Florida collects more data on COVID hospital patients than it shares with the public
The state agency that tracks COVID-19 hospitalization data gathers far more information than it shares with the public, including how many patients are suspected to have the disease but haven’t yet tested positive, how many are in intensive care beds and how many are on ventilators.
The Agency for Health Care Administration, or AHCA, also tells Florida hospitals in its data reporting guidelines dated April 19 to exclude from official COVID hospitalization numbers people who tested positive for the coronavirus but are being treated for other medical issues — even heart attacks and strokes, which are two conditions that can be associated with complications from the disease.
More detailed data would help researchers and public health experts understand the spread of the virus, especially by analyzing trends in areas such as hospital admissions and ICU volume. But AHCA shares only how many people are hospitalized with COVID-19 as a primary diagnosis, by county. The agency began sharing that information on July 10 after pressure from public health experts.
“There is so much granularity here that we could report on,” said Jason Salemi, an epidemiologist and professor at the University of South Florida, after reviewing the guidelines. “... What’s being made available to the public right now is woeful.”
Salemi, who closely tracks the state’s COVID numbers and has built his own dashboard to monitor trends, said keeping stroke and heart attack patients who have a secondary diagnosis of COVID out of the official statistics could “muddy the waters” of the true number of cases.
He said it’s harder for epidemiologists to suss out trends and identify new hot spots with just county-level aggregate data.
Florida was one of the last three states to report current COVID hospitalization data to the public. The state health department has long included “cumulative hospitalizations” in its county reports, but that information does not allow public health experts to track the disease’s progression in a community or its strain on local hospitals.On Friday afternoon, there were about 9,200 patients hospitalized with a primary diagnosis of COVID statewide, including about 2,000 in Miami-Dade and nearly 1,300 in Broward, according to the state.
Patrick Manderfield, an AHCA spokesman, did not respond to questions about why AHCA does not share more of the information the agency collects from hospitals with the public. He said hospitals enter all information, including the primary diagnosis, into the Emergency Status System, or ESS, an electronic database.
“From the onset of the public health emergency, the agency has leveraged the ESS to collect key information to inform the state’s response,” Manderfield said.
Manderfield added that AHCA also uses ESS data to produce a daily report on COVID-positive staff and residents in long-term care facilities, such as nursing homes.
The AHCA reporting guidelines and data instructions use both stroke and heart attacks as examples of conditions that should not be counted as a COVID hospitalization even if the patients have tested positive.
In its data instructions, AHCA tells hospitals to include the current number of COVID positive patients receiving care for COVID symptoms and to “exclude patients receiving ... care for reasons other than COVID symptoms such as an accident, heart attack or childbirth.” Elsewhere in the document, the agency uses the examples of “a car accident or a stroke.”
Marcus St. John, an interventional cardiologist and medical director of the cardiac catheterization lab at Baptist Hospital Miami, said that those conditions can be triggered by COVID-19 inflammation, though he said he believes it’s unusual for an otherwise healthy person to suffer a heart attack or a stroke purely because of a COVID-19 infection.
“COVID can result in cardiovascular complications in folks who otherwise might not have had a cardiovascular event,” St. John said. “But it’s still such a common underlying condition that the majority of patients are going to have their events in spite of, not because of, COVID infection.”
St. John added that cardiovascular disease is a leading cause of death in the United States and that COVID infection is more likely to aggravate an existing medical condition that could push someone over the edge than it is to cause a heart attack or stroke on its own.
He said Baptist Hospital’s cardiology department has not been inundated with COVID-related complications. Instead, St. John suspects that more patients who need cardiovascular care are not receiving it.
“What has been more notable as a consequence is a drop-off in presentations in heart attacks and strokes by people avoiding care,” he said.
Salemi, the USF epidemiologist, said there is a general lack of transparency from state health officials on COVID-19 statistics, but he said the reporting of hospitalizations was particularly meaningful to better understand the virus.
“They’re clearly ... receiving these reports,” Salemi said. “So why are we getting such aggregated information?”
This story was originally published July 24, 2020 at 4:54 PM.
