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Disputes over coronavirus case counts in reopening states like Georgia, Arizona, and Florida are worrying public health experts, who fear public trust in health agencies is being destroyed by moves to silence or obscure unwelcome data.
“Ultimately this is going to kill people,” said biostatistics professor Ruth Etzioni of the Fred Hutchinson Cancer Center in Seattle. “People are going to see low numbers from these reports with manipulated numbers, go outside when they should stay in, get ill, and die.”
As those three states pushed to ease stay-at-home orders in recent weeks, they have each reportedly taken steps to obscure data that would have run counter to their plans, hiding or misapplying complete numbers of those who have died or become ill from COVID-19. The White House’s April guidelines to states called for a 14-day downturn in case counts before reopening, but the three states and others have proceeded before that happened.
Most public health projections see cases dipping nationwide from the effects of the past stay-at-home orders, but then climbing as May ends as people get sick from new exposures during reopenings. The data problems in Georgia, Arizona, and Florida come as overall US coronavirus cases counts stand at more than 1.5 million, with over 92,000 deaths. New US case reports have declined to less than 25,000 new cases a day in May, however, down from more than 35,000 a day in late April. More than 40 states have in the last month reopened businesses after widespread stay-at-home orders in March led to staggering US unemployment and financial losses.
Among the hard-hit states is tourism-heavy Florida, which reopened on May 4. The head of the state’s widely praised coronavirus dashboard, Rebekah Jones of the Florida Department of Public Health, reported in an email update on Friday that she had been removed from her role for "reasons beyond my division’s control." Jones, who had previously won praise from White House coronavirus task force leader Deborah Birx, later told a local TV station that the state had asked her to “manually change data to drum up support for the plan to reopen.”
The Florida Department of Public Health did not respond to a query from BuzzFeed News over whether it had manipulated data to make reopening more attractive. A statement sent from Helen Ferré of the office of Florida Gov. Ron DeSantis said “Rebekah Jones exhibited a repeated course of insubordination during her time with the Department, including her unilateral decisions to modify the Department’s COVID-19 dashboard without input or approval from the epidemiological team or her supervisors.” Ferré added that Jones had until Thursday to resign or would face termination.
Jones did not respond to requests for comment. An email sent to her work address bounced back on Wednesday morning.
The Sunshine State was criticized in April for pressuring medical examiners not to release their COVID-19 death counts, then 10% higher than official state figures. A Tampa Bay Times report on Wednesday concluded that COVID-19 had likely led to “hundreds” of unreported deaths in Florida since March.
Arizona started a limited reopening plan on May 8. Four days earlier state officials directed Arizona State University and University of Arizona researchers modeling the projections for state coronavirus cases to “pause” all their work. “Also, we have been asked to pull back the special data sets which have been shared under this public health emergency effort,” the order said, according to a copy obtained by BuzzFeed News.
The university models had suggested the only way to keep deaths from rising in the state was to delay reopening until the end of May, but the state officials had said they wanted to rely on federal models instead. After the researchers said they planned to continue releasing their projections anyway, the state backed down from the pause order.
Georgia was among the first states to reopen business, on April 27. The state was criticized last week for mistakes in its data just ahead of its reopening, showing that new cases in counties with the highest infection rates had been in a steady two-week decline when in fact they’d stayed flat. The same errors were made three times. Critics suggested that the mixed-up dates and incorrect case counts were part of misleading bids to suggest that fewer people were getting sick just ahead of reopening.
The accuracy of case count data is essential for safe state reopenings, which rely on declining case numbers, accurate testing data, and hospitalization rates to proceed in states like Virginia and California, still under regional lockdowns.
A recent Georgia Tech report suggested that people staying at home rather than readily mixing after Georgia’s reopening would cut the peak of June and July cases in the state by 40%. That makes strong public messages about physical distancing and staying at home crucial during any reopenings, the report concluded.
“When public health agencies are not being transparent, not being complete and accurate over the long term, they are fundamentally undermining the trust of the public,” said George Washington University health policy professor Jeffrey Levi. The pandemic will likely see repeated periods of calls for stronger physical distancing to blunt future outbreaks, making this particularly dangerous, he added. “The next time you tell them to trust your data, they won’t.”
The pandemic is already a tough situation for collecting accurate data, Levi noted. Many people don’t get tested because of a lack of symptoms or poor access to tests, and reports from New York, New Jersey, and Michigan have suggested large undercounts of deaths are likely. A healthcare company in Florida reported on Tuesday that as many as 33,000 people there were given unreliable diagnostic tests, not the first time that unreliable tests have muddied the waters for epidemiologists.
Most worrisome, the three-week lag between the onset of a COVID-19 outbreak and deaths in hospitals shooting upward makes maintaining public trust in public health agencies even more crucial, said Levi. He called the allegations being raised against the state public health agencies altering data and censoring scientists "unprecedented."
“Anything short of full transparency does not serve the public good,” American Public Health Association President Lisa Carlson told BuzzFeed News. “People make mistakes; people dispute data. What’s important is to get to, and to maintain, accurate, timely, and complete data — and transparency.”
Zahra Hirji contributed reporting to this story.