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Alarmed by “near-exponential” growth in COVID-19 cases across Wisconsin, Gov. Tony Evers in September declared his third public health emergency during the pandemic and extended a statewide mask mandate to Nov. 21. The governor blamed a September spike in cases on young people clustering together as universities started a new semester with in-person classes.
Evers pointed to state data to claim his mask mandate remained an essential tool for fighting the virus.
“New cases of COVID-19 slowed down in August as a result of the (mask) mandate, but as campuses reopened the last several weeks, there has been a new surge in cases across our state,” his office said in a press release.
Opposing the Democratic governor’s action, Republicans cited COVID-19 data to reach another conclusion.
“Data is in: masks either hurt or do not seem to make a difference,” said Rep. Scott Allen, R-Waukesha, in a press release flagging “the large growth in COVID-19 positive tests since this mandate was put into place in late July.”
The scientific evidence is clear: Widespread and proper use of face masks limits transmission of the coronavirus, as do physical distancing and handwashing. But contradictory messages from state leaders illustrate how data alone cannot help Wisconsinites agree on how to respond to a politicized pandemic that has infected more than 244,000 Wisconsin residents and killed more than 2,150 as of Nov. 5.
Allen has since learned about the virus firsthand. He told the Waukesha Freeman on Oct. 3 that he had tested positive for the virus and was experiencing symptoms: losing his sense of smell and taste while feeling fatigued.
Wisconsin’s public health agencies each day release a deluge of data about where and how quickly COVID-19 is spreading. The river of information helps communities gauge everything from where to expect new outbreaks to which hospitals are likely to see a flood of patients. And the data have helped businesses, school districts and others evaluate tools such as face masks, which have become a cultural and political flashpoint.
But the data are hardly perfect, particularly as underfunded public health agencies scramble to report them in real time. And as the wealth of information grows, real and perceived gaps have fueled arguments from skeptics of public health regulations and muddled the public’s understanding of the pandemic.
Unprecedented levels of data
The Wisconsin Department of Health Services, like other state health agencies, publishes nearly real-time data about topics ranging from COVID-19 cases, hospitalizations, deaths, testing capacity, outbreak investigations and demographic trends related to the disease.
Many local health departments offer additional data.
The La Crosse County Health Department has tracked how quickly their often overwhelmed contact tracers alert people about potential exposures. It has also named establishments linked to outbreaks, but paused that practice. That was due to a surge in cases that made La Crosse one of the nation’s top virus hotspots in September and strained the agency’s capacity. The Washington Ozaukee Public Health Department has named schools within its two-county jurisdiction where students or teachers have tested positive.
Choosing and calculating those metrics has proved challenging, public health officials say. That is partly due to the federal government’s lack of guidance and Wisconsin’s sprawling public health apparatus. An example of this dynamic: daily differences between the data local health authorities and the state Department of Health Services report.
Dr. Ryan Westergaard, state epidemiologist for communicable diseases, defended Wisconsin’s COVID-19 data practices during a July 30 media briefing. Citing the uniquely urgent circumstances of the pandemic, Westergaard said discrepancies are bound to occur when so many agencies are releasing data daily.
Such frequent reporting is “truly without precedent” in public health, Westergaard said, noting that agencies typically release similar data for other diseases monthly or annually to allow time for analysis and to correct errors.
The state health agency’s “Outbreaks in Wisconsin” listing offers the state’s most comprehensive source of COVID-19 data, an assortment of spreadsheets, graphs and maps depicting COVID-19’s impact on Wisconsin.
But the data visualizations can confuse the casual observer.
The free-flowing data has inundated health agencies with questions from news media and other members of the public since March, and short-staffed communications offices have struggled to keep up.
For instance, questions from WisContext about how the state defines and tracks COVID-19 cases labeled “active” and “recovered” extended for weeks as reporters exchanged sometimes confusing messages with DHS. As it turns out, the definition for “recovered” cases is ripe for misinterpretation; it simply means patients are no longer considered infectious — not necessarily that they have overcome symptoms.
Still, the state agency occasionally makes data experts available to sort out confusion. It also published a series of explanations about how to interpret its data.
“We’ve had a lot of conversations recently about this,” said Traci DeSalvo, acting director for the state’s Bureau of Communicable Diseases, adding that the agency prefers releasing as much data as possible — even at the risk of public misinterpretation.
“It’s really a transparency thing and wanting to be consistent with what other states are doing,” DeSalvo said.
Data bottlenecks fuel suspicions
Wisconsin’s COVID-19 data primarily flows through the Wisconsin Electronic Disease Surveillance System, a secure central clearinghouse where healthcare providers and laboratory technicians upload reports about test results.
Some local health officers have criticized the surveillance system as ill-equipped to handle the urgent needs of their departments as the disease surges across Wisconsin.
They include Jeanette Kowalik, the former health commissioner for the city of Milwaukee, who in late September joined the growing ranks of public health officials leaving their positions amid the pandemic’s tumult.
Kowalik, who took a job with a Washington, D.C.-based health policy organization, called Wisconsin’s surveillance system “an archaic technology” that wasn’t built to handle the steady waves of daily test data.
Among Kowalik’s frustrations with the system: For most of the pandemic, local health departments weren’t able to automatically tally negative COVID-19 test results from within their communities. Instead, workers had to first manually confirm each negative result.
“For that not to be automated has created a huge bottleneck for us,” Kowalik said.
This limitation has led to reporting bottlenecks in multiple communities. A Dane County backlog of negative results temporarily inflated the county’s rate of positive tests — a crucial statistic for measuring outbreaks.
The episode led some critics, including Republican leaders in the state, to accuse officials in Dane County, a Democratic stronghold, of intentionally inflating positivity rates to justify its pandemic public health restrictions, which are among the most stringent in the state.
“While processing negative tests is cumbersome there is no reason the counties intent on living shut down cannot keep up,” Washington County Executive Josh Schoemann tweeted on July 24 in response to a Milwaukee Journal Sentinel story about Dane County’s reporting backlog. “In (Washington County), we have the team in place to contract (sic) trace positives & notify negatives. Living w/ COVID takes leadership, not lockdowns.”
Kirsten Johnson, health officer for Washington and Ozaukee counties, said problems with manually entering negative test results in the surveillance system prompted her team to refrain from reporting positivity rates during much of the pandemic.
“It’s just the way the system is set up, and it’s been a huge challenge for everyone since March,” Johnson said. “It’s time consuming, and it takes a lot of human capital to do it.”
Staff are in short supply at chronically underfunded public health departments overwhelmed with the Herculean task of responding to COVID-19. Budget boosts during the pandemic have largely funded testing and contact tracing efforts.
Just one full-time Washington Ozaukee Health Department employee manages the flow of COVID-19 data, spending most time tallying negative results, Johnson said. In October, the state delivered a long-promised system update to allow automatic tallying of negative results.
Transparency and trust
Wisconsinites can gaze across the Mississippi River to see the high stakes in publishing and communicating COVID-19 data.
The Iowa Department of Public Health lost public trust after acknowledging in August a glitch in its COVID-19 data reporting system. The flaw erroneously lowered the state’s case numbers, and it fueled concerns about how the state calculated a key metric for assessing the safety of returning to in-person K-12 schooling.
Iowa Gov. Kim Reynolds, a Republican, made returning to in-person instruction a top priority, and barred districts from moving any instruction online unless 15% or more of local tests return positive over a two-week period.
However, the Iowa health department’s 14-day test-positivity statistics have not aligned with those local media calculated based on the state’s own public data, and officials haven’t clearly explained the discrepancies.
Sowing more confusion, a state health department spokeswoman in August erroneously said Iowa was calculating the metric by averaging daily positivity rates over the two-week period — instead of dividing all confirmed cases by all test results.
Wisconsin officials say the described method skews the data, overweighting results on days with lower numbers of tests reported. But Iowa’s COVID-19 dashboard indicates the state actually calculates the metric in the same way as Wisconsin — properly weighting the results, despite the spokeswoman’s description to the contrary.
The errors and inconsistencies eroded trust between Iowa’s state and local health officials during the crucial lead up to the new school year. Des Moines Public Schools even defied the state’s demands to begin the year in person, openly questioning the metrics and public health advice.
Johnson, the Washington and Ozaukee County official, said she continues to err on the side of transparency, drawing on her research from the 1918 influenza pandemic, when Wisconsin’s robust public health system limited statewide deaths from a disease that killed an estimated 675,000 Americans.
“The communities that fared the best were the ones who were most transparent with the information they had,” Johnson said. “So that was sort of our guiding value going into this, and that’s still our value.”