Concerned about the accuracy and uniformity of COVID-19 data, a bipartisan coalition of fiscal watchdogs have banded together to try to help make sure states are compiling and tracking information the same way.
The state auditors will take a close look at how health officials in their own states are collecting, reporting and monitoring data. The goals are to ensure that information presented to the public is consistent and accurate, to allow apples-to-apples comparisons among states and to help officials get a better handle on the issue if the pandemic gets worse in the coming months or there is another disaster in the future.
“This is an audit for the people. I believe it can save lives,” said Delaware State Auditor Kathy McGuiness, who came up with the idea and organized the effort. “This can help us understand the pandemic’s progression and how to better guide public health actions. And it’s a real opportunity for transparency.”
So far, auditors from the District of Columbia, Puerto Rico and 11 states — from Hawaii to Louisiana — have joined the effort. The auditors plan to release the findings from their states to the public as soon as their work is completed.
In many states, COVID-19 data presented to the public has been conflicting and confusing.
In North Carolina, for example, lagging lab test results gave a distorted view of how many tests were performed and how many people tested positive. Last month, for example, the state health department announced that a discrepancy between electronic and manual reporting of testing data from a private lab resulted in an overcounting of tests by more than 200,000.
In Florida, the state health department counted as COVID-19 deaths only people who claimed residency in Florida, whereas medical examiners included anyone who visited or lived there part-time and had died in the state.
And in Washington state, officials have blamed an overwhelmed disease reporting system, software issues and changes in methodology for creating hurdles to providing timely, accurate data, including the coronavirus positivity rate.
State and local health officials admit they’ve had problems providing up-to-date, accurate information. They say insufficient budgets, technology glitches and disjointed state and local reporting systems can make it difficult to standardize data.
Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists, applauded the state auditor coalition’s effort.
“I think public health is always interested in improving our processes and ensuring we are able to have the best data and information possible,” she said. “From that standpoint, it’s wonderful.”
But Hamilton cautioned that it’s important for auditors not only to focus on health departments, but also to “look downstream as to what’s coming in.”
“It’s not uncommon that reports will be received with missing or incomplete information,” she said. “The health department gets what they get. They’re left sorting things out.”
Although physicians are required to report detailed COVID-19 information to state health departments, they often don’t, according to Hamilton. Labs, which are also required to, generally send it, though information often is missing, such as a patient’s address, phone number, race and ethnicity. And labs new to COVID-19 reporting either don’t send the information, or they get it to the state late or in batches.
Another problem is with testing locations outside of labs, such as mobile units and urgent care centers, Hamilton added. Those sites focus more on returning results than collecting information for public health officials. “They are plagued with some of the largest volume of missing information.”
And rapid testing, which delivers COVID-19 results fast, also poses a challenge when it comes to data collection and reporting, she said.
“It’s like a toaster,” she said. “Fifteen minutes later, the results come out and they don’t often get sent to public health.”
Delaware’s McGuiness, a Democrat, said she became interested in COVID-19 data after noticing major inconsistencies being reported nationwide. After sending out a quick survey to her colleagues in other states and getting more than two dozen responses, she convened in May a national task force of five state auditors’ offices, including her own. She asked them to designate staff to be part of a working group.
The groups met virtually once or twice a week. By July, they had developed a template that auditors could use to determine how states were reporting and monitoring coronavirus data.
Auditors who use the framework will try to find out whether states collected information such as the type of tests used, the results and case information such as gender, race, exposure source and outcome. They also will look into guidance states give testing entities, how information is to be reported and whether it is timely.
Auditors also would try to determine whether results include information such as the number of positive and negative tests, recoveries and deaths and the source of exposure. They also will ask whether states monitored or sampled testing procedures and data to ensure accuracy and how they contacted and monitored people who tested positive.
Government and media reports played a role in how the groups developed the questions, said McGuiness, who also is a pharmacist. One team member has done extensive research in epidemiology and another has a health policy background, and they helped distill information and get input from other states, she added.
“Not only is it good for states but eventually, we’ll be able to compare and contrast and maybe get some great ideas from another state rather than reinvent the wheel,” McGuiness said. “Knowledge is power. It can be useful for policymakers and any health officials. I can’t tell you one state that hasn’t seen room for improvement.”
Several state auditors’ offices involved in the project, including McGuiness’, already have started their reviews. Some are doing a special report, which presents and summarizes information. Others are ordering a more formal “performance audit,” which is a systemic examination of evidence to assess how well an entity is performing.
Ohio has a new portal for the public to send in tips if they have gotten notices with erroneous test results, such as those that were later reversed or were for tests the person didn’t take.
“It is important that Ohioans have confidence in the data used for making COVID-19 policies,” Republican State Auditor Keith Faber said in a statement to Stateline. He also has launched a general performance audit for the state’s data.
Some state auditors are starting smaller, asking health officials questions from the coalition’s template more informally.
That’s what Mississippi will be doing, said State Auditor Shad White, a Republican. Right now, his office is focusing its attention on how the state is spending its $1.25 billion in CARES Act money. That doesn’t mean he won’t order a full-fledged performance audit of COVID-19 data collection down the road, he added.
“You keep an eye on answers to these questions,” he said, “and see if you get satisfactory ones and the documentation.”
In Iowa, Auditor of State Rob Sand had already issued an audit that dealt with COVID-19 response issues when he learned about the coalition. He quickly joined, he said.
“Oversight is always important, but it is even more important in the middle of a pandemic,” Sand said. “Whether it’s hospitalization or test-taking or the kind of tests being used, the systems we create should be focused on serving people, not on politics or anything else.”
Given that so much of the coronavirus debate has become political, Sand, a Democrat, said he was particularly impressed that the coalition included Democratic and Republican state auditors. “The fact that it was bipartisan was really important,” he said.
Having state auditors take a close look at how health officials are collecting and reporting COVID-19 data is essential for the public, he said. “You have to have an independent body that comes in and calls balls and strikes. Who better than state auditors?”
But the auditors’ project isn’t just about paperwork and process, he added.
“When we talk about positivity rates, every number going into that calculation is a human being who took a test and then waited anxiously for its results,” he said. “There are a lot of people behind every number.”