Working 4 You: How outdated tech is letting COVID-19 cases fall through the cracks

Working4You

LITTLE ROCK, Ark. — Every day the Arkansas Department of Health reports the latest COVID-19 numbers, but what’s on the record is not the full picture with the state admitting there are cases that aren’t being counted.

It’s something our Susan El Khoury experienced firsthand when she tested positive for COVID-19. To date, the Department of Health hasn’t been able to provide a record showing it received her positive test result.

FAX MACHINES AREN’T UP TO SPEED FOR A PANDEMIC

While time is critical to counting every case of COVID-19, the Department of Health relies on technology that it knows isn’t up to speed.

“The fax system is kind of the bane of our existence,” said Chief Epidemiologist Dr. Mike Cima. “It is largely inefficient, and it comprises probably the majority of the reports that we get in.”

Digital options are the preferred choice, but instead fax machines are how the state receives thousands of COVID-19 test results. It’s a system that used to work, but now many see it as archaic. Now the influx of faxes during the pandemic, is just highlighting concerns.

“It’s really an outdated way of doing thing,” Dr. Cima added.

Missed cases are causing a clash at the Department of Health between leadership and those on the frontlines who are investigating cases.

A person, who at one time worked for the Department of Health, said they came across hundreds of people infected with the virus who were going uncounted.

“It’s absolutely concerning and it’s frightening,” the source said. “I would say well into the hundreds and probably thousands. They’re no one in our system, nowhere. Their test result is nowhere in our system.”

This person agreed to speak with us if we hid their identity. In the course of their work, they discovered a concerning disconnect in reporting between COVID-19 testing centers and the state.

“More often than not they [testing centers] fax it and we may get the result three or four months down the line, so those numbers aren’t even counted in real-time, so the numbers are skewed,” they explained.

The numbers they’re referring to are what the state reports every day, logging both confirmed and probable cases.

At the Department of Health, it’s Dr. Cima’s job to oversee test results. He says it takes two days to log most cases, and missed cases are the outliers.

“I believe our numbers are very accurate,” Dr. Cima said. “I don’t believe that it’s hundreds of cases. Admittedly there are some cases that we come across that, unfortunately, they were missed.”

COVID-19 CASES FALLING THROUGH THE CRACKS

There are a few ways he knows of where someone can be overlooked. He says the first is testing centers that aren’t sending any results to the Department of Health.

So how many places are doing that? The answer is more of a shade of gray. The state isn’t counting and throughout the pandemic hasn’t kept tabs on which places are offering COVID-19 tests. When we asked for an exact number of test centers, the state couldn’t give us one.

What is black and white is the law. The Department of Health laid out rules for reporting diseases, which requires test centers to send results to the state “within 24 hours.”

That leads to the second way Dr. Cima outlined how cases can be missed; testing centers that send results late.

We asked if any places were cited or fined for not reporting or delay reporting COVID-19 tests, and were told none to date.

“This has just grown so exponentially to be able to cover all our bases is taking a lot of resources,” Dr. Cima explained.

For him possibly the biggest base to cover goes back to the state’s fax machines, which can lead to the third way cases can be overlooked.

Dr. Cima says the state knew the fax system was due for an upgrade long before the pandemic, but that never happened and now the state is stuck with a system that’s being pushed to the limit.

“That is a paper form that gets sent over, and we have to manually enter it into our system,” he added.

That’s a step that our Susan El Khoury found out likely didn’t happen in her case. Records from the center she was tested at, show her result was faxed to the Department of Health hours after she tested positive. The status on the fax says “ok,” but to date, the Department of Health hasn’t been able to provide a record showing it processed the test result, even now months past the two day processing period Dr. Cima says is average.

PUSH FOR DIGITAL CASE REPORTING

“We meet every single week to discuss what we can do better,” Dr. Cima said.

One of those discussions led to an online portal, which the state launched in late October. All test centers have to do is sign up and then start uploading.

“That feeds directly into our system which really negates the need for any manual data entry,” Dr. Cima added.

It’s a notable upgrade from fax machines, but only time can tell how this change will work out and if test centers will get onboard. The way things stand, the online portal is an optional service.

According to our source, they believe a faster connection could signal a turning point.

“The facilities that are doing the testing, whether it’s antigen or PCR, needs to be linked with the public health department the Arkansas Department of Health so that we can effectively contact the cases and decrease the spread,” they said.

There’s also the chance the online system could cut down on the unknown and keep a digital footprint, tracking where someone may have slipped through the cracks.

“I think it would certainly would be an interesting publication to look at the indirect and cascading effects of faxing reports versus electronic reports,” Dr. Cima noted.

Don’t expect that report soon though, Dr. Cima says there’s no plan to see if rising cases are linked to these reporting changes.

Regardless, there’s a fact he can’t deny, fax machines aren’t wired for a pandemic.

“Unfortunately I can’t really put parameters around how many cases that are going missed, we don’t know what we don’t know,” Dr. Cima said.

The Department of Health couldn’t give an exact number of the reports that are faxed in every day, saying it fluctuates but is in the tens of thousands.

A number that is consistent is how many employees work the fax machines. There are 6 of them and the Department of Health says it has been that way since the pandemic started.

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