The numbers that state health officials report each day keep going up and up and up. The number of people tested for the coronavirus, the number of people who have been diagnosed with COVID-19, the number of people who have been killed by the virus. There's another number that does not get reported but also keeps rising -- the number of people in Massachusetts who have recovered from COVID-19.
"People can and do recover, and we need to remember that," Public Health Commissioner Monica Bharel said late last month after she recovered from her own COVID-19 diagnosis and returned to work.
There have been 73,721 cases of COVID-19 confirmed in Massachusetts since Feb. 1. As of Thursday, 4,552 people have died of the disease and another 3,436 people are currently hospitalized with the virus. That leaves 65,733 people who could be sick with the virus but not badly enough to need hospital care, could have been treated at a hospital and released, or could have made a full recovery like Bharel.
A COVID-19 simulator built by Massachusetts General Hospital estimates that the number of active cases of COVID-19 in Massachusetts -- meaning "anyone who is in the infectious period" -- is roughly 6,200. But there is no real way to know for sure yet.
Clinicians in Massachusetts are required to report positive cases of COVID-19, but are not required to report when a patient recovers and the Massachusetts Department of Public Health does not track the number of recoveries in the state, a spokeswoman said.
Many local boards of health do track the number of COVID-19 recoveries in their own communities. Boston said Thursday that 2,882 of the 10,589 residents who have been diagnosed with COVID-19 have recovered. Somerville reported 291 recoveries among 665 positive tests in its city. Framingham reports the total number of cases (1,146 as of Wednesday) and then breaks it down into fatalities (42), recoveries (290) and active cases (814). Pittsfield does the same. Brockton reports the cumulative number of confirmed cases, the number of deaths and the number of active cases, making it easy to determine the number of people who have recovered.
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A number of states around the country report statewide recovery numbers daily or weekly, too. But things get murky in the fine print of each state's report.
"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," the Florida Department of Health, which like Massachusetts does not report statewide recoveries, said in a statement.
To cut through some of that static, Massachusetts is among a group of states talking with the U.S. Centers for Disease Control and each other about coming up with a standardized definition of what it means to have recovered from COVID-19, DPH confirmed to the News Service.
Alaska's Department of Health and Social Services publishes a chart that visually displays the number of cumulative cases along with how many of those are active, how many patients have died and how many people have recovered. The chart shows that while the cumulative number of cases increases, so too does the number of recoveries.
As of Wednesday, Alaska reported that about 78 percent of people who have tested positive in that state have recovered. The state defines a recovered patient as someone "whose symptoms have improved enough to meet the CDC criteria to be released from home isolation, and are no longer considered to be infectious."
Michigan reports a cumulative number of people who have recovered from COVID-19 infection each Saturday. Last weekend, the state said 15,659 of the 44,397 people who had been diagnosed with the virus had recovered, about 35 percent of all cases.
There, public health officials count as recovered any COVID-19 patient who is still alive 30 days after testing positive for the virus.
On Sunday, Texas Gov. Greg Abbott tweeted that more people in his state had recovered from COVID-19 than had been newly diagnosed with it over the last two days.
"That's exactly what we want to see," the governor wrote. "Texas ranks 3rd highest among states for number of people who have recovered from #coronavirus."
In Abbott's state, the Department of State Health Services reports daily on the number of cumulative COVID-19 cases in the state, and estimated numbers of active cases and of patients who have recovered from the virus.
But the fine print on the state's COVID-19 dashboard reveals that the estimates are "based on several assumptions related to hospitalization rates and recovery times, which were informed by data available to date" and that the estimates "are subject to change as we learn more about COVID-19." The estimates also do not include any cases reported before March 24.
Tennessee, which got its first COVID-19 case from Massachusetts, reports recoveries and counts in that category "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."
As of Tuesday, Tennessee reported that 6,783 people had recovered from COVID-19, representing about 48 percent of the state's cumulative cases.
Mississippi public health officials put out a number for "presumed recovered cases," which is a count of all living COVID-19 patients who were not hospitalized and are 14 days beyond their initial positive test, plus the number of patients who were hospitalized but are 21 days beyond their initial positive test.
In Wyoming, a patient is considered 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 7 days have passed since symptoms first appeared."
Having a uniform definition of what it means to have recovered from this new virus could play a major role as states reopen their economies and send people back to work. Some have suggested that people who have recovered could return to work sooner or could be asked to take frontline jobs in medicine or retail, if studies show that recovery from COVID-19 comes with some level of immunity from re-infection. But that all hinges on knowing what recovered actually means.
"We've asked the CDC this question so we don't all define it in different ways just based on the state," North Carolina Health and Human Services Secretary Mandy Cohen said in an April 16 news conference. "We're trying to figure out how we as a country can all define recovery so we have that sort of standardization and not apples to oranges if we define it in different ways."