What Florida's Switch To Weekly COVID-19 Reports Means For Tracking Efforts Against The Disease
Throughout the pandemic, Florida’s Department of Health put out daily COVID-19 reports with data including new cases and positivity rates. Now, those reports are weekly. Reports on cases at long-term care facilities, correctional facilities and schools are also gone from the department's website.
"This decision was made as Florida transitions into the next phase of the COVID-19 response," wrote Weesam Khoury, the Department of Health's communications director, in an email to WLRN. "As vaccinations increase and new case positivity rate decreases, the weekly report includes identified key data."
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Dr. Jason Salemi, a professor of epidemiology at the University of South Florida's college of public health, used those reports to create his own daily COVID-19 dashboard, and he's now scaling it down, based on what's available from the health department.
Salemi spoke with WLRN’s Verónica Zaragovia about the changes.
Below is an excerpt of their conversation which has been edited for length and clarity.
WLRN: What role do daily weekly reports have in epidemiology? What are we missing out on with this transition to weekly reports that you would need to keep your dashboard updated as you've had it before the switch?
SALEMI: Daily reports are absolutely valuable. A good example is the effective reproductive number of the virus. That is, how many new infections can we expect from a single person who's been infected? We track that over time as one indicator of how the pandemic is progressing well, to estimate that it's certainly easier to do it reliably when one has access to data that are provided more frequently. Again, just one example of how daily versus less frequent reports are valuable.
But in all honesty, I believe we've paid way too much attention to the daily ebb and flow of the numbers, especially when we're speaking about metrics like COVID-19 deaths that are impacted by lags in reporting. And so it wasn't uncommon during this pandemic to see an unusually low number of cases reported one day, followed by a huge number the next day, and we end up getting overly excited about both of those numbers when a simple average of the two might actually have been no different than other numbers that were reported recently.
So I think that's why for almost every measure, most epidemiologists monitor the seven-day or the 14-day rolling average, whether it's cases, positivity, hospitalizations, deaths, vaccination, you name it. The underlying trend is what really tells us what's going on and takes out some of the noise in the daily ebb and flow in reporting. So the weekly reports should do about the same thing.
The other really important thing that comes to my mind is if you really still wanted to track the numbers daily in Florida, the CDC's COVID Data Tracker has, in my opinion, really upped its game in terms of the comprehensiveness and granularity, the information they provide. So if you still have a yearning for daily numbers, there is a place to go get it for virtually every state in the United States at a decent level of granularity.
Can you expand on why seven-day or 14-day averages help the average person understand how Florida is doing?
For some time now, I had been focusing on a weekly report from the Department of Health made available as a county level electronic spreadsheet that tracked positivity. And what I liked about this weekly report is it only counted each person tested during that week one time. And why I like that is, it removes the effect of people being tested, let's say, for their jobs, who are likely to test negative multiple times within that week. They're only counted once now in a weekly report.
And so I think hanging on to each day's positivity report, it's just not a good idea, especially in small counties that may be impacted by reporting lags and a resultant daily variability in the numbers. So I think the underlying trends are what's most valuable. And to me, seven or 14-day trends would work just fine.
So why might be your hunch as to why the Department of Health made this change in its public reporting?
I imagine a lot of people think it's ultimately down to just, you know, the press of a few buttons and this automated process begins behind the scenes and pushes out all of that information that we got from Florida. I know, because people are surprised to hear that I spent at least two hours every day on my own dashboard, even after I had automated many of the data extraction and data cleaning and the upload tasks. But any good team of epidemiologists would likely be waking up early in the morning to pore over each data report. They'd scrutinize each of the numbers they were getting ready to make publicly available. They would be searching for anomalies, obvious errors, anything that would ultimately mislead the public and create a lot of headache for themselves.
So even though they they still have a lot of raw data being submitted to the CDC and the Department of Health and Human Services, I imagine not having to engage in that process every single day, it should open up members of their team to be able to do things like, I don't know, continue tracking and disseminating information on the 60-plus other reportable diseases that we have in our state. You know that responsibility has not been lost.
The Department of Health has said one reason for the change from daily to weekly weekly reporting is because vaccinations are up. Vaccination rates are a little more nuanced than just increasing, right?
The topic about vaccinations is much more nuanced than they're just increasing. Of course, you know, the number of people vaccinated cannot go down over time. It can either stay the same or increase. The question is how much is it increasing and how is Florida doing? Florida has vaccinated nearly 11 million people. That's the fourth most of any state, but of course, Florida is the third largest state in the country. So we really need to focus on comparing vaccination rates.
I like to focus on two different rates. First, how were we doing it? Vaccinating all people of vaccine eligible age. So anybody who's 12 or older and how are we doing specifically vaccinating seniors, because they're the most vulnerable to severe illness. And so out of all 50 states and the District of Columbia, if we look at the percent of those individuals of vaccine eligible age with at least one dose, Florida ranks 26th. So right in the middle of the pack at 57.8% of that group of people who have gotten at least one dose. If we look at now that same number, but among those who are fully vaccinated, we fully vaccinated almost 47% of vaccine eligible age individuals, and that lowers down to 30th.
So I think where we need to do a better job is not only vaccinating people in the first place, but to make sure that they're coming out if they got an initial dose of Pfizer or Moderna, coming out to complete that two-dose series. And then if we focus on seniors, where I know we were prioritizing that very early on, Florida ranks 20th in the country. Now, again, it's vaccinated a very high proportion of seniors with at least one dose — over 88%, but that still ranks 20th in the country. Then if we focus on the percentage of seniors that we've been able to fully vaccinate, that said almost 76% and that ranks 27th in the nation.
So in most cases, we're in the middle of the pack in terms of how we're doing with vaccinations. There are still many challenges ahead of us in convincing the millions of people who have yet to receive a dose of the vaccine. I know there's at least 700,000 who are 65 years of age or older alone — how do we convince them that it is safe and a responsible decision to go out and get vaccinated? I think that continues to be a challenge to all of us.
The new weekly COVID-19 report doesn't have the vaccinations of Hispanic or Black residents by county, only by state. Is that perhaps one flaw of this weekly report that now we can see it at such a granular level?
Right, I have not been able to find that. As I mentioned earlier, one of the things that we are inherently going to lose, it's not just that we're moving to less-frequent reporting. The information is less granular. And you're right, one of the things that I paid a lot of attention to is not just county level vaccination rates, but the populations in each county in Florida are very different. So I like to look at the racial, ethnic differences or the age differences and how we're doing within certain counties.
That granularity helps us to target our efforts and do a better job. Now, again, I'm positive that that information continues to be available at that granularity for county health departments, for people who are making decisions on how do we improve things, but I have not seen that level of granularity persist in what the CDC is tracking and making publicly available or in this new weekly report from the Department of Health.