Problems in CalREDIE, California’s Infectious Disease Reporting System, Lead to ‘Significant’ Undercoverage of COVID-19

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Multi-week problems plaguing CalREDIE, California’s infectious disease registry system, have resulted in crippling delays in filtering information to counties – and “significant” undercoverage in COVID-19 cases.

Governor Gavin Newsom yesterday spoke of “encouraging signs” and “early positive signs” regarding coronavirus infection rates. But officials in several California counties told Mission Local they believed it was a mirage caused by flawed data.

The problem is CalREDIE, the state’s disease registration system. Test data from laboratory vendors is transmitted electronically to CalREDIE, which then forwards the information to the counties.

Technological glitches, however, erased this process for weeks. An appeal with all state health directors was called last night and, in an email, the state today acknowledged that “we have discovered an underreporting of COVID-19 cases in due to technological issues with the electronic laboratory reporting system that reports to the Disease Registration System (CalREDIE).

The extent of the underreporting is not known. In a series of documents obtained by Mission Local, state officials say the system began to experience difficulties in routing electronic lab reports to the state system on July 25. But Jeff Smith, the Santa Clara County executive, said problems were detected there as early as July. 15.

“We don’t know if there was a problem between the 15th and the 25th. We don’t know what happened before that,” he said. “It’s basically a black box at this point.”

Marin County health worker Dr Matt Willis said he noticed a discrepancy in late July between the number of cases reported by CalREDIE and those coming directly from labs in the area.

CalREDIE, he says, is allowing county officials to begin raising awareness about positive cases. “It’s an essential tool,” he says. But it is a system that is not fully functional or reliable.

“If we cannot trust the test results, we cannot measure or predict the course of the pandemic,” Smith said. “If we don’t have quick and timely results on positive cases, we can’t even begin to properly trace and isolate contacts. It’s just a really big deal.

California Health and Human Services Secretary Dr Mark Ghaly acknowledged the situation today in an online briefing.

“We have discovered discrepancies,” he said. “Many counties are relying on state information to keep their own information up to date… They have seen a drop in the number of their cases.”

The state’s Department of Public Health today issued instructions to labs handling COVID-19 testing to essentially remove CalREDIE from the process.

“Report positive SARS-CoV-2 results directly to the local health jurisdiction where the patient resides,” read the new instructions. “Laboratories should report using the attached Excel template and include as
as many data elements as possible.

On the Santa Clara County COVID-19 data portal – as well as those in other counties in California – a warning is now being issued:

Due to a significant and unresolved issue with the California Reportable Disease Information Exchange (CalREDIE) reporting system, the Santa Clara County Department of Public Health, as well as government departments counties in the state are experiencing significant underreporting. of COVID-19 test results. The state has informed us that counties have received incomplete information regarding test results, which affects our ability to identify new cases of COVID-19, accurately report the test positivity rate in our community, and to identify the number of people tested for the last few weeks. Without timely reporting of all new lab results, it is impossible for national and local health authorities to identify how much COVID-19 is circulating in the community. It also hampers our ability to conduct effective contact tracing and case investigations to slow the spread of COVID-19.

We do not yet know the extent of this problem or when the State will be able to resolve it, but we are in communication with the State and have offered to provide any assistance it may need to resolve this promptly. problem. In the meantime, we will continue to report the test data we receive and make it clear to the public which data reported on our website is affected by this issue. The State has confirmed that the data actually received is valid, but incomplete. We expect the test positivity rate, daily and cumulative number of cases and other data points on the county’s COVID-19 data dashboards to change as more comprehensive test results are released. reported to the Santa Clara County Public Health Department.

Calls from the local mission to the state’s public health department have yet to be referred. On Tuesday, he informed the counties that he had “deployed a strike team from the Ministry of Technology”, among other measures.

While San Francisco reports data to CalREDIE, it is one of the many counties that are not dependent on receiving data.

Update, August 5: Smith of Santa Clara says state officials are still communicating that they are unaware of the origin of the problem, but believe it may be from an overlay purchased and installed in the hope of acceleratingthe reporting process. Unfortunately, perhaps the opposite has happened.

“They still can’t tell us when they’re going to fix it or if they’re going to fix it,” says Smith.

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