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Florida’s health department undercounted COVID cases and deaths, state audit says

A state spokesperson disputed the Florida auditor general’s report, which claims that health officials failed to address “inaccurate and incomplete” COVID-19 data.
John Foss (left)  a nurse with the Pinellas County School Board  and Dr. Pedro Lense with the Florida Department of Health Pinellas, prepares to administer COVID-19 tests to local residents during a free drive-up and walk-up testing site coordinated by the Pinellas division of the Health Department on Saturday May 2, 2020 at the Frank H Pierce Recreation Center at Bartlett Park in St. Petersburg. Officials estimated that approximately 130 people were tested.
John Foss (left) a nurse with the Pinellas County School Board and Dr. Pedro Lense with the Florida Department of Health Pinellas, prepares to administer COVID-19 tests to local residents during a free drive-up and walk-up testing site coordinated by the Pinellas division of the Health Department on Saturday May 2, 2020 at the Frank H Pierce Recreation Center at Bartlett Park in St. Petersburg. Officials estimated that approximately 130 people were tested. [ BOYZELL HOSEY | Times ]
Published Jun. 7|Updated Jun. 10

Florida’s COVID-19 data was so inaccurate, incomplete and delayed during the first months of the pandemic that government officials and the public may not have had necessary information to determine the effectiveness of the state’s COVID-19 precautions and the best plan to fight the virus, according to a state report released Monday.

Covering the state’s pandemic response from March to October 2020, the yearlong analysis by the state auditor general found missing case and death data, unreported demographic details and incomplete contact tracing as the virus spread across the state. In addition, the report concluded that state health officials did not perform routine checks on the data to ensure accuracy and did not follow up on discrepancies.

Yet one top state health official, Department of Health spokesperson Jeremy Redfern, said the auditor general’s report was flawed.

Redfern said “some of the conclusions come from (the auditors’) misunderstanding of the purpose of different datasets,” adding that “the report does not address the huge advancements we’ve made in modernizing our reporting systems.”

Related: Florida sees signs of a COVID surge, but hospitals coping so far

State auditors reviewed a sample of 2,600 tests taken at three state-run testing facilities and found that state-contracted laboratories failed to return results for nearly 60% of tests. The report did not specify the locations of the three testing sites.

Redfern said he could not say whether any of the missing results were positive, or whether potentially positive individuals had been notified of their results.

Test results that were returned often failed to report basic demographic information. Nearly 60% of cases didn’t list the ethnicity of the individual, and more than half didn’t list the race.

Missing demographic data wasn’t unique to Florida, said Beth Blauer, executive director of the Centers for Civic Impact at Johns Hopkins University, but it is “the most critical piece of information that we lacked.”

Once cases were identified, health officials were to contact all COVID-positive individuals within 48 hours of being diagnosed, according to state guidelines.

However, auditors found that the state never spoke with 23% of infected individuals. Those who the state did contact were often reached more than a week after testing positive, leaving ample time for them to spread the virus to others.

Yet given how quickly the pandemic escalated to more than 80,000 cases per week in the first seven months, the state’s contact tracing wasn’t bad, Redfern said.

“We wouldn’t be able to hire enough people fast enough to meet that demand,” Redfern said. “It’s unrealistic to think that’d be sustainable.”

Related: How the CDC’s COVID warning system fails Tampa Bay and Florida

In January 2022 the state officially recommended that county health departments cease COVID-19 contact tracing, according to an email from Florida Surgeon General Joseph Ladapo.

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Auditors also found more than 3,000 cases of COVID-19 deaths reported by physicians that didn’t appear in the state’s list of deaths.

Many missing records were likely due to typos or clerical errors, the report concluded. However, the report found state records were missing or significantly delayed for almost 40% of missing deaths it reviewed.

Department of Health officials told auditors that death reports may take up to 60 days to appear in the official state count — “a very long time to wait to see how deadly an emerging disease is,” Blauer said.

Redfern said that auditors misunderstood death reporting requirements and that the delay in reporting did not substantially alter the state’s pandemic response.

The Department of Health responded in an email to the auditor general that it concurs with the report’s recommendation to improve the accuracy of future data collection. The Health Department said it will investigate discrepancies and review data policies by the end of the year.

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