begin posting the number of patients who recover, as is expected for most people who contract the virus.

“It’s too early for that right now,” Emerick said. “Those who have positives are still recovering, so they’re not fully without symptoms yet.”

Bridger said health departments in general aren’t used to being asked for the total number of tests conducted.

“For example, nobody’s ever said to us, how many HIV tests have you done?” Bridger said. “What people care about is how many of them are positive, so it’s a different way of thinking about the work that we do.”

Bridger also said that her and Metro Health’s main priorities are ramping up testing, following up on those with positive cases, and helping the medical system prepare for an influx of cases. Metro Health has approximately 500 employees, with 75 percent of them currently focused on responding to coronavirus.

“The number of people that are testing negative feels like a lower priority than making sure that we get the tests out there and that we follow up with all of the positives,” Bridger said.

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Brendan Gibbons is a former senior reporter at the San Antonio Report. He is an environmental journalist for Oil & Gas Watch.