Florida's health department undercounted COVID-19 cases, deaths, due to technical issues: state audit

The number of COVID-19 cases and deaths reported in Florida from March 1, 2020, to Oct. 9, 2020, by the Department of Health were underreported because of data collection problems, according to the state’s auditor general report published on June 1.  

The report comes after this past March when a Florida Department of Health Office (FDOH) of Inspector General investigation found "insufficient evidence" or no evidence to support self-proclaimed whistleblower Rebekah Jones' claims that she was asked to falsify COVID-19 data on the state’s dashboard, according to Office of Inspector General Investigative Report. Her claim she was directed to restrict access to underlying data was also found to be false, according to that report.

"To evaluate the State’s readiness to provide essential information needed to respond to the global pandemic, this operational audit focused on COVID-19 data collection and reporting processes at the Agency for Health Care Administration (Agency), Department of Health (Department), and Division of Emergency Management (Division) during the period March 1, 2020, through October 9, 2020," the state’s auditor general report said. 

"As subsequently described, the number of entities reporting data, apparent inaccurate or incomplete data reported to the State by those entities, and the lack of effective access controls in the systems used to gather data, impacted the State’s ability to accurately report COVID-19 data at the beginning of the pandemic." 

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Florida’s Health of Department used a data software called the Merlin system, but it "did not appear complete or contained anomalies" when compared to data in the Bureau of Vital Statistics. 

"We compared Merlin death records to Bureau of Vital Statistics death records where COVID-19 was included as a cause or contributing factor of death and identified differences between the records," the report said. 

The health department records also didn’t always show evidence that COVID-19 patients were contacted in a timely manner, which was against the state’s health department requirements for contact tracing.  

The audit noted "for 168,880 of the 729,552 cases, Merlin did not evidence that the COVID-19 positive individuals were either contacted or contact was attempted by the Department." 

Using the individual’s full name and date of birth, the auditor general concluded that 2,495 death records that were reported in the Merlin software system were not included in the Vital Statistics reports, while 3,082 death records reported in Vital Statistics data were not included in the Merlin data, per the audit. 

"Absent complete and accurate information related to the extent and severity of the COVID-19 pandemic, government officials and the general public may not have had all the information necessary to assess the efficacy of COVID-19 control measures and take appropriate actions," the report said. 

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The auditor general said if the health department’s management did not receive a positive lab result or if the demographic information on the laboratory report differed from the death certificate, it may have not been able to definitively note that the individual who died was the same individual listed on the test result. 

There was also "data quality issues" regarding data for the number of COVID-19 cases, independent of the death records, but FDOH management said "data quality issues were due to having to rely on data being sent from the laboratories, along with the large number of cases and limited resources to address data accuracy and completeness issues." 

The auditor general found that even though FHOH did try to make sure some data was accurate and complete, the audit also found "7,718 instances where the dates of follow-up contact attempts were missing from Merlin."  

But FHOD told the auditor general that "inaccurate contact information and the refusal of some individuals to speak with the department hindered" their ability to contact all COVID-19 individuals.  

State Surgeon General Dr. Joseph Ladapo agreed with the report’s findings with a plan of action in progress to correct it, but added data discrepancies are expected, according to WFLA News Channel 8. 

"If COVID-19 testing was not performed, occurred more than 30 days before the death, was not reported to the Department, or could not be matched to a Vital Statistics record because of data quality deficiencies, the death would not be counted as a [COVID-19] associated surveillance death included in the Department’s COVID-19 surveillance reports," Ladapo wrote. 

He noted "most data quality issues the Department experienced during the COVID-19 pandemic originated from laboratories that submitted inaccurate or incomplete data," adding FDOH no longer recommends county health departments do contact tracing for every COVID-19 case. 

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The Agency for Health Care Administration and the Department of Emergency Management noted monitoring and reporting challenges in response to the report, but strengthening IT controls was mentioned as a way to improve data management, per the news outlet.  

The report said data recorded after the audit period might be subjected to future audit.