DC Health officials are defending their current COVID data reporting process, after two-weeks worth of missing case numbers prompted lawmakers to question the agency’s accuracy.

It’s the latest installment in a saga over how — and how often — the city publishes public COVID statistics, with councilmembers asking the agency to scale up its reporting as COVID cases surge. In March, the city stopped publishing daily COVID numbers and instead shifted its focus to analyzing weekly trends in case rates. (D.C. isn’t alone in this — nearly every state in the U.S. by this point has foregone public daily case counts.) In March, officials said weekly reporting would better help the public assess risk, but with cases rising and many going unreported thanks to at-home rapid tests, residents and lawmakers are scrutinizing the agency’s public dashboards.

Last week, Ward 1 Councilmember Brianne Nadeau sent a letter to DC Health director Dr. LaQuandra Nesbitt, calling for an investigation into why two weeks of COVID data went missing. The city failed to report those numbers to the Centers for Disease Control at the beginning of the month. (While D.C. updates its own dashboard weekly, it frequently sends raw case numbers to the CDC). After two weeks, DC Health restored the data, but failed to explain how the error occurred. In Nadeau’s letter, signed by six other lawmakers, she also asked that the city report its weekly COVID data on Mondays, two days earlier than the current Wednesday data dump, and restore the dashboard that shows outbreaks in certain settings.

Nesbitt responded Thursday to lawmakers with a letter of her own , largely defending the agency’s current data reporting process and stating that any changes to reporting wouldn’t be feasible, given the stress that the public health staff is under. She characterized the lawmakers’ letter as a public statement that “had the unfortunate effect of undercutting trust in DC Health and public health.”

“The current public health workforce is experiencing a high degree of psychological stress, commonly referred to as ‘burnout,’  having experienced of two years of 12+ hour workdays, attacks — both physical and verbal — on public health professionals, and significant misinformation about public health and our work,” reads the letter, first reported by Axios and later obtained by DCist/WAMU.

Nesbitt’s letter addressed the missing the CDC data, but didn’t exactly explain why it happened. The city sends case data to the CDC automatically through AIMS — a data sharing information system — and also manually. According to Nesbitt’s letter, the automatic data was still sent to the CDC via AIMS during those two weeks, but DC Health’s data team suspended the manual submission of data “out of an abundance of caution.”

Patrick Ashley, a senior officer at DC Health, explained to DCist/WAMU that the manual data entry was temporarily suspended by a member of the agency’s data team in order to check for accuracy. Unlike the case data that’s submitted automatically, manual entry allows for DC Health to “clean” the numbers for increased accuracy. For example, if the same resident tests positive three days in a row, that automatic data submitted to the CDC will show three unique cases — but that’s not really three different cases. This manual data cleaning is also why when new data is posted, it’s often posted a few days after the last collection date of the reporting period.

“[The data team] just wants to make sure the data was was fully accurate,” Ashley said of the two-week gap. “And so that that was why there was a pause there. There was never a policy decision that said, you know, ‘we’re going to stop this.’ It was just a decision about making sure the data was accurate.”

Nesbitt’s letter further goes on to to reject the lawmakers’ request to publish data on the city’s websites on Monday instead of Wednesday, claiming that “shifting weekly reporting from Wednesday to Monday would increase burnout, decrease morale, and it will not improve the public’s ability to understand their public health risk.” She also rejected their request to reinstate outbreak surveillance, citing an updated CDC recommendation; the CDC now only recommends outbreak surveillance in high-risk settings like jails or when 10 or more cases are linked to transmission in a specific setting. 

“Outbreak reporting no longer serves the same purpose it did earlier in the pandemic and so has ended,” she writes.

In a phone call with Ashley and City Administrator Kevin Donahue on Friday, councilmembers reiterated their concerns with the weekly reporting. Chairman Phil Mendelson said he was confused by the city’s current COVID dashboard, which was last updated on Wednesday this week. It shows that for the week of May 8 to May 14, the city reported a case rate per 100,000 resident of nearly 300 — putting the city in the “medium” spread zone. (That’s up significantly from 168 the week prior.) Mendelson noted that  today, May 20th, that data is already a week old.

“Maybe this is just a bit Pavlovian…we’ve gone through these cycles where we see these spikes, and the number of cases most currently on the website is over 100 more per 100,000 [residents], than in the week before. If this is going to start to grow the spike the way it did last spring, don’t we want to know more recently than once a week?” Mendelson said.

Ashley admitted that it may be confusing, but that there’s inevitably going to be a lag when reporting case trends over weeks. Still, he maintained it’s a helpful measure for residents.

“No matter how you try to explain it, it’s certainly confusing. But again, as we look at it on a week-by-week, trend basis, that’s what we want people to look at,” Ashley said. (He also explained the manual data entry pause to councilmembers on the call.)

Nadeau said during the call that the lawmakers’ letter was a last resort at getting some answers from the agency, but that ultimately the council and DC Health are working toward the same goal of keeping residents informed.

“When we sent our letter last week, it was in large part because there’s been really an information vacuum, and even when we’ve asked questions via email, we haven’t gotten the answers,” Nadeau said during the call.  “We try to do everything we can and then we send a formal letter, but let’s not have a whole media war about it, that was not the intent. We may not all agree on how the data needs to be reported, or when or why, but all of us are working together to serve the people of the District of Columbia.”

Aside from disagreements on data dashboards, Nesbitt’s letter did provide a hopeful update on wastewater surveillance — a valuable tool in assessing the spread of the virus in a community, as it can often identify new variants and potential surges early. According to Nesbitt, DC is expanding its wastewater collection to include more than 20 locations, and will report this data to the National Wastewater Surveillance System.

This post was updated with additional comment from DC Health senior officer Patrick Ashley.