SARANAC LAKE — The number of confirmed cases of COVID-19 in Essex and Franklin counties is climbing. But the numbers don’t tell the full story.

There were nine confirmed cases in Franklin County as of Friday and another 11 in Essex County as of Thursday, according to each county’s health department. But the reality is likely far higher than those figures, according to Franklin County Public Health Director Kathleen Strack.

As testing capabilities are ramped up in densely populated downstate communities where the number of reported coronavirus cases has exploded, testing in the North Country is still severely limited.

The two counties’ four hospitals — Adirondack Medical Center in Saranac Lake, Alice Hyde Medical Center in Malone, Elizabethtown Community Hospital and ECH’s Ticonderoga Campus — have restricted COVID-19 testing to hospital inpatients and health care workers in an effort to conserve testing materials amid a nationwide shortage.

With limited access to testing, many patients with COVID-19 symptoms that aren’t severe enough to require hospitalization are being asked to self-quarantine at home.

But health care providers are not required to report to county health departments the number of patients who they have told to self-quarantine by their doctor, according to Strack.

Public health officials such as Essex County Public Health Director Linda Beers have said this area is now facing “community spread” — meaning there are now confirmed cases where the source of a person’s exposure to the virus is unclear. But with limited testing, it’s difficult to gauge how many people in North Country communities actually have COVID-19, or even how many were told by doctors that they probably do.

“We expect there are people under self-isolation orders issued by a provider that aren’t on our radar,” Essex County Health Department Public Information Officer Andrea Whitmarsh said. “It is also a certainty that there are people who are/were COVID-19 positive that were never sick enough to seek medical care and therefore did not receive any guidance from a provider or their local health department. That is why social distancing and staying home as much as possible is so important.”

–

Suspected cases

In light of the testing restrictions, Essex County’s health department has changed how it itemizes COVID-19 data it releases to the public. The department has also changed how it issues quarantine and isolation orders to people with COVID-19 symptoms.

Whitmarsh said the county’s old system of compiling data based on test results, and its process for issuing quarantine orders, was “developed under the scenario of widespread testing availability.”

That hasn’t been the reality.

“All suspect cases determined through clinical evaluation (not tested/lab confirmed) and reported to the health department are placed under our isolation orders,” Whitmarsh said. “Contact tracing for suspect cases is performed in the same manner as it is for lab-confirmed cases, with contacts of the case being issued quarantine orders.

“The isolation and quarantine numbers we report out will now include the individuals placed under isolation and quarantine as a result of a suspect case. We are reporting total positive cases with a breakdown of lab-confirmed and suspect cases (doctor diagnosed). The isolation and quarantine numbers will not show the breakout because we handle lab-confirmed and suspect cases the same way — they are positive cases.”

The onus of reporting suspected cases is really on doctors, according to Whitmarsh. As of April 1, health care providers were given an avenue to report a person as a “suspect for COVID19” with a new PUI (Person Under Investigation) form through the health department.

“Confirmed positives are lab results received through an electronic surveillance system,” she said. “Suspect positives are reported to us by the healthcare provider performing the clinical evaluation. That is, the patient was clinically evaluated by a medical provider and identified as a suspect COVID-19 patient (though was unable to access testing).”

–

Counties differ

While Essex County has taken the step of itemizing suspected and confirmed cases in public notices and altered its process, Franklin County appears to be taking a different route.

Counties around the state are taking different approaches to how they compile data, what information they choose to release and how they choose to release it.

For days, Schenectady County provided only the number of positive cases countywide with no additional information, the Daily Gazette reported Wednesday.

In Franklin County, confirmed cases are still “contingent on specimen testing,” according to Strack.

“Providers are calling and discussing nearly every case tested (or not) with the department,” she said. “Communication with providers in the healthcare system is frequent, thorough, by daily Webex or phone (call), and united to offer the best possible medical care.”

—

(Correction: An earlier version of this article incorrectly said Franklin and Essex counties have three hospitals, omitting Elizabethtown Community Hospital’s Ticonderoga Campus. The Enterprise regrets the error.)