ABSTRACT
Background. High-quality data are necessary for decision-making during the SARS-CoV-2 pandemic. Lack of transparency and accuracy in data reporting can erode public confidence, mislead policymakers, and endanger safety. Two major data errors in Iowa impacted critical state- and county-level decision-making. Methods. The Iowa Department of Public Health (IDPH) publishes daily COVID-19 data. Authors independently tracked daily data from IDPH and other publicly available sources (i.e., county health departments, news media, and social networks). Data include: number and type of tests, results, hospitalizations, intensive care unit admissions, and deaths at state/county levels. Results. Discrepancies were identified between IDPH and non-IDPH data, with at least two confirmed by IDPH: (1) The backdating of test results identified on May 28, 2020. IDPH labeled results as occurring up to four months before the actual test date. IDPH confirmed that if a person previously tested for SARS-CoV-2, a new test result was attributed to the initial test's date. Corrections on August 19, 2020 increased positivity rates in 31 counties, but decreased the state's overall rate (9.1% to 7.5%). (2) The selective exclusion of antigen test results noted on August 20, 2020. Antigen testing was included in the total number of tests reported in metric denominators, but their results were being excluded from their respective numerators. Thus, positive antigen results were interpreted as de facto negative tests, artificially lowering positivity rates. Corrections increased Iowa's positivity rate (5.0% to 14.2%). In July 2020, the Iowa Department of Education mandated in-person K-12 learning for counties with < 15% positivity. These data changes occurred during critical decision-making, altering return-to-learn plans in seven counties. The Center for Medicare and Medicaid Services' requirements also caused nursing homes to urgently revise testing strategies. Timeline of changes to Iowa state COVID-19 testing through the end of August 2020. Change in positive and overall test results due to IDPH data corrections. These graphs represent the difference in cumulative total reported test results when pulled from the IDPH website on September 29, 2020 compared to data for the same dates when pulled on August 19, 2020 before the announced adjustment. The adjustment and subsequent daily changes in reported data amount to a dramatic change in the number of reported positive cases (A) with an increase of nearly 3,000 cases by April 25, as well as the loss of tens of thousands of data points when tracking total resulted tests (B). Conclusion. Data availability, quality, and transparency vary widely across the US, hindering science-based policymaking. Independent audit and curations of data can contribute to better public health policies. We urge all states to increase the availability and transparency of public health data.
ABSTRACT
Background. Fifteen states have defunded family planning health centers (FPHCs), causing thousands to be left without health services. This has accelerated in the COVID-19 era. FPHCs provide low-income individuals in rural areas with essential primary care services, including sexually transmitted infection prevention, testing, and treatment. The purpose of this analysis is to use spatiotemporal methods to examine the impact of FPHC closures in Iowa on the reported number of gonorrhea and chlamydia cases at the county level. Methods. This analysis investigates the association between FPHC closures and changes in the number of gonorrhea and chlamydia cases between 2016 and 2018. Iowa implemented defunding policies for family planning clinics, resulting in four FPHC closures in June 2017. 2016 pre-closure STI incidence rates were compared to 2018 post-closure rates. Gonorrhea and chlamydia rates in the four Iowa counties with clinic closures were compared to the 95 Iowa counties without closures. T tests were used to compare changes in reported gonorrhea and chlamydia rates in the two settings. Linear regression modeling was used to determine the relationship between clinic closures and changes in gonorrhea and chlamydia cases. Results. The gonorrhea burden in Iowa increased from 83 cases per 100,000 people in 2016 to 153.8 cases per 100,000 people in 2018. The four counties with clinic closures experienced a significantly larger increase (absolute 217 cases per 100,000 population) in their gonorrhea rate compared to counties without FPHC closures (absolute 121 cases per 100,000 population). There was also a significant relationship between clinic closures and increasing gonorrhea rates (p = 0.0015). Over the three-year period, there was no change in chlamydia rates (p = 0.1182). However, there was a trend towards counties with more FPHC closures having a higher number of chlamydia cases (p = 0.057). Conclusion. Despite the fact that many STI diagnoses are made and reported by FPHCs, our data suggest that clinic closures may have contributed to an increase in gonorrhea and chlamydia cases. This is consistent with delayed diagnoses and missed opportunities for providing essential STI services to vulnerable and under-served rural residents. Legislative action is urgently needed to curtail this trend.