‘Flu-like’ data might help track coronavirus spread. Why did Florida stop publishing it?

As state officials struggled to expand testing for the novel coronavirus in late March, the Florida Department of Health quietly decided to stop posting positive flu test data in its weekly reports — a move that experts said could obscure the pandemic’s true impact on the state.
The Florida Department of Health stopped including flu test data in its weekly surveillance reports in late March. []
The Florida Department of Health stopped including flu test data in its weekly surveillance reports in late March. []
Published April 7, 2020

Flu season normally winds down in Florida as March turns to April. This year was no exception — but with an alarming anomaly. While positive flu tests declined as expected, hospital emergency rooms simultaneously reported a spike in patients complaining of flu-like symptoms such as fever, cough and sore throat.

But in late March, as state officials struggled to expand testing for the novel coronavirus, the Florida Department of Health quietly decided to stop posting the data in its weekly surveillance reports — a move that experts said could obscure the pandemic’s true impact on the state.

Marc Lipsitch, a professor of epidemiology at Harvard University’s T.H. Chan School of Public Health, said he didn’t know what motivated the decision, but the end result is that a strong indicator of possible COVID-19 patients is no longer captured in the data public health experts nationwide depend on to help guide their battle to stem the pandemic.

“If you don’t look for something, you can’t see it,” Lipsitch said.

Florida’s decision to stop reporting the data publicly also stands in contrast to federal policy to monitor the number of people with flu-like illnesses as a potential COVID-19 indicator — information experts stress is especially important in the absence of widespread and readily available testing. A map produced for a weekly report by the U.S. Centers for Disease Control and Prevention, in fact, shows Florida in the “minimal risk” category for flu-like symptoms — that, despite ranking sixth in the nation for confirmed COVID-19 cases.

The state Department of Health and the Centers for Disease Control and Prevention did not immediately respond to questions about why Florida was classified at minimal risk on the map, despite clear evidence that the state has widespread community transmission.

The Florida Department of Health downplayed the significance of the data — collected in weekly surveillance reports of flu-like illness, called the Florida Flu Review — suggesting that people with flu-like symptoms typically don’t have COVID-19.

The Centers for Disease Control and Prevention, however, notes that the disease can display very similar symptoms to the flu, including cough, fever and shortness of breath.

Florida Department of Health communications director Alberto Moscoso said the department’s COVID-19 online site and daily emailed reports “reflect our current operational commitment to ending the pandemic in Florida.”

“Correspondingly, changes were made to the Florida Flu Review to keep that tool tailored to influenza response, which remains an important function of the Florida Department of Health,” he said. The state does continue to report confirmed flu cases, which are different than COVID-19.

The health department also said it includes “detailed COVID-19 surveillance data” in its daily reports — which include testing data, confirmed cases and municipal level information.

But those reports rely largely on test results that have grown increasingly bottlenecked, delayed several days to a week or more. Some labs say they have a turnaround time of four to five days, but Miami residents have complained of waiting nearly two weeks for results.

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Lipsitch said it’s that exact lack of widespread testing and delayed results that makes the flu-like symptom data among the key ways for epidemiologists to track the early spread of the coronavirus.

He called the health department’s decision to only report confirmed flu diagnoses “bad practice.”

“Even with the best intentions, to change the meaning of the numbers you’re reporting in the middle of an epidemic certainly makes things a lot worse,” he said.

It’s also clear that federal health officials have taken a different view of similar data — putting the influenza-like illness numbers at the forefront of their risk assessment for coronavirus. The Centers for Disease Control and Prevention recently started publishing a weekly surveillance summary called “COVIDView,” which includes influenza-like illness data from across the country.

Lipsitch acknowledges that flu-like illness data also are not without their issues. For one, it is imprecise in that it only picks up the sickest people, or at least those who wind up in hospital emergency rooms. Another challenge is that flu-like illness data are reported as a percentage of total visits rather than a total number — and trips to the emergency room for everyday accidents like car wrecks might be down due to stay-at-home orders. That could skew the data upwards.

But he also said Florida officials cut off the data stream just as it was growing increasingly useful — at the end of cold and flu season, when COVID-19 cases are likelier to make up a significant proportion of people with flu-like symptoms.

“It’s probably becoming a better and better indicator of COVID activity,” he said.

The Department of Health and the CDC have not yet responded to questions about the impacts of the state’s decision to stop sharing the data.

Aside from the change in its weekly reports, Florida had already come under scrutiny from public health experts because it is the only state in the nation not making information about influenza-like illness publicly available through a Center for Disease Control and Prevention data portal used by academics, said Nicholas Reich, a professor of biostatistics and epidemiology at the University of Massachusetts Amherst.

“In times like this, not having that raw data easily available to researchers limits our ability to analyze and report effectively on emerging trends of respiratory infections in Florida,” he said.

Data on influenza-like illness are an important indicator of how much respiratory illness is circulating in the population at a given time, Reich added.

“In the public health community, it is one of the most widely used metrics for monitoring the typical ‘flu season,’” he said.

Researchers are monitoring the data right now to determine how much “excess respiratory illness” might exist, Reich added.

“Especially in the context of the U.S. not having had a lot of testing capacity to date, these data are critical for understanding how COVID-19 is spreading across the U.S.,” he said.

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