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For more news about the COVID-19 coronavirus, access the News Tribune Health section.

Numbers among Missouri's official count of COVID-19 cases can sometimes be ahead or behind other sources' tallies. The state's health department said that's because how quickly updates can be made depends on the quality of information about a case that's initially received.

For example, there was a time this week when the Missouri Department of Health and Human Services' count of COVID-19 cases in Cole County was ahead of the total posted by the Cole County Health Department. Another time, the opposite was true.

There have also been times when the total number of deaths in the state due to COVID-19 has been lower than what the number's been understood to be based on announcements from county health officials across the state.

"We have committed to updating the web daily at 2 p.m. with the information collected by our epidemiology team as they receive information and then verify it. We do not base this information on news reports," DHSS spokeswoman Lisa Cox said.

"Sometimes we have to go back and change the county once the epidemiology team gets working and determines the case belongs with a different county. A lot of the preliminary information we receive is dependent on validity and accuracy of information provided by patients, and sometimes paperwork is filled out incorrectly," Cox added.

DHSS updates COVID-19 case and death totals statewide and by county at health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/.

The state also groups cases by age range and how people were infected — through travel, contact with someone else known to be infected or not really knowing, having had no known contact with another identified infected person but also not having traveled.

There's also a separate "unknown" category, where most cases actually fall.

Of the 356 reported cases on Wednesday afternoon, 33 in the state were travel-related; 19 were contact-related; 9 had no known contact; and 295 were listed in the unknown category.

"Many of the 'unknowns' are from commercial labs. When testing is done outside of our lab, we do not have PUI (person under investigation) forms that has some of that initial work completed. Since the investigation has not yet begun, we don't yet know the etiology," Cox said.

Most of the COVID-19 tests done so far in the state and that have been reported as positive were done by commercial or other labs beyond the State Public Health Laboratory.

In St. Louis County, where there were 129 reported cases of the disease, according to DHSS, 112 of the positive tests had been done by a commercial or other lab.

In Kansas City, that was 42 of 43 cases; Boone County, 19 of 20 cases.

Cole County's case total listed by DHSS had not yet been updated to match the county health department's reported total of seven, but so far, the testing split was even between the state and other labs.

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