Increased demands for public information and not enough people to process data are among the reasons for a 36 hour lag in reporting new COVID-19 cases in Hawaii, health officials say.

The Hawaii Department of Health receives reports of positive COVID-19 test results on a rolling basis through the state’s electronic laboratory reporting system.

But the data verification process involves sifting through 4,000 to 5,000 test results daily, identifying and deleting duplicate tests and checking for other reporting errors, according to Janice Okubo, spokeswoman for the health department. Once the data is scrubbed, the state’s data team sends reports to county district health offices and other agencies such as the Hawaii Emergency Management Agency.

“When we started this back in March there were much fewer cases but staff had to start their day early in the morning to do that,” Okubo said. “With the increase in cases we just have to make adjustments so our staff is able to handle this kind of workload in addition to all of the other data products that we put out for the public.”

State health officials say they’re intentionally delaying reports of new COVID-19 cases to ensure accuracy.

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The health department posts new case numbers every day at noon. But cases posted on Friday, for example, reflect lab results submitted to the health department on Wednesday. Previously, the reporting lag was 15 hours instead of 36.

The increased lag in reporting prompted an outcry this week among some state lawmakers and a University of Hawaii epidemiologist, Hawaii News Now reported.

Lt. Gov. Josh Green, who declined to comment for this story and deferred questions to the health department, said in an interview Wednesday with Hawaii News Now that he planned to take up the issue in discussion with health department leadership.

Some counties, including Hawaii County and Kauai County, publish case counts in advance of the statewide report.

Dr. Janet Berreman, the Kauai District Health Officer who is involved with collecting new infection and fatality data for Kauai, said there’s a reason why Kauai’s county-level reports are sometimes faster than the statewide report: the Kauai district health office is sometimes able to verify new local infections directly.

About three-quarters of the infection reports the Kauai District health office receives are from hospitals, clinics or doctors who report them directly, she said, as opposed to relying solely on the state’s statewide report. The Kauai team then verifies those local documents with the state’s daily list.

“That flow of information maybe gives us a 12 to 24 hour head start,” she said.

A medical technician demonstrates how to administer a COVID-19 test during a free testing clinic at the Waikiki Shell, in Honolulu, HI, Wednesday, November 11, 2020. (Ronen Zilberman photo Civil Beat)

A medical technician demonstrates how to administer a COVID-19 test during a free testing clinic at the Waikiki Shell. The state now has a 36-hour lag for posting test results.

Ronen Zilberman/Civil Beat

When the Kauai district receives the statewide report from DOH’s central Oahu office, Berreman and her Kauai district staff use it to cross-check the information with the local case reports.

It’s possible that the state’s electronic laboratory reporting system has identified cases that Kauai doctors are not yet aware of, she said. Berreman believes Kauai’s practice is only possible because of the island’s small network and relationships she and her colleagues have with health providers on the island.

“The local information flow — that’s not a methodology that’s scalable to Oahu or statewide,” she said.

The weekly trends, Berreman says, are more important to pay attention to than daily counts, which can fluctuate. Constant escalating cases elsewhere in the nation are also important to watch, she said.

“What matters is are we going up and are we going up more steeply than last week, or are we going down or are we staying stable?” she added.

Reporting lag times vary across the nation. In Nevada, county-level reports also differ from statewide reports, according to Nevada Health Response.

Okubo and other health department officials did not respond to questions about how many staff members were specifically dedicated to producing daily data reports.

The state health department has also yet to verify more than a dozen deaths that occurred on the Big Island.

Information about COVID-19 related fatalities is collected differently, according to Okubo. Rather than electronic reports, the health department receives documentation directly from a coroner, hospital or facility where the person died.

Health officials review paperwork to verify the death correctly shows COVID-19 as the cause of death.

“Medical records come from the facility or individual who is verifying that the death did indeed take place,” Okubo said.

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