Yvonne Moore collects specimen for COVID-19 testing outside of the Aaron E Henry Community Health Services Center in Clarksdale, Miss., Wednesday, March 29, 2020.

As state leaders continue to relax statewide safety measures and businesses reopen, Mississippi reported its highest ever weekly count of COVID-19 cases.

The state health department recorded 1,956 new cases this week, the most total cases for a week in Mississippi. Daily new cases have remained steady all week, whereas prior weeks have shown more day-to-day variability in new cases numbers. The past week is the first to have only one day reporting less than 200 cases: Monday’s 136 cases.

The startling weekly statistics come days after Gov. Tate Reeves announced additional safety restrictions would be relaxed. Reeves has kept a “safer at home” recommendation in place, which suggest that Mississippians stay socially distanced and avoid public places. But his previous orders that closed many businesses across the state have largely been retracted. As of Monday, the only businesses that remain closed because of executive order are indoor entertainment venues such as theaters and museums.

Sundays and Mondays traditionally show lower case counts due to weekend reporting lags from labs. But even with the lags, this week’s numbers have remained high, averaging 279 daily cases, the highest rolling average for any week since the pandemic began. At last count, the health department estimated 69 percent of all cases had recovered, meaning about 3,500 are considered actively contagious.

More than a month ago, officials said the state was likely in a new case plateau, though they warned there was no way to know for sure. Both Gov. Tate Reeves and State Health Officer Thomas Dobbs said that the state has successfully “flattened the curve,” meaning prevented cases from spiking as to not overburden the health care system.

Though hospitalizations have risen over the week, they have remained mostly stable. However, number of new cases are distinct from hospitalizations, and those trends could reverse if cases don’t flatten and continue to spread, especially to those most vulnerable.

Testing has increased over the week, averaging 5,300 daily diagnostic tests over the last four days, potentially accounting for increased cases. Mississippi is now reporting COVID-19 diagnostic tests separately from its reported antibody tests, which look for past infections. Antibody tests account for growing proportion of all COVID tests in the state now at 6 percent, up from 3 percent mid-week. Since a handful of states have separated out the two tests, their total testing numbers have declined, recovering from the artificial boost of the antibody test inclusion.

Thursday, the Sun Herald reported that the state health department has been aggregating antibody tests and diagnostic tests since antibody testing came online last month, confounding public health experts who question both the reasoning and effect of the unusual methodology decision. At least seven other states and even the Centers for Disease Control and Prevention have since admitted the same.

“It does indicate infection, it’s just past infection, so it does give us historical perspective about the total number of cases, so there’s value in it,” Dobbs said Thursday in a press briefing. “We could separate them out. That’s not a big deal. I don’t think it’s an inflation of numbers. It’s just a different mechanism of identifying an infection.”

Dobbs has been emphatic in the past that antibody testing could be useful for understanding how widespread the disease is, but that there are unknowns about its medical value and should be distinct from diagnostic testing.

The two tests measure different snapshots of COVID infection. Viral tests — performed by a DNA nose swab — diagnose a current infection. But serology tests, a blood draw, show the presence of antibodies that the immune system develops to fight off infections, suggesting a former infection.

Antibody tests caught on quickly in the month since they have been available, though experts have warned against reading too much into the tests as it’s not clear what former infections mean for immunity other than helping to identify a true prevalence of the disease.  The Food and Drug Administration, which regulates the tests, has warned against reading too much into the tests and recently increased previously lacking standards for the tests.

Quest Diagnostics has performed 975,000 antibody tests nationally as of Monday and offers the test direct-to-consumers, bypassing state health systems. As of Sunday, Mississippi reported *9,057 antibody tests.

The problem with lumping in the two different counts is two-fold. First, it could inflate testing numbers, like is the case in Georgia, if the cases identified through antibody tests are not added to the tally of confirmed cases. Mississippi says they are including antibody-identified cases in the total case count, so the artificial boost in tests should be countered by adding in the cases found.

Dobbs has said antibody tests have shown a 2 percent positive rate, though the health department has not updated the antibody case-identification rate since Thursday. If the 2 percent figure is still accurate, 181 cases in the state have been identified this way over the month, accounting for just 1 percent of the more than 13,000 confirmed cases in the state and 2 percent of the new cases over the past month.

However, adding in those cases begets its own challenge — those 181 reflect previous infections, and don’t help identifying active cases. Because diagnostic and antibody tests measure different things, they are not helpful in the same way to the public or to scientists. At worst, it can be misleading, and at best, it identifies overall disease prevalence but does not aid case-tracing for current infection or help stop active spread by isolating cases.

Despite the inclusion of antibody tests, diagnostic testing alone has ramped up over the week after slowing in previous weeks. The state’s lab reported its most ever single-day tests this week, averaging 730 daily tests. Mississippi has had a consistently high rate of tests compared to other states, ranking 18th in the U.S. — accounting for diagnostic tests only — as of Friday, according to Mississippi Today’s analysis of the COVID Tracking Project’s national data.

The state announced universal testing for long-term care facilities in mid-May, which partially accounts for both the testing increase and the case increase. However, long-term care cases have only slightly edged up over the week — by 204 cases, or 14 percent — less than they increased the week prior at 25 percent.

*Editor’s Note: The Mississippi Department of Health changed its methodology and is reporting 6,781 antibody tests as of May 25.

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Erica Hensley, a native of Atlanta, has been working as an investigative reporter focusing on public health for Mississippi Today since May 2018. She is a Knight Foundation fellow for our newsroom’s collaboration with local TV station WLBT and curates The Inform[H]er, our monthly women and girls’ newsletter. She is the 2019 recipient of the Doris O'Donnell Innovations in Investigative Journalism Fellowship. Erica received a bachelor’s in print journalism and political science from the University of Southern California Annenberg School for Communication and Journalism and a master’s in health and medical journalism from the University of Georgia Grady College for Journalism and Mass Communication.