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State and labs, including some in Northeast Florida, question accuracy of COVID-19 data

Florida Times-Union - 7/15/2020

Florida Department of Health officials said that some laboratories have not complied with procedures for reporting negative COVID-19 tests, while some labs pointed to state errors for potentially distorting a key metric in management of the coronavirus pandemic.

The statistical issues, which include the omission of negative tests from several labs as well as apparent errors in classification, further complicate the task of assessing the scale, scope and relative risks associated with the pandemic.

Flagler Hospital officials told the Times-Union Wednesday that its COVID-19 testing data as displayed by the health department does not look complete, the latest inconsistency to surface in the state's statistics.

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Though Florida's totals for positive tests, hospitalizations and deaths -- all of which have risen markedly over the past six weeks -- remain unaffected, the omission of negative tests potentially inflates the state's positivity rate, the percentage of COVID-19 tests that yield positive results.

Health experts view the rate, which state records showed rising as high as 20.71 percent in tests processed on July 8, as a significant metric in a region's performance in containing the disease.

Blaming "smaller, private labs" for failure to submit negative results, the health department said that it is seeking to reinforce "proper protocol" to ensure that all tests are counted.

In a statement to the Times-Union, the health department said, "All COVID-19 cases are confirmed through diagnostic and antigen testing and then reported to the state by the labs performing the testing. Private and public laboratories are required to report positive and negative test results to the state immediately. In recent days, the Florida Department of Health noticed that some smaller, private labs weren't reporting negative test result data to the state. The Department immediately began working with those labs to ensure that all results were being reported in order to provide comprehensive and transparent data. As the state continues to receive results from various labs, the Department will continue educating these labs on proper protocol for reporting COVID-19 test results."

The source of these errors, however, is not always clear.

An administrator at one of the Northeast Florida laboratories that listed an overwhelming positivity rate for the duration of the pandemic said the data in the state report was "clearly inaccurate."

"We've had hundreds and hundreds of negatives" that "far, far, far outweigh the positives," said the administrator, who asked not to be identified because of concerns that speaking out could trigger conflict with the health department.

The state health department's daily report said that Flagler Hospital in St. Augustine had recorded a cumulative total of 98 positive tests, 15 negative tests and three inconclusive results -- a positive rate of 84 percent.

In response to an inquiry from the Times-Union, Flagler Hospital vice president Gina Mangus said the 84 percent applied only to "very specific rapid tests" for hospitalized patients. She said the positivity rate for all specimens processed by way of the hospital, including those processed by outside labs, was around 11 percent.

Among labs listing very high positivity rates in Northeast Florida are Naval Hospital Jacksonville, at 96 percent, and Avecina Medical's three locations at Oakleaf (93 percent), Julington (81 percent) and Southside (45 percent). The state listed that Amelia Urgent Care, based in Fernandina Beach, reported 31 tests, all positive.

By comparison, the statewide percentage of tests yielding positive results, when compiled on a cumulative basis starting with the outset of the pandemic, is about 11 percent.

The issues are not limited to Jacksonville.

Earlier this week, Orlando Fox affiliate WOFL and the Orlando Sentinel reported that multiple coronavirus testing laboratories had been reporting only positive test results -- not negative results -- to the state health department.

Orlando Health, listed with a 98 percent positivity rate in state records, told Orlando media that the figure was incorrect and that its actual positive rate was 9.4 percent. As of Wednesday, the state health department has not amended the Orlando Health data in its daily report.

The degree to which the omission of negative tests may have affected the positivity rate, both in Jacksonville and across the state, is more difficult to quantify.

Since the top 20 laboratories listed with the most tests in Florida have combined for a total of more than 2.5 million -- all with rates ranging from 3 percent to 18 percent -- the effect of the errors on the positive rate is limited.

Although 474 laboratories were listed as reporting 100% positives -- entirely positive results with no negative COVID-19 tests -- in Wednesday's report from the Florida Department of Health, most of those were linked to only trace numbers of positive tests. A majority reported only one or two.

However, the numbers in some cases were more substantial: 41 of the 474 reported processing more than 20 positive tests.

In some instances, trace listings appeared to be the result of classification errors.

The health department's report listed "Baptist Clay" with nine tests, all positive. However, a separate entry for Baptist Emergency Center Clay showed 47 positive tests and 393 negatives, for an 11 percent positivity rate.

In an e-mail to the Times-Union, a Baptist Health spokeswoman said the "Baptist Clay" positive tests should have been grouped instead with the others from Baptist Emergency Center Clay, and did not know why the set of nine positives had been given its own category.

"Those figures should have been merged into a single category. We are not sure why there were separated out," she said.

For many major Jacksonville health institutions, the positive test percentage listed by the state falls well within normal bounds.

These include Mayo Clinic (8 percent), St. Vincent's Riverside (9 percent), Baptist Medical Center (5 percent), Baptist Medical Center South (7 percent), Baptist Medical Center Beaches (6 percent) and the Bureau of Public Health Laboratories in Jacksonville (15 percent). Near the high end of the normal range are Memorial Hospital Jacksonville (19 percent), Lake City Medical Center (19 percent) and Orange Park Medical Center (19 percent), while UF Health Pathological Laboratories (3 percent), Baptist Medical Center Nassau (4 percent), St. Vincent's Southside (2 percent) and St. Vincent's Clay (3 percent) are toward the low end.

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