Revised definitions for probable COVID-19 cases and related deaths by the Texas Department of State Health Services could result in a spike of reported cases of the virus, according to a county official.

Aisha Souri, an epidemiology department official for the county, informed Collin County commissioners of the reasoning behind the state’s decisions at a May 18 meeting.

The definition for a confirmed COVID-19 case has not changed and is determined by a positive polymerase chain reaction, or PCR, test result from a lab, Souri said.

A probable case of COVID-19 can now be confirmed by a positive FDA-approved lab result paired with certain clinical criteria or certain epidemiological links, she said.

However, a probable case can also be determined without an FDA-approved test if someone meets definitions of certain clinical criteria and epidemiological links, Souri said.

“That still gets counted towards the case count,” she said. “It’s different. It’s not confirmed; it’s probable; but it’s still a case.”

Collin County Judge Chris Hill said he is worried COVID-19 cases will spike in a way that does not accurately represent the virus’s spread in the county.

“I fear that this is coming at a time when we’re just now starting to reopen,” he said during the meeting. “If the numbers jump in a false way, it’s going to start to be very concerning to our citizens that we’re actually going backwards.”

The state—which will soon take over contact tracing of COVID-19 cases for all of Texas—is expected to report probable cases separately from confirmed cases, Hill said.

Additionally, a positive PCR test result will no longer be required to determine a COVID-19-related death, Souri said.

If COVID-19 was determined to be a possible cause of death—even among other possible causes—it will be counted as a COVID-19-related death, she said.

“That also has the opportunity for COVID deaths to go up dramatically,” Hill said.

Clinical criteria needed to meet the definition of a probable COVID-19 includes:

  • at least two of the following symptoms: fever that is measured or subjective, chills, rigors, myalgia, headache, sore throat, or new smell and taste disorders;

  • at least one of the following symptoms: cough, shortness of breath or difficulty breathing; or

  • severe respiratory illness with at least one of the following: clinical or radiographic evidence of pneumonia, or acute respiratory distress syndrome and no alternative more likely diagnosis.

Epidemiological links needed to meet the definition of a probable case includes:

  • close contact with a confirmed or probable case of COVID-19;

  • close contact with a person with clinically compatible illness and linkage to a confirmed case of COVID-19; or

  • travel to or residence in an area with sustained, ongoing community transmission of SARS-CoV-2.

Close contact, Souri said, is defined by being within 6 feet for at least a period of 10 minutes to 30 minutes or more depending on exposure.

“There are 15 different options on how you can be classified as a probable case,” she said.

Someone in a location considered endemic, Souri said, satisfies the definition for an epidemiological link for a probable case.

“Right now, Texas has stated that they are considering the state as an endemic area,” she said.

Hill said the state being endemic has a significant impact on COVID-19 case counts in the county. All county residents satisfy the epidemiological link by residing in Collin County, he said.

“If you have a subjective fever and you have a headache and you live in Collin County, you now meet the qualifications to be a probable COVID patient,” Hill said. “It is remarkable how low the standard is now.”