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

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The number of COVID-19 cases and deaths reported in Florida from March 1, 2020 through October 9, 2020 by the Department of Health was underreported due to data collection issues, according to the Florida Auditor General’s report. report released June 1.

The report comes after last March, when an investigation by the Florida Department of Health Office (FDOH) Inspector General found “insufficient evidence” or no evidence to support self-proclaimed whistleblower Rebekah Jones’ claims that he had been asked to falsify COVID-19 data on the state dashboard, according to Investigation report of the Office of Inspector General. Her claim that she was asked to restrict access to the underlying data was also found to be false, according to this report.

People line up to receive a COVID-19 test, Wednesday, Nov. 18, 2020, in Opa-Locka, Florida.
(AP Photo/Marta Lavandier)

“To assess the State’s readiness to provide critical information needed to respond to the global pandemic, this operational audit focused on the processes for collecting and reporting COVID-19 data to the Agency for Health Care Administration (Agency), Department of Health (Department) and Emergency Management Division (Division) during the period March 1, 2020 through October 9, 2020,” the Auditor General’s report states. ‘State.

“As described below, the number of entities reporting data, apparently inaccurate or incomplete data reported to the state by these entities, and the lack of effective access controls in the systems used to collect data, impacted the state’s ability to accurately report COVID-19 data early in the pandemic.”


The Florida Department of Health used a data software called the Merlin system, but it “did not appear complete or contained anomalies” compared to data from 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 differences identified between records,” the report said.

Health department records also did not always show evidence that COVID-19 patients were contacted in a timely manner, which violated state health department search requirements. contacts.

Signage stands ready (foreground) in case COVID-19 testing at Barnett Park reaches capacity, as cars line up in Orlando, Fla., Thursday, July 29, 2021.

Signage stands ready (foreground) in case COVID-19 testing at Barnett Park reaches capacity, as cars line up in Orlando, Fla., Thursday, July 29, 2021.
(Joe Burbank/Orlando Sentinel via AP)

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

Using the person’s full name and date of birth, the Auditor General concluded that 2,495 death records reported in the Merlin software system were not included in vital statistics reports, while 3,082 death records reported in vital statistics data were not included in the Merlin data system, according to the audit.

“In the absence of complete and accurate information about 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 effectiveness of COVID-19 control measures and take appropriate action,” the report said.


The Auditor General said that if the health department leadership had not received a positive lab result or if the demographic information on the lab report differed from the death certificate, they might not have been in able to definitively note that the deceased person was the same person listed on the test result.

There were also “data quality issues” regarding data on the number of COVID-19 cases, independent of death records, but FDOH management said “data quality issues were due to having to rely on data sent in by labs, as well as the large number of cases and limited resources to address data accuracy and completeness issues.”

The Auditor General found that while FHOH tried to ensure that some data was accurate and complete, the audit also found “7,718 instances where dates of follow-up contact attempts were missing from Merlin.”

But FHOD told the Auditor General that “inaccurate contact information and some people’s refusal to speak with the department hampered” their ability to contact all COVID-19 people.

A Florida resident gets vaccinated at the Orange County Convention Center drive-thru site in Orlando, Monday, Feb. 22, 2021.

A Florida resident gets vaccinated at the Orange County Convention Center drive-thru site in Orlando, Monday, Feb. 22, 2021.
(Joe Burbank/Orlando Sentinel via AP)

Dr. Joseph Ladapo, state surgeon general, endorsed the report’s findings with an action plan underway to correct it, but further data gaps are expected, according to WFLA News Channel 8.

“If the COVID-19 test was not performed, occurred more than 30 days before death, was not reported to the Department, or could not be matched to a statistics record from the marital status due to gaps in data quality, the death would not be counted as a [COVID-19] associated surveillance deaths included in the Department’s COVID-19 surveillance reports,” Ladapo wrote.

He noted that “most of the data quality issues encountered by the Department during the COVID-19 pandemic stemmed from labs that submitted inaccurate or incomplete data,” adding that the FDOH no longer recommends county health departments contact tracing for each case of COVID-19.


The Agency for Healthcare Administration and 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 management data, depending on the medium.

The report indicates that data recorded after the audit period may be subject to future audit.


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