Recovery data on coronavirus is lacking

Ahead of his announcement that Texas would commence the second phase of its reopening after a statewide stay-at-home order had lifted, Gov. Greg Abbott celebrated "GREAT NEWS" for the state in a tweet.

"The number of Texans who have RECOVERED from #COVID19 now exceeds the number of active COVID cases for the past 2 days," Abbott said. "That’s exactly what we want to see. Texas ranks 3rd highest among states for number of people who have recovered from #coronavirus."

Abbott had announced that he would allow the statewide stay-at-home order he issued on April 2 to expire on the last day of April, allowing retail stores, restaurants, movie theaters and malls to open, with limited capacity, on May 1.

At the time, Abbott said he would commence the second phase of his reopening plan by May 18, assuming there was no secondary "flare-up" of COVID-19 cases in the state.

But on Tuesday, Abbott said coronavirus metrics for the state signaled that it would be appropriate to start the second phase of his plan ahead of schedule, allowing barbershops, and hair, nail and tanning salons to open at limited capacity later in the week.

Ahead of his this announcement, Abbott shared the statement we’re checking and said Texas is the third highest in the nation for the number of people who have recovered from the coronavirus.

But what does that number mean?

Recovery statistics are not a factor that indicate a state’s readiness to reopen, according to guidelines from the White House.

The guidelines, released in April, highlight certain criteria states should meet before opening: a downward trajectory of COVID-19 or flu-like symptoms, a downward trajectory of positive tests as a percent of total tests and a robust testing program for healthcare workers, including antibody testing.

The number of recoveries is also not a metric used to calculate the prevalence (current cases) or incidence (new cases) of an infectious disease, according to Dr. Myron Cohen, director of the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill’s School of Medicine.

"Recovery, even if it were measured properly, does not reflect interventions because we have almost none," Cohen said. "Such statistics are generally used to measure the success of a health care system when testing and treatments might be robust."

Examining recoveries

The raw counts of recovered cases available show that Texas does rank third, but there is a lot to unpack with this data. Abbott’s office did not return a request for comment seeking information about the data behind his statement.

The main difficulty in weighing the statement is the quality of the data on recoveries. Fourteen states do not have current recovery data recorded by the COVID Tracking Project, an organization launched by The Atlantic that collects and publishes data from each state’s health agencies on the virus.

The group’s website warns that data on patient outcomes, including hospitalizations, deaths and recoveries is "less consistently reported" than other data, like the number of tests administered.

A visit to the website of each of these 14 states’ health authorities did not turn up any data on recoveries.

There are also different definitions for what it means to have recovered from COVID-19. The Centers for Disease Control and Prevention has offered guidance on this front, but says that states and local health authorities can adapt the guidance as needed.

The guidance outlines different standards, based on whether an individual has tested positive for the virus and whether the person is displaying symptoms. It also depends on whether a person is caring for themselves at home or has been in the care of a physician.

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A person without symptoms can discontinue isolation, as long as at least 10 days have passed since first testing positive for COVID-19 and the individual did not later develop symptoms. In cases where symptoms are present, it depends on when the person last had a fever and when symptoms show signs of letting up.

In places with ample testing supplies, the CDC recommends a "test-based strategy" for assessing whether a person is still sick.

In Texas, the number of patients recorded as recovered is an estimate "based on several assumptions related to hospitalization rates and recovery times, which were informed by data available to date. These assumptions are subject to change as we learn more about COVID-19," according to the state’s coronavirus dashboard.

But even using the limited data available, there is also the size of the state’s population to consider.

Given that Texas is the second most populous state, it makes more sense to consider the rate of recovery by state — the number of people who have recovered from COVID-19 relative to the total number of those infected — than the total number of recoveries.

Looking at the numbers

When Abbott shared this tweet on May 4, the latest coronavirus figures from Texas were as follows: 407,398 tests administered with 32,332 positive results, 884 deaths and 16,090 recoveries.

Looking just at the cumulative number of recoveries at this date, Texas ranks third among all 37 states and Washington D.C. that have statewide recovery data available.

New York recorded the most recoveries, with 58,950, followed by Louisiana, with 20,316. New York has reported far more cumulative coronavirus cases than any other state (318,953 as of May 4), and Louisiana has been a hot spot for the virus, although it has reported fewer cases than Texas.

In March, Abbott instituted a mandatory quarantine order for travelers arriving in the state from various coronavirus hot spots, including New York and Louisiana. At the end of April, Abbott removed Louisiana from the list. 

Travelers from California, Connecticut, New York, New Jersey and Washington and the cities of Atlanta, Chicago, Detroit and Miami are still required to self-quarantine for two weeks upon their arrival in Texas.

Recovery rate

At the time of Abbott’s claim, nearly half of all people who tested positive for coronavirus had been reported as recovered — a recovery rate of 49.76%.

Using this figure to compare across the 37 states and Washington D.C. that have recovery data, Texas ranks 16th using this measure.

Montana has the highest recovery rate, as more than 88% of the 457 people who tested positive have been reported as recovered.

Our ruling

Abbott said Texas ranks third among states for the number of people who have recovered from the coronavirus.

The available figures on cumulative COVID-19 recoveries by state show that Texas ranks third — but that data has limitations. For one, just 37 states and Washington D.C. have been recording data on recoveries. Also, different standards are in place for determining whether a patient has recovered.

In Texas, the statewide figure for recoveries is an estimate based on hospitalization data.

Plus, a better metric for comparison is the recovery rate of the virus, given Texas’ population size. Using this measure, Texas ranks 16th among those states with data.

Abbott’s statement is partially accurate but leaves out important details or takes things out of context. We rate this claim Half True.