As Covid-19 surges again in the U.S., the high percentage of “recovered” cases might be cited as a sign that a vast majority of those infected quickly rid themselves of the virus.
But the “recovered” statistics are incomplete, inconsistent and call into question the accuracy of any total number of recovered cases, according to a review of 50 state public health sites by CU-CitizenAccess.org
Indeed, the word “recovered” often is used for people still suffering serious after-effects.
When there is a definition of “recovered,” it varies widely from state to state. In Illinois, an infected person is considered “recovered” if they have not died within 42 days of when the person has been diagnosed with the virus. In Delaware, patients are considered recovered if they are symptom free within 7 days.
Half of the states in the U.S. either have no clear definition for “recovered” COVID-19 patients or do not track recoveries at all, according to the CU-CitizenAccess review of state public health websites.
While there is no standard definition for a “recovered” COVID patient, a more generalized indicator given by the CDC is: if the patient has not had a fever for at least 72 hours, symptoms have improved, and at least seven days have passed since their first symptom. If a patient is to be tested, they also need to receive two negative tests in a row at least 24 hours apart.
The CU-CitizenAccess review of state sites was done in the first week of July.
The review found some states had been changing their definitions of recovered over the duration of coronavirus, which had begun in January when the first cases were diagnosed.
|STATE||PUBLIC HEALTH LINK||DEFINITION||SOURCE LINK||Entered By||Verified By||Comments by the one who checked|
|Alabama||https://www.alabamapublichealth.gov/index.html||Presumed Recoveries - Cases are presumed recovered if it has been 14 days or more since the case tested positive if they were not hospitalized, or if it has been 32 days or more since the case tested positive if they were hospitalized or if hospitalization was unknown. All deaths excluded.||https://covid19.alabama.gov||Dasha||Isaiah|
|Alaska||http://dhss.alaska.gov/Pages/default.aspx||Recovered cases are those whose symptoms have improved enough to meet the CDC criteria to be released from home isolation, and are no longer considered to be infectious. Active cases are those whose symptoms continue to persist and/or continue to be at home isolation, and are still considered to be infectious. When a new recovered case is determined, the recovery date may be earlier than when it was reported, which will adjust the number of recovered and active cases on that recovery date. Therefore, the Cumulative Cases graph by Active, Recovered and Deceased status will change daily as existing patient investigations are concluded and recovery dates are determined.||https://coronavirus-response-alaska-dhss.hub.arcgis.com/datasets/cases-and-testing-frequently-asked-questions||Dasha||Isaiah|
|Arizona||https://www.azdhs.gov||No definition of Recovered cases. Only a guide "Release from isolation": If a person is s ymptomatic* and tested positive for COVID-19 by PCR, antigen testing, or serology**: ○ Stay home away from others or under isolation precautions until you have had no fever for at least 3 days (72 hours) without the use of medicine that reduces fevers; AND ○ Other symptoms have improved; AND ○ At least 10 days have passed since symptoms first appeared||https://www.azdhs.gov/documents/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/novel-coronavirus/public-resources/release-from-isolation.pdf||Dasha||Isaiah|
|Arkansas||https://www.healthy.arkansas.gov/||At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications with progressive improvement or resolution of other symptoms; and, At least 10 days have passed since symptoms first appeared||https://www.nwahomepage.com/news/covid-19-recoveries-increase-drastically-in-arkansas/||Sam||Dasha||At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications with progressive improvement or resolution of other symptoms; and, At least 10 days have passed since symptoms first appeared .https://www.healthy.arkansas.gov/images/uploads/pdf/When_can_I_stop_isolation_or_quarantine__5.7.20_.pdf https://www.healthy.arkansas.gov/images/uploads/pdf/DiscontinuationIsolation_at_Home5.6.20.pdf|
|California||https://www.cdph.ca.gov||No definition of Recovered Cases. There is also no statisctics on recovered patients.||https://covid19.ca.gov/data-and-tools/||Dasha||Isaiah|
|Colorado||https://www.colorado.gov/cdphe||No definition, only numbers. The Colorado Hospital Association reports discharge data, which provides a snapshot of people who have recovered from the most severe illnesses related to COVID-19.||https://cha.com/colorado-hospital-association-statement-on-covid-19-hospitalizations-data-april-15/ , https://covid19.colorado.gov/frequently-asked-questions-faq||Dasha||Isaiah|
|Connecticut||https://portal.ct.gov/Coronavirus||No definition, no numbers. "recovered" is used only for mentioning facilities||Dasha||Isaiah|
|Delaware||https://dhss.delaware.gov/dhss/dph/index.html||Recovered COVID patient, >7 days since symptom resolution, no isolation needed||https://coronavirus.delaware.gov/wp-content/uploads/sites/177/2020/06/DPH-covid-training-06112020.pptx||Dasha||Isaiah|
|Florida||https://floridahealthcovid19.gov||No definition. Comment from the Health Depatment: "Currently, there are multiple ways for recovered cases to be recorded and several methods are used by different countries and states. Some states and countries measure a case as recovered when a person has had COVID-19 for more than 14 days, while others upon hospital discharge data – neither of which completely capture recovery of the full COVID positive population."||https://www.mypanhandle.com/health/coronavirus/why-florida-doesnt-report-covid-19-recovery-numbers//||Dasha||Isaiah|
|Georgia||https://dph.georgia.gov||No definition, no records. "We now have the capability to track these internal patients, and we know when the 21-day is initiated as recovered," -- article about White County in Georgia||https://www.whitecountynews.net/local/new-white-county-report-now-featuring-covid-19-recoveries-among-total-confirmed-cases||Dasha||Isaiah|
|Hawaii||https://health.hawaii.gov||"Released from Isolation": Includes cases that meet isolation release criteria (Isolation should be maintained until at least 3 days (72 hours) after resolution of fever and myalgia without the use of antipyretics OR at least 10 days have passed since symptom onset, whichever is longer||https://health.hawaii.gov/coronavirusdisease2019/||Dasha||Isaiah|
|Idaho||https://healthandwelfare.idaho.gov/EmergingHealthIssues/COVID-19/tabid/4740/Default.aspx||No definition. have data for "no longer monitored"||https://coronavirus.idaho.gov||Dasha||Isaiah|
|Illinois||https://www.dph.illinois.gov/covid19||Recovered cases are defined as persons with initial positive specimen collection date > 42 days who have not expired.||https://www.dph.illinois.gov/covid19/covid19-statistics||Isaiah||Sam|
|Indiana||https://www.in.gov/isdh/||The current advice is at least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and, at least 7 days have passed since symptoms first appeared. CDC link here: https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html||https://www.coronavirus.in.gov/files/IN-COVID-19_FAQforPublic%206.13.20.pdf||Isaiah||Sam|
|Iowa||https://idph.iowa.gov/||No definition from government sources, but others say "recovery defined as resolution of fever without the use of fever-reducing medications"||https://www.mercyone.org/health-and-wellness/health-answers/covid-19-what-you-need-to-know/||Sam||Dasha||I cannor find info from at the officail governemt resources. Des Moines Register: the state began considering Iowans to have recovered from COVID-19 28 days after a positive test|
|Kansas||https://www.coronavirus.kdheks.gov/160/COVID-19-in-Kansas||10 days from the beginning of symptoms OR 72 hours after fever is gone without the use of fever reducing medicine and other symptoms have significantly improved WHICHEVER IS LONGER||https://www.coronavirus.kdheks.gov/DocumentCenter/View/134/Isolation--Quarantine-Guidance-and-FAQs-PDF---6-29-20||Isaiah||Sam||No clear definition but to get out of isolation, "• 10 days from the onset of symptoms OR • 72 hours after fever is gone without the use of fever reducing medication AND there has been a significant improvement in symptoms • WHICHEVERIS LONGER. "|
|Kentucky||https://govstatus.egov.com/kycovid19 https://chfs.ky.gov/agencies/dph/Pages/default.aspx||3,719 Recovered cases At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications; and, Improvement in respiratory symptoms (e.g., cough, shortness of breath); and, At least 10 days have passed since symptoms first appeared. Additionally, upon returning to work, it is an expectation that a surgical face mask will be worn for universal source control in the work setting. Also says this "Employees, including HCPs, with laboratory-confirmed COVID-19 who have not had any symptoms should be excluded from work until 10 days have passed since the date of their first positive COVID-19 diagnostic test, assuming they have not subsequently developed symptoms since their positive test."||https://chfs.ky.gov/agencies/dph/covid19/Guidanceforreleasefromisolation.pdf||Isaiah||Sam||Also says this "Employees, including HCPs, with laboratory-confirmed COVID-19 who have not had any symptoms should be excluded from work until 10 days have passed since the date of their first positive COVID-19 diagnostic test, assuming they have not subsequently developed symptoms since their positive test."|
|Louisiana||http://ldh.la.gov/||A person is presumed recovered if 1) it has been more than 14 days, since he/she tested positive and he/she is not currently in the hospital or deceased (when hospital status is known), or 2) it has been more than 21 days, since he/she tested positive and he/she is not deceased (when hospital status is unknown).||http://ldh.la.gov/Coronavirus/||Isaiah||Sam|
|Maine||https://www.maine.gov/dhhs/coronavirus-resources||Recovered means a person has met the released from isolation requirements defined by Federal CDC. The requirements are: at least 3 days (72 hours) have passed since recovery, defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and, at least 10 days have passed since symptoms first appeared.||https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/coronavirus/data.shtml||Isaiah||Sam|
|Maryland||https://coronavirus.maryland.gov/||(* Does not keep records/ no mention of recovery)||Isaiah||Sam|
|Massachusetts||https://www.mass.gov/orgs/department-of-public-health||(* Does not keep records/ no mention of recovery)||https://www.mass.gov/doc/covid-19-dashboard-june-28-2020/download||Isaiah||Sam|
|Michigan||https://www.michigan.gov/coronavirus/||The number of persons with a confirmed COVID-19 diagnosis who are alive 30 days post-onset (or referral date if onset is not available).||https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173-531113--,00.html||Isaiah||Sam|
|Minnesota||https://www.health.state.mn.us/diseases/coronavirus/||Patients no longer needing isolation represents individuals with confirmed COVID-19 who no longer need to self-isolate. As of 5/18/2020 patients no longer needing isolation does not include those who have died; the cumulative number was adjusted to reflect that change.||https://www.health.state.mn.us/diseases/coronavirus/situation.html#noiso1||Isaiah||Sam|
|Mississippi||https://msdh.ms.gov/msdhsite/_static/14,0,420.html||Presumed Recovered if: 1) It has been 14 days or more since the case tested positive, if they were not hospitalized. 2) It has been 21 days or more since the case tested postive, if they were hospitalized or hospitalization was unknown||https://msdh.ms.gov/msdhsite/_static/14,0,420.html||Isaiah||Sam||They also note deaths are excluded|
|Missouri||https://health.mo.gov/||Missouri doesn't report recovery numbers, but defines recovery as "Have been free from COVID-19 symptoms for at least 14 days."||http://mophep.maps.arcgis.com/apps/MapSeries/index.html?appid=8e01a5d8d8bd4b4f85add006f9e14a9d , https://www.ky3.com/content/news/coronavirus-missouri-arkansas.html||Sam||Dasha||Have been free from COVID-19 symptoms for at least 14 days .https://health.mo.gov/news/newsitem/uuid/b824125a-9d7d-47b5-b610-96118c3920b1/recovered-covid-19-patients-encouraged-to-donate-plasma-to-treat-current-patients|
|Montana||https://dphhs.mt.gov/publichealth/cdepi/diseases/coronavirusmt||Recovered COVID-19 includes cases who have recovered and are released from isolation.||https://dphhs.mt.gov/Portals/85/publichealth/documents/CDEpi/DiseasesAtoZ/2019-nCoV/COVID_EPI%20PROFILE%2006122020_2.pdf||Isaiah||Sam||persons who have recovered, meaning they have cleared the illness and are released from isolation|
|Nebraska||http://dhhs.ne.gov/Pages/default.aspx||Recovery defined as resolution of fever without the use of feverreducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath) ● At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever- reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); AND, ● At least 7 days have passed since symptoms first appeared.||http://dhhs.ne.gov/Documents/COVID-19%20Guidance%20to%20Public%20and%20Testing.pdf||Sam||Dasha||Add : ● At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever- reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); AND, ● At least 7 days have passed since symptoms first appeared.|
|Nevada||http://dpbh.nv.gov/||(* Does not keep records/ no mention of recovery)||Isaiah||Sam|
|New Hampshire||https://www.dhhs.nh.gov/dphs/index.htm||At least 7 days have passed since symptoms first appeared, AND At least 72 hours (3 days) have passed since recovery – which is defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms.||https://www.dhhs.nh.gov/dphs/cdcs/alerts/documents/covid-19-update10.pdf||Isaiah||Sam|
|New Jersey||https://www.nj.gov/health/||At least 10 days have passed since symptoms first appeared, AND You are fever-free for 72 hours (or 3 full days of no fever without the use of fever reducing medicine), AND Your other symptoms such as cough or shortness of breath have improved||https://www.nj.gov/health/cd/documents/topics/NCOV/COVID_infographic_recovery.pdf||Isaiah||Sam|
|New Mexico||https://cv.nmhealth.org/||(* Does not keep records/ no mention of recovery)||Isaiah||Sam|
|New York||https://www.health.ny.gov||(*NY does not publish "recovered cases data") "Recovered = discharged. As of April 27, New York is reporting people tested. Cumulative hospitalized and recovered are calculated using the 3 day average change in hospitalization benchmarked from April 12. There is a significant gap between deaths reported by New York City and New York State. As of 6/1, the difference between the state reported deaths, which we use, and the NYC deaths was 5740" -- from the independent project||https://covidtracking.com/data/state/new-york||Dasha||Isaiah|
|North Carolina||https://www.ncdhhs.gov||a median time to recovery of 14 days from the date of specimen collection for non-fatal COVID-19 cases who were not hospitalized, or if hospitalization status is unknown. The estimated median recovery time is 28 days from the date of specimen collection for hospitalized non-fatal COVID-19 cases. Estimates are used since patient-specific data on the actual time to resolution of all symptoms are not available for all COVID-19 cases in North Carolina.||https://files.nc.gov/covid/documents/dashboard/Weekly-COVID19-Patients-Presumed-to-be-Recovered.pdf||Dasha||Isaiah|
|North Dakota||https://www.health.nd.gov/diseases-conditions/coronavirus/north-dakota-coronavirus-cases||Number of cases who tested positive and have since been released from isolation and are no longer contagious.||https://www.health.nd.gov/diseases-conditions/coronavirus/north-dakota-coronavirus-cases||Isaiah||Sam|
|Ohio||https://odh.ohio.gov/wps/portal/gov/odh/home / https://coronavirus.ohio.gov/wps/portal/gov/covid-19/home||No data still, however, public officials promised to publish it (in May). At least three full days (72 hours) have passed since recovery (no fever without use of fever-reducing medications and improvement in respiratory symptoms) AND at least 10 days have passed since the onset of symptoms. OR There is no fever without use of fever-reducing medications AND improvement in respiratory symptoms AND there are negative results (showing no COVID-19) on at least two consecutive lab tests of respiratory specimens collected at least 24 hours apart.||https://coronavirus.ohio.gov/wps/portal/gov/covid-19/checklists/english-checklists/Businesses-Employers-COVID-19-Checklist https://www.nbc4i.com/community/health/coronavirus/ohio-begins-tracking-recovery-rates-for-covid-19-patients-but-odh-says-numbers-arent-perfect/||Dasha||Isaiah|
|Oklahoma||https://coronavirus.health.ok.gov/||Recovered: currently not hospitalized or deceased and 14 days after onset/report.||https://looker-dashboards.ok.gov/embed/dashboards/77||Sam||Dasha|
|Oregon||https://www.oregon.gov/oha/ph/pages/index.aspx||No sufficient definition. However, there is a number of recovered cases in data||https://govstatus.egov.com/OR-OHA-COVID-19||Dasha||Isaiah|
|Pennsylvania||https://www.health.pa.gov||Individuals who have recovered is determined using a calculation, similar to what is being done by several other states. If a case has not been reported as a death, and it is more than 30 days past the date of their first positive test (or onset of symptoms) then an individual is considered recovered.||https://www.health.pa.gov/topics/disease/coronavirus/Pages/Coronavirus.aspx||Dasha||Isaiah|
|Rhode Island||https://health.ri.gov||People with COVID-19 can stop home isolation (leave isolation) under the following conditions: If you will NOT have a test to determine if you are still contagious, you can leave home after these two things have happened: You have not had a fever for at least 3 days (72 hours) without the use of fever-reducing medications, and your respiratory symptoms (e.g., cough, shortness of breath) have improved; AND At least 10 days have passed since symptoms first appeared. Your healthcare provider may consider ordering you a test if you are immunocompromised. There should be two negative tests 24 hours apart. If you tested positive and never had symptoms, isolate for 10 days from the date of your positive test.||https://health.ri.gov/diseases/ncov2019/||Dasha||Isaiah|
|South Carolina||https://www.scdhec.gov||-Those who reported being hospitalized were deemed as “recovered” based upon having no reported adverse outcome reported as of > 32 days since their illness onset. -Those who reported not being hospitalized were deemed as “recovered” based upon having no reported adverse outcome reported as of > 14 days since their illness onset. -Those where hospitalization status was unknown were deemed as “recovered” based upon having no reported adverse outcome reported as of > 32 days since their illness onset.||https://www.scdhec.gov/infectious-diseases/viruses/coronavirus-disease-2019-covid-19/sc-demographic-data-covid-19||Dasha||Isaiah|
|South Dakota||https://doh.sd.gov/news/coronavirus.aspx||A person is considered recovered after they have been released from isolation by SD-DOH upon meeting the following: (1) at least 10 days have elapsed after their symptoms began, and (2) at least 3 days have elapsed after their fever resolved and their other symptoms have improved.||https://doh.sd.gov/news/coronavirus.aspx||Isaiah||Sam||A person is considered recovered after they have been released from isolation by SD-DOH upon meeting the following: (1) at least 10 days have elapsed after their symptoms began, and (2) at least 3 days have elapsed after their fever resolved and their other symptoms have improved.|
|Tennessee||https://www.tn.gov/health.html||TDH defines "recovered" as people who (1) have been confirmed to be asymptomatic by their local or regional health department and have completed their required isolation period or (2) are at least 21 days beyond the first test confirming their illness.||https://www.tn.gov/content/tn/health/cedep/ncov/data.html||Sam||Dasha|
|Texas||https://www.dshs.texas.gov||No clear definition. This number 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||https://txdshs.maps.arcgis.com/apps/opsdashboard/index.html#/ed483ecd702b4298ab01e8b9cafc8b83||Dasha||Isaiah|
|Utah||https://coronavirus.utah.gov/||(* Does not keep records/ no mention of recovery) However, If tested positive for COVID-19 but never had symptoms, self-isolation stops 10 days after tested positive. If tested negative, must finish 14-day quarantine even if you don't feel sick.||https://coronavirus-download.utah.gov/Health/Care_Booklet_English.pdf||Isaiah||Sam|
|Vermont||https://www.healthvermont.gov/||Recovery is when all three have happened: 1) It’s been three full days of no fever without the use of fever-reducing medication, and 2) Other symptoms have improved, and 3) At least 10 days have passed since any symptoms appeared. Or if you didn’t have symptoms when you were tested, recovery is when 10 days have passed since the date of your first positive test and you continued to have no symptoms.||https://www.healthvermont.gov/sites/default/files/documents/pdf/COVID-19-chart-observation-isolation-quarantine_final.pdf||Isaiah||Sam|
|Virginia||https://www.vdh.virginia.gov/||Virginia Department of Health does not collect recovery information data||https://www.vdh.virginia.gov/coronavirus/frequently-asked-questions/virginia-questions/||Isaiah||Sam|
|Washington||https://www.doh.wa.gov/||If tested positive for COVID-19, but have not had any symptoms, you can stop your home isolation when: At least 10 days have gone by since the date of your first positive COVID-19 test, AND You have not gotten sick with COVID-19. If confirmed or suspected COVID-19 and have symptoms, you can stop your home isolation when: You’ve been fever-free for at least 3 days without the use of fever-reducing medication AND Your symptoms have gotten better, AND At least 10 days have gone by since your symptoms first appeared.||https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/COVIDcasepositive.pdf||Isaiah||Sam|
|West Virginia||https://dhhr.wv.gov/COVID-19/Pages/default.aspx||At least 10 days have passed since symptoms first appeared; AND At least 3 days (72 hours have passed since recovered which is defined as resolution of fever without the use of fever reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath).||https://dhhr.wv.gov/COVID-19/Documents/hcp/What-to-do-if-you-were-potentially-exposed-to-someone-with-confirmed-COVID19.pdf||Isaiah||Sam|
|Wisconsin||https://www.dhs.wisconsin.gov/covid-19/index.htm||The number of confirmed cases who are currently alive based on Wisconsin state vital records system data and had one or more of the following: Documentation of resolved symptoms Documentation of release from public health isolation 30 days since symptom onset or diagnosis*||https://www.dhs.wisconsin.gov/covid-19/cases.htm||Isaiah||Sam|
|Wyoming||https://health.wyo.gov/publichealth/||A lab confirmed or probable case is defined as recovered when there is resolution of fever without the use of fever-reducing medications and there is improvement in respiratory symptoms (e.g. cough, shortness of breath) for 72 hours AND at least 10 days have passed since symptoms first appeared. Cases with laboratory-confirmed COVID-19 who have not had any symptoms are considered recovered when at least 10 days have passed since the date of their first positive test and have had no subsequent illness provided they remain asymptomatic.||https://health.wyo.gov/wp-content/uploads/2020/06/Data-interpretation_Case-Dashboard-5.pdf||Isaiah||Sam|
Using the information posted on state public health websites, the survey found four primary categories on cases where the patient has “recovered.” CU-CitizenAccess summarized those categories as:
- No Definition. 16 states (32 percent) have no definition for “recovered” and do not report “recovered” data or similar data.
- Day-Based. 19 states (38 percent) define “recovered” as being symptom-free for a certain number of days, which ranges anywhere between 3 and 42 days depending on the state.
- Alternative Definitions. 8 states (16 percent) do not record “recovered” data, but count cases using metrics such as hospital discharges or being symptom-free and no longer needing isolation.
- Tiered System. 7 states. (14 percent) These states have more complex requirements for a person to be considered “recovered.” Hawaii, for example, includes cases that meet isolation release criteria defined as: “Isolation should be maintained until at least 3 days (72 hours) after resolution of fever and myalgia without the use of antipyretics OR at least 10 days have passed since symptom onset, whichever is longer.”
“Recovered” can be misleading
Public health officials say the majority of people with COVID-19 only suffer mild symptoms, then get better usually after about two weeks, and some states report “recovered” numbers as a sign of progress in fighting the pandemic.
But medical studies and first person accounts have revealed that patients can struggle for weeks if not months to regain their health, and in some cases, patients are unsure they will ever be the same again. The lingering illnesses’ effects include fatigue, weakness of muscles, respiratory and cardiovascular issues, among other short- and long-term effects.
“[The term] ‘recovered’ on our FB [Facebook] page & reporting just means that the person is no longer infectious, and no longer in isolation, and if relevant no longer hospitalized,” said Julie Pryde, public health administrator for the Champaign-Urbana Public Health Department, said in an email. “It does not mean, necessarily, that they are feeling better. There have been many reports of people having symptoms like shortness of breath, lung scarring, amputations, a young woman in Chicago had a double lung transplant, etc.”
Pryde also said reports on the long-term effects of the virus will come out when there is more information: “Public Health is not following-up on the morbidity, just the mortality… It is likely that some people will have a lifelong disability from their infections.”
Justine Kaplan, interim director of the master of public health program at the University of Illinois in Urbana, said a lack of knowledge about the virus leads to confusion over the effects.
“On the recovered definition, we don’t have that clarity, so it’s hard to ask people to be consistent when we’re not sure that’s the accurate message,” she said.
Kaplan said there are so many unknowns about the virus.
“That’s why when folks from public health or the clinical community are talking more specifically, they’ll keep referring to it as the novel virus, and ‘novel’ just means truly new and that’s an indicator of the lack of clarity we have about it,” she said.
Kaplan’s work at the College of Applied Health Sciences focuses on public health management and chronic disease prevention, with over 15 years of experience in the field. Much of her work also focuses on health in underserved communities. She said part of the vagueness in COVID-19 “recovered” definitions comes from a lack of testing in some communities.
Kaplan said some people who have been diagnosed with COVID-19 may not have had a test because some communities did not have testing early on in the pandemic — and some communities still don’t have access to reliable or available testing.
”So, sometimes in public health and medicine we say, ‘OK we’ll test you for something and then when you no longer test positive, aha that’s recovered.’ Well, if that was your plan, that doesn’t work if you didn’t test someone in the first place,” she said.
States, counties differ in data and definitions
As of July 7, the U.S. had recorded over 3.1 million COVID-19 cases. Of that number, there have been at least 133,000 deaths and over 960,000 recovered cases, according to Johns Hopkins University. According to its COVID-19 dashboard, the university team uses state-level “recovered” data from the COVID Tracking Project, including data for states that don’t have a “recovered” definition or don’t track recoveries on the state level, like Colorado. Some of the state’s county health districts report “recovered” cases, but not all counties do, and definitions may vary across counties.
COVID Tracking Project is run by The Atlantic magazine and publishing company. The project managers have not yet responded to a request to comment on their methodology.
States with alternative definitions, typically based on patient discharges from the hospital and needs to isolate, are mostly open or reopening except for Arizona, which is closing.
The state has no definition for “recovered” and instead uses a guide to “release from isolation.” If one were to test positive, then in order to release from isolation, they must have no fever for three days without use of medicine, other symptoms have improved, and at least 10 days have passed since symptoms appeared. Although similar to states that track “recovered” cases, the definitions and numbers differ greatly.
Two-thirds of states with day-based definitions are mostly reopened or reopening. Tiered system states, which have more complex requirements like Hawaii and Kentucky, are mostly reopened with Wyoming as the one state pausing.
In Wyoming, a lab-confirmed or probable case is defined as recovered when there is resolution of fever without the use of fever-reducing medications, there is improvement in respiratory symptoms (e.g. cough, shortness of breath) for 72 hours and at least 10 days have passed since symptoms first appeared. Cases with laboratory-confirmed COVID-19 who have not had any symptoms are considered recovered when at least 10 days have passed since the date of their first positive test and have had no subsequent illness provided they remain asymptomatic.
Tiered systems simply have more complex requirements in order for a person to be considered “recovered,” whereas alternative definitions do not use “recovered” at all.
Having reliable data is critical to better understanding the virus and finding possible solutions, said Timothy Wiemken, an associate professor at the Saint Louis University School of Medicine who focuses on infectious diseases, allergies and immunology.
“At this point in the pandemic, all data matters,” he said. “Anything that can be obtained in a valid and reliable manner helps us piece everything together in hopes of coming up with more specific and less difficult interventions.”
Wiemken said, in general, the United States has had difficulty obtaining reliable data because some people can’t access testing or there are delays in testing.
“Often, by the time people get their test results back they feel better and may not report back on recovery – so we lose those folks to follow-up unless they can be rigorously followed and their outcomes reported back to public health departments. Unfortunately, this isn’t happening everywhere,” he said.
Half of the states with no definition for recoveries are reopening — and the other half are pausing reopening plans or closing the state. Texas, for example, began to reopen in phases, but has reimposed restrictions on restaurants and Governor Greg Abbott issued a mask mandate on July 2.
Pam Dempsey contributed to this report.