On Monday night, for example, the state was reporting 91 cases in St. Louis. The city reported 150. And that’s far from the only example. Some counties seem to report more infections than the state. Others fewer.
At one point, the state health director tried to solve the problem with a new order, requiring laboratories to report positive tests to the state. The order itself says those tests should be reported “only” to the state — but that never really happened.
In the end, the discrepancies are all about new technology, old practices, mixed messages, and health departments trying hard to understand what’s in front of them.
St. Louis city — which serves as its own county — gets more data and updates its website more quickly than the state, St. Louis officials said. The state enters the cases into a database first, said St. Louis Department of Health spokesman Harold Bailey.
Staff from the city health department also call hospitals to ask for positive test results, Bailey said, instead of waiting for hospitals to call.
And some labs notify counties, out of habit, before telling the state, said Mary Enger, spokeswoman for St. Charles County. It depends on the lab, she said. The state, for example, receives results from its labs before counties do.
In other cases, labs call doctors’ offices to notify them of results, said Lisa Cox, spokeswoman for the Missouri Department of Health and Senior Services. Then the doctors inform local health departments. Somewhere in the chain, she said, the state gets notified. But it may take days.
Cox said the state can’t attribute the data discrepancies to one particular lab, health care provider, public health agency or even one single reason.
Fixing the communication gap would mean getting government agencies, public and private laboratories and doctors’ offices all on the same page.
The state recently tried. It issued an order saying laboratories must only submit test results to the state health department. With other infectious diseases, labs typically notify local agencies first, which then send the results to the state.
But in the case of a global pandemic, the state needs clear information reported to it as quickly as possible, said Missouri Department of Health and Senior Services Director Randall Williams.
“We think people are, naturally, anxious, and the more we can educate them and give them an idea of what’s going on — we think that’s therapeutic in some way,” Williams said.
Williams said, after the order was issued, that he didn’t mean to prevent local agencies from receiving information, but instead to assure the state receives all lab results more quickly.
But he also noted that reporting to two different agencies increases the workload for labs.
Pam Walker, a consultant providing services to public health agencies free of charge during the pandemic, said local agencies should usually take priority when labs or providers are deciding who in government to notify about confirmed cases. Local agencies are the ones who will treat the patient and conduct the disease investigation, Walker said, so they should be notified first.
Walker spent nine years as director of the St. Louis Department of Health, and before that, set up the state’s emergency disaster response system — the system the state is using right now, she said.
In the case of a global pandemic, rules change. Walker echoed Williams’ sentiments about quelling public fears.
“In this situation, I do think it’s helpful for the information to go to both so they can be reporting the same numbers,” Walker said.
In the end, problems may also be traced to technological know-how and system capacities.
“This thing is crazy, because the systems and processes in place are just being pushed to the limit,” said Sgt. Benjamin Granda, a St. Louis County police spokesman helping with the county’s coronavirus response.
City, county and state agencies all said they’re making efforts to streamline COVID-19 reporting.
“Everyone is working to try to get reports to all parties at the same time and share information as quickly as possible,” Enger said. “As you know, with a pandemic, everything moves very fast.”
©2020 the St. Louis Post-Dispatch. Distributed by Tribune Content Agency, LLC.
