{"id":266139,"date":"2020-08-22T07:43:18","date_gmt":"2020-08-22T11:43:18","guid":{"rendered":"https:\/\/canadianinquirer.net\/v1\/?p=266139"},"modified":"2020-08-22T07:43:18","modified_gmt":"2020-08-22T11:43:18","slug":"californias-data-failures-stymie-efforts-to-curb-the-virus","status":"publish","type":"post","link":"https:\/\/canadianinquirer.net\/v1\/2020\/08\/22\/californias-data-failures-stymie-efforts-to-curb-the-virus\/","title":{"rendered":"California\u2019s Data Failures Stymie Efforts to Curb the Virus"},"content":{"rendered":"
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Gov. Gavin Newsom\u2019s administration is still struggling to fix the problems and prevent future breakdowns, even as school districts are weighing difficult decisions about sending kids back into classrooms, businesses are contending with repeated openings and closures, and the state is working to tamp down rising infections \u2014 all life-or-death scenarios that rely on accurate COVID-19 data. (File photo<\/a>: Gavin Newsom\/Facebook<\/a>)<\/figcaption><\/figure>\n

The failure of California\u2019s infectious disease monitoring system for a stretch of at least 20 days in July and August triggered potentially deadly fallout that continues to reverberate across the state.<\/p>\n

The fallout has been most severe in heavily populated counties, which rely primarily on a statewide electronic information system to guide their pandemic response. Local health departments couldn\u2019t clearly see where the coronavirus was spreading, dramatically slowing their efforts to trace and track new infections \u2014 leading to more death and disease, public health officials said.<\/p>\n

Data system failures left California with a backlog of about 300,000 lab reports. Of those, nearly 15,000 turned out to be positive for COVID-19, according to state Health and Human Services Secretary Dr. Mark Ghaly.<\/p>\n

\u201cBy the time you get those cases, even if you do your best to trace the contacts, you might be too late,\u201d said David Campos, deputy Santa Clara County executive. \u201cIndividuals who were positive didn\u2019t know they were positive and therefore may not have isolated and quarantined, so they ended up spreading the virus to other people unknowingly.\u201d<\/p>\n

\u201cIt\u2019s frustrating and it\u2019s very scary,\u201d Campos added.<\/p>\n

Gov. Gavin Newsom\u2019s administration is still struggling to fix the problems and prevent future breakdowns, even as school districts are weighing difficult decisions about sending kids back into classrooms, businesses are contending with repeated openings and closures, and the state is working to tamp down rising infections \u2014 all life-or-death scenarios that rely on accurate COVID-19 data.<\/p>\n

\u201cThe whole key to lab testing is the speed with which it\u2019s done,\u201d said Bruce Pomer, a public health expert and chief lobbyist for the California Association of Public Health Laboratory Directors. \u201cThe system is slower than it should be, and it means more people are going to get sick and die. The lifeblood of public health is data.\u201d<\/p>\n

Ghaly said he and Newsom first became aware of the magnitude of the state\u2019s data failures on Aug. 3, though the California Department of Public Health had alerted counties about problems as early as July 15.<\/p>\n

By the time Ghaly said he was informed, the state infectious disease database \u2014 the California Reportable Disease Information Exchange<\/a>, known as CalREDIE \u2014 had experienced a series of breakdowns, including an outage that prevented electronic lab reports from flowing to counties, and a lapsed security certificate needed by the commercial lab giant Quest Diagnostics to transmit records. The problems did not affect death and hospitalization data.<\/p>\n

The state says it has since cleared the backlog.<\/p>\n

\u201cIt is clear that CalREDIE simply does not have the capacity to scale as we had hoped,\u201d Newsom said following the resignation of the state\u2019s top public health officer<\/a>, Dr. Sonia Angell, after the data system collapse. \u201cWe will reform that.\u201d<\/p>\n

California isn\u2019t alone in its COVID-related data problems. Iowa<\/a> recently discovered a major flaw that backdated thousands of test results; North Carolina learned that another commercial testing company, LabCorp, had been including out-of-state tests in its data since April; and Alabama found<\/a> that some labs were not properly sending test results to the state.<\/p>\n

But the breakdown in California stands out for its size and consequence.<\/p>\n

In Santa Clara County, public health officials felt they finally had resources to aggressively track people who might have been exposed to the virus.<\/p>\n

But a contact tracer for the county who declined to be named confirmed that the number of cases trickling in from the state data system was so slow by late July that tracking operations had nearly ground to a halt.<\/p>\n

Santa Clara County did not receive data on many residents who tested positive during that time. Dr. Sara Cody, the county\u2019s health officer, said earlier this month that she had discovered missing cases of infected people as far back as July 8.<\/p>\n

\u201cIf we can\u2019t get the data from the state system, we\u2019re all kind of flying blind,\u201d said Contra Costa County health officer Dr. Chris Farnitano. \u201cThen our case investigation and contact tracing efforts aren\u2019t very effective.\u201d<\/p>\n

Contra Costa and other counties are still digging themselves out of the data failures \u2014 and working to dramatically expand testing. But public health officials worry that an influx of tests will overwhelm the system, once again undercutting counties\u2019 ability to adequately respond to the pandemic.<\/p>\n

\u201cThis really puts our whole strategy at risk,\u201d Farnitano said. \u201cWe\u2019re looking to start doing in-person school at some point in the fall, if conditions allow, but that would add a whole bunch more tests that need to perform in the system.\u201d<\/p>\n

Mendocino County provides a glimpse of how vital real-time data is for an aggressive response. Since the beginning of the coronavirus pandemic, the sprawling rural Northern California county has kept up its old-school strategy of tracking infectious diseases by telephone and fax machine, providing a reliable flow of COVID-19 data even as the state system crashed.<\/p>\n

That meant local officials could see that cases were spiking in the county even as state data suggested it was faring relatively well, keeping the county off the state watchlist<\/a>. Mendocino County health officer Dr. Noemi Doohan nonetheless decided to proactively shut down high-risk businesses like bars without being ordered to by the state.<\/p>\n

\u201cI wanted to retain local control for our county, and I also wanted to do the right thing,\u201d Doohan said.<\/p>\n

The county has since been added to the state\u2019s watchlist, which means that nine schools that had planned to hold in-classroom instruction now either have to move teaching online or seek permission to open from the county and state.<\/p>\n

In Riverside County, where contact tracing efforts were also hampered by the data failure, public health director Kim Saruwatari said she is at the mercy of the state data system. She said fax-and-phone data collection efforts like those used in Mendocino County are not possible for larger counties like hers.<\/p>\n

\u201cThe volume of data that we have coming in, it would take an army to receive all the reports and enter them into a system separately,\u201d she said.<\/p>\n

Saruwatari and other county officials had been asking for state assistance to identify potential data discrepancies in the weeks before the state took action. During that time, state health officials knew there were issues but appeared to be unaware of the magnitude of the data failures and were slow to respond, some county officials said.<\/p>\n

\u201cWe can\u2019t get a hold of anyone\u201d at the California Department of Public Health to help, wrote Wendy Hetherington, chief epidemiologist for Riverside County, in an email to a state epidemiologist while trying to figure out why she couldn\u2019t access critical data.<\/p>\n

\u201cI am not aware of any specific issues, however we are starting to notice problems \u2026 because the files are becoming too large for our computers to obtain in this manner,\u201d the state epidemiologist responded.<\/p>\n

Kate Folmar, a spokesperson for the California Health and Human Services Agency, said in a statement that the administration has \u201caccelerated a replacement project\u201d to ensure accurate, timely COVID-19 data. A state bid for the project went out last week, Folmar said, and Ghaly said this week that the new system is weeks away from being ready.<\/p>\n

For years, the state has patched holes in its communicable disease information system, which was designed 20 years ago and also tracks other infectious diseases, including the flu.<\/p>\n

Local health officials, who blame the long-standing lack of investment<\/a> in public health infrastructure, describe it as clunky, slow and at times ineffectual. But COVID-19 has presented an even bigger challenge than routine cases of measles, syphilis and meningitis.<\/p>\n

\u201cOur systems were not designed for this kind of pandemic threat,\u201d said Daniel Zingale, a former top Newsom adviser who led health care initiatives for previous Democratic and Republican administrations.<\/p>\n

Data failures are likely to continue given the limitations of the system, and not only will they harm public health officials\u2019 ability to trace COVID-19 and prevent its spread, but they will also erode the community\u2019s confidence in public health efforts, Saruwatari and others said.<\/p>\n

Already, comments on social media<\/a> and at public meetings suggest that state failures have undercut trust in public health, especially in conservative-leaning regions like the Inland Empire and California\u2019s rural north.<\/p>\n

\u201cThere\u2019s been a lot of the questioning of the data all along, like if somebody dies, did they really die of COVID-19,\u201d said Lake County health officer Dr. Gary Pace. \u201cNow people that were prone to not trust us or not follow guidance before are even less likely to follow it.\u201d<\/p>\n

 <\/p>\n

 <\/p>\n

This KHN<\/a> story first published on\u00a0California Healthline<\/a>, a service of the California Health Care Foundation<\/a>.<\/p>\n

 <\/p>\n

Kaiser Health News<\/a> (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation<\/a> which is not affiliated with Kaiser Permanente.<\/em><\/p>\n

USE OUR CONTENT<\/h3>\n

This story can be republished for free (details<\/a>).<\/p>\n

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