Depending on whom you ask, somewhere between 1.87 million and 2.14 million Texans have tested positive for the COVID-19 coronavirus. As of this week, the official Texas Department of State Health Services count sits at the former, while Johns Hopkins University, which took on a role as one of the major nationwide clearinghouses for information about the pandemic, says it’s the latter. But the thing is, all the experts agree, if you want to know how many people have actually been infected by the virus in Texas—including the cases never confirmed by a test—neither the state’s nor Johns Hopkins’s numbers come close.
The fact that we can’t even settle on a confirmed case count speaks to one of the most difficult parts of managing a pandemic, something that remains as depressingly true in January 2021 as it was in March 2020: we’ve never really had enough information vital to combatting the disease’s spread. Without regular, widespread surveillance testing of Texans, including those who don’t have any reason to believe they were exposed to the virus, we’re not facing the reality of the pandemic. Instead, we’ve spent more a year just fumbling along with incomplete data.
I’ve done a lot of fumbling myself since the pandemic first surged in the U.S. last March. I’m not a health or science writer by training. I started my career as a music writer, then began writing about news and politics, sports, food, business, and other subjects that caught my interest. In 2020, with virtually every aspect of life abruptly changed, the most interesting thing happening was the pandemic, so I threw myself into covering it. I’ve spent the past year learning how to read charts that track an epidemiological curve, or that project an Rt figure to estimate how rapidly the disease was spreading. I’ve learned how many trauma service areas Texas is divided into (22) and can tell with a glance at the number of available ICU beds in each one those whether the pandemic is relatively under control in a given part of the state. I can explain the concept of a “lagging indicator” to a third-grader, and can tell you why positivity rates alone are an inadequate metric. I’m not an epidemiologist, an infectious disease specialist, or a public health expert—but I now have many who are saved in my phone contacts, for whenever I need a better understanding of what’s happening.
There are a million things I want to understand better about the pandemic. I want to know why we’ve never come close to testing enough people. I want to know if the mutated virus first detected in the U.K. is transmitted more easily outdoors, or through masks, than earlier SARS-CoV-2 strains. I want to know if the increasingly grim epidemiological curve, which has steadily bent upward since the fall, was exacerbated by the decision to bring students back to universities and to host crowds at football games. I want to know if the monoclonal antibodies that UT-Austin researchers helped develop are a game changer, and why we don’t hear about them every day. I want to know when the vaccines will stop being this year’s hottest, hard-to-get ticket and start being something you just walk into H-E-B to get along with a cartful of groceries.
Ultimately, I want to know when life is going to be “normal” again, if I’m going to be okay, if my family is going to be okay, when I’ll be able to see my friends again, when it’ll be safe to hug my niece and nephew, when we can go to the movies without hearing the threat of a potentially deadly infectious disease behind every stranger’s cough.
I can’t answer those questions, though, so I’ve looked for answers to other questions instead. I’ve returned to the one I’ve tried to figure out since the beginning: how many people in Texas have actually been infected with this thing? Having that kind of information has always felt important to me, as if it’d keep me safe somehow. We know that roughly 7 percent of the state has been diagnosed with the virus—rounded up, if you use the DSHS numbers, or rounded down, if you use those from Johns Hopkins. We know also that we’ve missed a huge number of cases. As many as 30 or 40 percent of the infected remain asymptomatic, and people tend not to get themselves tested when they have no symptoms. So how can we know how widespread the virus is? I reached out to Dr. Ted Cohen, professor of epidemiology of microbial diseases at the Yale School of Public Health, whose team has attempted to track this number for each state.
There isn’t a specific formula you can use to estimate undiagnosed cases, I learned. Throughout the pandemic, various numbers have been thrown about regarding the cases we miss, but those numbers often change, depending on the conditions of the pandemic at the time. When COVID is relatively controlled in a given area, as it was in Texas before Memorial Day or early in the fall, we miss fewer cases than when it’s raging the way that it is now. “There is a large amount of uncertainty about how many infections there are right now,” Cohen told me. In mid-May, when the disease was relatively rare in Texas and the state was averaging about 1,300 new positive tests a day, the Yale School of Public Health projections say there were 3,698 daily infections—meaning that we caught only a little more than one-third of them. In mid-January, Texas was diagnosing nearly 23,000 cases a day, at the same time Cohen’s team was projecting more than 85,000 Texans infected daily.
Cohen’s model estimates that—in contrast to the 7 percent that the state and Johns Hopkins confirmed cases suggest—nearly 27 percent of Texans have contracted the novel coronavirus since the onset of this pandemic. That’s more than 7.75 million people. (Another model, from MIT-trained data scientist Youyang Gu, estimates a similar figure, 26 percent.) “Our current method for this could overestimate this to some degree, but I would feel fairly confident stating that this is likely above 20 percent in Texas,” Cohen told me. Even if it’s the low end of that range, that’s still as many as an additional six million Texans who’ve contracted the virus, many without ever knowing they could have been contributing to its spread.
Those are big numbers, and having answers—even in the form of these rough estimates from expert models—feels like it should be meaningful. There are so many mysteries about COVID-19, and I’m ill-equipped to track down answers about why some people get sick and others don’t, or why some cases persist for months. Working to understand the answers that I can feels like I’m doing something. I’ve tried my best to learn as much as I can about the pandemic because it’s scary. A disease spreading uncontrolled throughout the state makes me feel powerless. Figuring out how things work is the best way I know to make them feel less frightening, like I have some measure of control. So I’ve pored over charts and graphs, texted with economists and statisticians to ensure I’m reading them right, and phoned experts and researchers to learn things I never imagined I’d be interested in a year ago.
Only, I don’t feel any different after learning what percentage of Texans have actually caught this thing. Similarly, tracking the rate of the spread in the Rio Grande Valley didn’t alleviate my worries for my friends there. Diving into the polling about how Texans felt about the pandemic during the summer didn’t make me feel like my family was any safer. There are other numbers I can try to track down, like how many active cases there likely are right now? (According to Gu’s model, 3.5 percent of Texans.) But after ten months of this pandemic, I’ve come to accept that learning as much information as possible doesn’t make me safer. It doesn’t even make me feel safer. They’re just more numbers, and all they really tell me is that this disease has forever changed many people’s lives. I already knew that. More than 33,000 Texans have died of COVID-19. That too is likely an undercount.
The answers I really want—when will this end, and will we make it out okay?—are harder to come by. There are vaccines, and a new president who seems to want to use the power of the federal government to get them into people’s arms more rapidly. There are reasons to hope that the answers I seek might be “soon” and “most of us.” But one of the hardest lessons of the pandemic I’ve had to learn is that when it comes to the big picture, there’s only so much that more information can teach you.