Ohio COVID-19 death, hospitalization data flagged in state audit

The state’s method of tracking COVID-19 related hospitalizations and deaths was one of six issues flagged in a performance audit of the Ohio Department of Heath released Wednesday.

“When counting the total number of hospitalizations and deaths, ODH does not differentiate between hospitalizations and deaths by COVID-19 and with COVID-19,” the Ohio Auditor’s Office said in the report. “This guidance conflicts with other federal and global public health organization guidance, which should be studied by ODH.”

“While ODH counts deaths in accordance with CDC guidance, some medical professionals may complete death certificates in a manner that allows for inclusion of some individuals who did not die due to COVID-19 but rather of other causes while also testing positive for COVID-19,” the report continued.

During the course of the audit, ODH also identified over 4,000 death certificates that had not been reconciled to the Ohio Disease Reporting System, which resulted in death statistics being inaccurate from October 2020 to February 2021.

>> Up to 4,000 COVID-19 deaths possibly under reported by Ohio Department of Health

“ODH has remedied the issues with death data reporting and is in alignment with the recommendations listed, including but especially the recommendation regarding implementing best practices in reporting COVID-19 deaths,” ODH Director Stephanie McCloud said.

Once the 4,000 deaths were discovered, ODH transitioned to using solely death certificates in reporting COVID-19 death data earlier this month. That led to the state only reporting COVID-19 deaths twice per week.

“The current method of reporting mortality data, which changed to the “gold standard” of mortality data on March 2 prior to the release of the audit findings, uses EDRS information from death certificates coded by the National Center for Health Statistics,” the health department said in a statement. “This verifies the death was a result of COVID-19.”

ODH said it rapidly transitioned to a pandemic response unseen in modern times when COVID-19 hit last March.

“This effort also required the ODH team to collect, analyze, and publish data for public consumption and understanding, oftentimes from antiquated technology and systems that were not designed for a pandemic or at the scale or speed at which they were needed,” McCloud said. “Indeed, COVID-19 shone a bright light on the impact of inadequate funding for state and local health departments, particularly in the areas of technology and informatics.”

Ohio Auditor Keith Faber said in general the numbers reported during the pandemic have been correct. He said ODH is taking steps to improve some operational issues and implement some of the recommendations made in the audit.


“I hope the Department continues to use this audit and our recommendations to improve its response to COVID-19 and any future pandemics,” Faber said.

The audit started in September and was part of a multi-state plan to study COVID-19 data collection and data management. It included offices from Ohio, Delaware, Florida, Mississippi and Pennsylvania.

“While our analysis of the data provided uncovered minimal errors and inefficiencies, opportunities to improve transparency, and methods to collect better data certainly exist,” Faber said. “For instance, the “COVID-19 dashboard” created by ODH, while informative, can be confusing and overwhelming for non-medical professionals. This makes drawing conclusions from the data harder for Ohioans and could lead to misinterpretation.”

Faber credited ODH for continuing to adapt public communication to what the public has demanded.

“This adaptation has progressed as ODH leadership has changed hands – from an ODH Director initially focused on being the voice of Ohio’s response, to now a third director focused on fixing operational shortcomings,” Faber said.

Dr. Amy Acton was the Ohio Department of Health Director when the pandemic began last March and she stepped down from the role in June. An interim director, Lance Himes, was named until current Health Director McCloud was named by Gov. Mike DeWine in early November.

When McCloud was named as Director of ODH a new role also was created. Chief Medical Officer Dr. Bruce Vanderhoff has become the face of medical expertise in the state, appearing during DeWine’s news conferences on a regular basis.

The auditor’s office also said it received 15 entries on its hotline established to report inaccurate test results and other concerns related to the virus. The report said “our ability to investigate these complaints was restricted by ODH’s assertion that HIPPA prevented us from matching these complaints with data in ODRS.

The first recommendation to ODH from the auditor’s office was for the health department to examine its current framework for collecting data and ensuring that its complete and accurate.

“In particular, the collection of negative test is critical for the accurate calculation of percent positivity, which is a metric that is used by policy makers to make decisions regarding mitigation efforts such as opening schools,” the report read.

Faber also said there is significant information available to the public, but said the usability and clarity of the information could be improved to better guide policy decisions.

The Auditor also said ODH should work with local health departments to better align data reporting to reduce skepticism that comes from differing data.

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