They also cautioned that the number of new cases per day, while generally improving in the state and locally, are not as good as they may seem due to reporting methods and inaccuracies in an increasingly popular type of test.

“We’re all a little nervous about the Labor Day weekend,” said David Spillers, CEO of Huntsville Hospital Health System, which includes Madison Hospital. “Every holiday weekend we’ve had in the past has created a spike in cases 10 days to two weeks out, and then hospitalizations two weeks to three weeks out. We would really love to avoid that this time.”

Complicating the picture over Labor Day weekend is the fact that the economy has reopened and schools are in session, providing more avenues for the spread of the virus. Another complication is that we’re headed into flu season, which generally adds to hospitalizations and which has symptoms similar to those of COVID-19.

“Now is not the time to let your guard down,” said State Health Officer Dr. Scott Harris, who stressed that all people ages 6 months old and older should get a flu vaccine as soon as possible.

Harris said he recognizes people are desperate to return to a sense of normalcy over Labor Day weekend, but he stressed the need for social distancing, masks, frequent hand washing and self-isolation for those who feel sick.

He said people who can spread the virus may have no idea they are infected. According to the Centers for Disease Control and Prevention, 40% of those with COVID-19 have no symptoms, and they account for much of the viral spread. That’s a unique characteristic of the coronavirus that can have especially devastating consequences when people who don’t realize they are infected have contact with the elderly.

“We need people to really pay attention and be careful. If you’re a person who’s 65 or older and you get infected with this virus, there’s a 1 in 10 chance you’re not going to survive,” Harris said. “Believe me, that’s a serious statistic we all need to be thinking about.”

Testing method

While the number of new daily cases has been trending down statewide in recent weeks, Harris cautioned that a focus on “confirmed cases” as reported by ADPH is increasingly misleading. That number, he said, should be combined with “probable cases” for a more accurate understanding of the number of new cases.

Harris said that, in order to be consistent with data reported nationally, ADPH only reports positive polymerase chain reaction (PCR) tests as “confirmed cases.” PCR tests are complicated, expensive, and take time to process. People are increasingly receiving antigen tests, which provide near-immediate results.

“Antigen tests are becoming much more popular because they’re easy to do quickly, and they require a lot less technical expertise and training and dedicated personnel as compared with the PCR testing that’s the gold standard so far. So that combination of speed and low cost are what make them more popular,” Harris said.

All positive antigen tests are reported by ADPH as “probable cases.”

The discrepancy was obvious in numbers reported Wednesday, when ADPH reported only 86 new confirmed cases, but 537 new probable cases.

A smaller number of cases are reported as probable, Harris said, when an untested person has COVID-19 symptoms, lives in a household with someone who has tested positive and has been diagnosed as having the disease by a physician.

Harris said the antigen tests are less reliable than the PCR tests, but their lack of reliability is reflected in a higher incidence of false negatives.

“A probable case is not a case that we have less confidence in the diagnosis,” Harris said. “When somebody says, ‘How many cases do we have in Alabama?’ the total of confirmed and probable is the right answer to that question.”

Until a vaccine is developed and distributed, Spillers said, the few tools available to fight the virus are primitive.

“We’ve got sticks and stones. We don’t really have any other way to fight this. Sticks and stones for us are masking, social distancing and washing your hands,” Spillers said. “… I think a majority of the people are going to try to do what’s right. A small minority will never try to do what’s right.”