A torrent of testing data exposed the aging digital infrastructure behind the Georgia Department of Public Health's online COVID-19 dashboard. Those issues and separate server problems left the agency unable to fully publish new information for several days earlier this month and resulted in delayed reporting a week later at the peak of Georgia's latest coronavirus surge.
The problems have been fixed, DPH officials told The Atlanta Journal-Constitution last week, and data published on the agency's website is accurate.
But the episode was the latest in a string of data problems at DPH during the pandemic that have revealed the impact of years of underfunding the agency.
The omicron and delta waves created crushing loads of information that overwhelmed the state's systems. And the challenges might not be resolved until DPH completes a multi-million dollar effort to overhaul a digital infrastructure that's more than a decade old.
"Many of our public health systems, and most of our public health IT systems, are legacy systems that were never ever designed to handle millions and millions of data points," Dr. Kathleen Toomey, the state's commissioner of public health, said in a statement to the AJC.
"As a result, these systems are failing when responding to the COVID pandemic, most specifically during surges," she said.
DPH Data Troubles
The AJC has chronicled a number of issues at DPH in how it tracks and visualizes pandemic data. — In April 2020, the AJC found data on infections and deaths in nursing homes was inaccurate or severely outdated. The state also had difficulty determining race and ethnicity data of infected individuals at a time when COVID-19 was hitting minorities particularly hard. Independent public health experts said detailed information is vital to understanding trends. — In May 2020, the AJC reported Georgia combined data about diagnostic and antibody tests, making it appear the state was testing more people for active infections than it was. — In May 2020, a chart suggested infections in the biggest counties were dropping over time when no clear downward trend was evident because the dates were out of order. — In July 2020, the AJC found DPH only knew the race and ethnicity in fewer than 7 out of 10 confirmed cases of COVID-19. — In November 2020, an AJC analysis found that Georgia virus rates were likely a third higher than the official tally. As many Georgians were relying on antigen tests, DPH's dashboard at the time did not include daily results for those tests in its statewide or county-level charts and maps of positive cases. DPH ultimately added this information to its dashboard in the months after the AJC story. — In late March and early April 2021, DPH took down its vaccine dashboard for nearly two weeks citing ongoing system and data transfer issues. — In April 2021, the AJC found the state consistently reported higher vaccination rates, particularly among seniors, because DPH used an older and smaller population estimate than the CDC.
Since the beginning of the pandemic, numerous independent experts have questioned Georgia's accounting of coronavirus cases, tests, deaths and vaccinations. Some of the state's handling of data has been held up for ridicule.
Last year, state lawmakers approved $11.1 million for a new vaccination data management system that is now online. The General Assembly also budgeted $16 million for what DPH calls its "Surveillance Program of the Future."
DPH provided no timeline for the launch of its new surveillance technology, but spokeswoman Nancy Nydam said it is under development. The investment might not result in a new public COVID-19 dashboard, but the system upgrades are expected to improve the performance of the agency's existing COVID-19 website.
Data experts outside Georgia government interviewed by the AJC continue to raise concerns about vulnerabilities in DPH's systems until they can be replaced.
Building this new technology platform during a raging pandemic will be no small task for DPH, said TJ Muehleman, founder and CEO of Standard Co., a company that helps public health agencies process and analyze data.
He said too often public discussions around infrastructure are limited to roads, bridges and Internet access, but should include data systems and other technologies.
"If we're worried about what happens when bridges start to fail, we should be 10-times (as) worried that our digital infrastructure is already falling apart," said Muehleman.
Georgia isn't alone, public health experts say. Tracking the pandemic and vaccination effort has been a challenge at the state and federal level.
The volume of data, combined with outdated systems has mixed with inconsistent standards and reporting delays, particularly for the most basic surveillance data — testing.
"This problem of legacy systems has been trailing us — and other states — since the start of the pandemic," Toomey said.
Omicron Triggers 'Overwhelming' Data
DPH built its COVID-19 Daily Status online dashboard in early 2020 during the first wave of the virus, and added capabilities over time. The site tracks testing, infections and deaths in each county and statewide.
Local governments, schools, businesses and the general public rely on the data to inform day-to-day public health decisions.
DPH typically updates the website each weekday, with Monday reports including weekend results. The first public sign of trouble appeared after the New Year's holiday weekend. DPH was unable to publish its Jan. 3 daily report, citing an "overwhelming" volume of data.
The next day, the agency reported 2.6 million PCR tests since its update four days earlier on New Year's Eve, a figure that appeared to be an error. But the testing figures reported Jan. 4 actually revealed a data processing problem that stretched back nearly two years, the AJC later reported.
The issue revealed an undercount of testing data on the website's prominent Reported Today column that stretched back to the start of the pandemic, DPH has said. Other areas of the website contained accurate data, DPH has said.
The problem persisted for the rest of that week and the agency didn't fully publish data again until Jan. 10.
DPH initially said the issue involved some incoming test results each day not receiving a specific timestamp as the agency tabulated data for its Reported Today column.
DPH later said further investigation also revealed a problem with the way incoming test results were classified by certain providers and reported via its electronic laboratory reporting (ELR) system.
The agency electronically receives tens of thousands of test results daily with a classification of positive, negative or inconclusive. Some tests do not include complete information from the provider. Those results are not assigned a classification and must be manually reviewed and classified by DPH staff.
After encountering a processing issue on New Year's Eve, DPH said it changed its coding process, which caused all 2.6 million tests that were previously accounted for manually to be reclassified with a Jan. 4 date.
Those problems have since been fixed and the website has undergone extensive testing, Nydam said in a series of responses to the AJC.
DPH said it has put in place new policies in the wake of the challenges and the agency is working to correct classification problems with labs on the front end to prevent future issues.
Still, challenges remain, including ones DPH can't control.
On Jan. 10, Nydam said the agency had resolved the problems. The next day, Jan. 11, an unrelated server issue delayed reporting again. Last Wednesday, a backlog of tests from outside labs resulted in about 8,000 positive results appearing that should have been reported to DPH a week to 10 days earlier.
(c)2022 The Atlanta Journal-Constitution (Atlanta, Ga.) Distributed by Tribune Content Agency, LLC.
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