The D.C. auditor is urging city officials to release even more data on COVID-19-related deaths and coronavirus cases in the city’s schools, and to initiate a comprehensive review of the District’s COVID-19 pandemic response to create a record of “what worked and what should be done differently in the face of a similar health emergency.”
The recommendations come in a report released Monday by the Office of the D.C. Auditor, which examined the District’s COVID-19 data reporting. Amid concerns about gaps in data, state auditors have launched an effort to track such reporting across the U.S.
The D.C. auditor’s findings were largely complimentary of the efforts of D.C. agencies, including DC Health. The audit concluded that the agency built detailed systems and teams to collect, analyze and report COVID-19 data and fine-tuned them over the course of the pandemic.
But the report also makes several recommendations for releasing more data it says the public needs, especially as the pandemic grinds on.
Gaps in school data
The audit report noted “substantial improvement” in the reporting of COVID-19 cases in the District’s schools over the past several months, including a detailed look at overall cases by school type — public, private or charter — as well as a weekly breakdown of total new cases.
However, schools with five or fewer COVID-19 cases since the beginning of the pandemic are left off the list, and the report also identified potential significant gaps in tracking the testing of students. That could have important ramifications as thousands of students prepare to return to classrooms later this month.
For the coming school year, city officials told the D.C. Council last week that they aim to regularly test 10% of students with signed consent forms, which is in line with recommendations from the Centers for Disease Control and Prevention on surveillance testing in schools.
But data uncovered by the auditor’s office indicates this could be a heavy lift. In March, when there were just 10,000 students attending in-person classes, fewer than half — about 3,800 students — had the necessary consent forms on file. That meant the system could test just 4% of students attending in-person classes.
“All of a sudden, we now have way more than 10,000 students coming back to school in a couple of weeks across the city, and some schools have already started,” said Erin Roth, director of education research with the D.C. auditor’s office. “So in light of our failure to meet 10% of the population for asymptomatic testing last year, it remains to be seen how we’re going to meet … an even higher total number of students this year, especially given that the consent form is not yet available.”
While the school data dashboard contains the overall number of cases, it doesn’t contain data on the number of cases identified through surveillance testing, or even the total number of students attending in-person classes at each school.
“Without that context, it makes it pretty impossible to tell the prevalence of cases in schools thus far,” Roth said.
Auditors also noted a continued lack of reporting of cases at child care centers.
“This lack of a one-stop shop for data on cases at child care centers is not in line with practices of our neighboring jurisdictions,” the report stated. “For example, Virginia is reporting outbreaks in multiple congregate settings, including daycare centers.”
‘Missed opportunities’ reporting deaths
Similarly, auditors said they identified potential gaps in the reporting of COVID-19-related deaths that led to “missed opportunities” in communicating with the public.
D.C. reports the daily number of new deaths in a daily press release, but not in a central place on its data dashboard.
“We still don’t have reporting on new deaths,” said Jennifer Bianca Browning, an analyst with the D.C. auditor’s office. “That’s kind of one of the most basic indicators you could have. If I wanted to look at our data dashboard and see, when did we have the most deaths over the pandemic, I can’t see that right now.”
In addition, auditors discovered other gaps. For example, throughout the pandemic, the Office of the Chief Medical Examiner (OCME) produced detailed internal reports on COVID-19 deaths, including other health conditions patients had at the time they died. But these reports were never made public.
For example, one such report from October 2020 revealed that 70% of COVID-19 deaths up to that point involved patients with high blood pressure and nearly half had diabetes.
“We could find no reason why this information was not made public,” the report stated, especially because the data could have provided context and support for a decision in the spring to prioritize COVID-19 vaccinations for people with certain high-risk medical conditions ahead of the general population.
However, the audit report also praised OCME in instances where they were particularly forward-thinking.
OCME began investigating deaths as possible COVID-19 cases in January 2020, some two months before the District’s first reported case, and it had a system in place for having highly trained medical examiners certify every COVID-19 death, which meant the District didn’t have to report some deaths as probable.
In other parts of the U.S., deaths are certified by a mix of chief medical examiners and coroners. Some are not well-trained, according to the National Center for Health Statistics, which said it has seen problems with death certifications in about 20% to 30% of reported COVID deaths across the country, in part because of the lack of a centralized system.
After-action report needed
The report praised other aspects of the District’s pandemic response, including D.C.’s contact tracing program.
“While there has been some critical feedback about the program from residents and complaints about safety protocols from contact tracers, we saw evidence that the contact tracing system has been continually strengthened and adapted,” the report concluded. “In addition to spending several hours speaking with us, DC Health’s contact tracing team maintained a positive and open tone with our team, such as being frank about challenges and sharing documents freely. This response is notable as other audit shops have not received such cooperation and transparency.”
A report by the Hawaii state auditor, for example, criticized that state’s response to its inquiries, reporting that “instead of cooperation and assistance, we encountered barriers, delays, and ultimately were denied access to those responsible for leading the department’s contact tracing.”
While the D.C. report’s findings are largely positive, Browning emphasized it was not a full performance audit.
“We were in the middle of a pandemic — we’re still in the middle of a pandemic,” Browning said. “We didn’t want to overburden DC Health and the Office of the Chief Medical Examiner and, really, the District government, who continue to be actively responding. So we looked more at the processes that were in place, and we looked at what data was reported.”
Still to come is an evaluation of the effectiveness of the District’s response.
“When the pandemic is over, we strongly believe that we need to know what worked well and what didn’t,” Browning said. “And so we are urging the mayor and the government to really do this comprehensive after-action report that can tell us” what aspects of the District’s response were effective.