A six-month POLITICO investigation shows a patchwork system in which state officials struggled to control the spread of Covid-19 because their outdated surveillance systems did not allow them to collect and analyze data in real time
Covid-19 was spreading rapidly throughout the United States, as cold winter weather began to drive people indoors, but the Centers for Disease Control and Prevention was flying blind: The state agencies that it relied on were way behind in their tracking, with numbers trickling in from labs by fax or even snail mail.
Top: Healthcare workers from the Colorado Department of Public Health and Environment check in with people waiting to be tested for Covid-19 at the state's first drive-up testing center on March 12, 2020 in Denver, Colo. Bottom: City of Stamford contact tracer Toni Parlanti calls a person identified as having been potentially exposed to coronavirus while working from her office at the Government Center on Dec. 22, 2020 in Stamford, Conn.
As public health officials saw it, the task of safeguarding their communities from Covid-19 was like jumping out of an airplane with a parachute peppered with holes. Officials were forced to try to patch their parachute while in free fall. Some found a way to the ground. Others did not. — There was widespread awareness that state health departments lacked sufficient funding and up-to-date technology, but the federal government continued to rely on state public-health systems to report positive and negative cases and Covid-19 deaths. Despite the clear limitations of the data systems, local and state health officials were largely left to fend for themselves.
— During Covid-19 surges, health departments in more than 10 states stopped conducting case interviews and issuing quarantine orders for people in close contact with Covid-19 patientsFederal officials said they were alarmed by what they saw in the states, as discreet outbreaks quickly mushroomed into full-blown crises with scores of deaths.
“We have too many illusions that we can, by writ, govern the remaining vital kingdoms, the microbes, that remain our competitors of last resort for dominion of the planet,” Lederberg wrote. “The bacteria and viruses know nothing of national sovereignties.” “Our nation had a patchwork of underfunded, understaffed, poorly coordinated health departments and decades out-of-date data systems—none of which were equipped to handle a modern-day public health crisis.”Since the 2008 recession, more than 35,000 state and local public healthcare jobs have vanished, according to data from the National Association of County and City Health Officials.
The agency began working on finding ways to create new IT infrastructure and standards. In the summer of 2013, only 62 percent of 20 million laboratory reports were being received electronically. The new five-year strategy called for increasing that number to 90 percent. Top: Joe Lupo, president of the Hard Rock casino in Atlantic City, N.J., walks through a thermal screening area where his body temperature is automatically checked on the first day the casino reopened amid the coronavirus outbreak on July 2, 2020.
For Dr. Scott Lindquist, the top epidemiologist in Washington State, the slapstick efforts to collect Covid-19 data were the sad result of the flawed ways the U.S. approaches public health. For many states, that system does not have control over the body’s limbs — the programs used to manage the spread of disease. The brain system can’t always tell the limbs how to accurately use the available information to complete tasks such as adding to an open case investigation or probing an outbreak.
A lab technician begins semi-automated testing for COVID-19 at Northwell Health Labs on March 11, 2020 in Lake Success, N.Y. | Andrew Theodorakis/Getty Images With small numbers, the epidemiological surveillance process is manageable, health officials said. But with Covid-19, it was unruly. In Washington state, health officials went from tracking 30,000 disease lab reports a month in 2019 to 30,000 a day during certain points in 2020. In Vermont, the state health agency received 182 times more lab results in December 2020 compared to January 2020.
In the summer of 2020, the CDC was forced to implement a supplemental program to scrape state and local public health department websites to get an aggregate count of Covid-19 cases and death counts, Yoon told POLITICO. Some state public health officials scrambled to create new systems. Others moved to supplement their existing systems by relying on Excel spreadsheets to track data like laboratory results. The stitched-together systems made it nearly impossible for health officials to understand the full scope of the pandemic, particularly in surge periods.
Health officials described a chaotic year filled with 15- and 18-hour days in which workers — many of them volunteers from other parts of the health department — were forced to work next to fax machines, pulling hundreds of sheets of paper out of the rickety systems only to have to rush back to their desks, open a spreadsheet, and type in the information.
Multiple state epidemiologists said the inconsistent reporting of lab results skewed their understanding of the percentage of positive tests in any given week. Sometimes it looked as if there were far fewer or far more cases of Covid-19 than there really were. For other health agencies, teaching new labs how to use electronic messaging wasted critical time and exhausted officials.
In New Mexico, officials said, the state health agency was stretched to the limit by cleaning data that arrived as if it had passed through a blender before being shot out in small, fragmented pieces. By that time, it was too late. Covid-19 had spread rapidly throughout the city. By March, hospitals were ordering refrigerated trucks to use as makeshift morgues.
At the CDC in Atlanta, federal officials received daily and weekly reports from state health departments about positive Covid-19 cases, percent positivity and deaths. But they did not have adequate county-level intelligence. Instead, they used anonymous mobility data — cellphone data masked by providers —
Taylor, for one, relied on his staff of volunteers in the old shopping mall in Oklahoma City to call as many Covid-19 positive individuals as possible. “A lot of that crucial data could have potentially been collected and it might have been really helpful for policy decisions,” said Rogers, Tulsa’s division chief of data and technology. “There's a few examples of that … where we were asking should or should we not have, like, a gym close, or is it safe to have them open? We can't answer that question to advise policy, if we don't have really robust data to back those decisions.
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