The Alabama Department of Public Health and Centers for Disease Control and Prevention (CDC) compile data about the COVID-19 novel coronavirus from a number of sources. Detailed data allows public health professionals, policy makers and health care providers to better understand and track the size and scope of the outbreak and strengthen prevention and response efforts.

No raw data is available to the public, so the information can appear confusing or inconsistent unless one gets into the specific definitions and explanations.

The CDC states on its website that number of positive tests in a state is not equal to the number of cases, as one person may be tested more than once. For example, 48 million total tests are reported in the U.S., with 4.5 million positive tests reported, or 9%.

“Provisional death counts may not match counts from other sources, such as media reports or numbers from county health departments. Counts by [incoming data from death certificates] often track one to two weeks behind other data,” explained CDC spokesperson Benjamin Haynes.

A spokesperson with the ADPH COVID-19 Response Team clarified Monday that “an individual is only counted one time. Each person tested is assigned a patient ID number, so that patient is counted using that number only once, no matter how many times they are tested. When a death occurs in a person who tested positive for COVID-19, the record is reviewed by an ADPH physician to determine factors related to deaths and whether the death is attributable to COVID-19.”

ADPH has conducted testing, case investigation and contact tracing since the beginning of the pandemic. The agency has about 85 staff members working on contact tracing and death investigations. A death investigation can take one hour or less once the medical records are received.

When a death occurs in a person who tested positive for COVID-19, the record is reviewed by an ADPH physician to determine factors related to death and any comorbid conditions.

The CDC concedes that “counting exact numbers of COVID-19 cases is not possible because [it] can cause mild illness, symptoms might not appear immediately, there are delays in reporting and testing, not everyone who is infected gets tested or seeks medical care, and there are differences in how completely states and territories report their cases.”

The CDC bases fatalities on death certificates using information reported by physicians, medical examiners, or coroners in the cause-of-death section of each certificate. Data from each of these pages is pending verification and are therefore subject to change. Counts from previous weeks are continually revised as more records are received and processed. Because not all jurisdictions report counts daily, counts may increase at different intervals.

“Confirmed deaths” have a laboratory confirmation of SAR-CoV-2, the virus causing this coronavirus, while “probable deaths” have no confirmatory laboratory testing performed for COVID-19.

The state recognizes that the process isn’t perfect due to rapid fluctuations in individual circumstances.

“(ADPH) does not receive hospital discharge data, making it difficult to collect all elements on patients discharged from the hospital with COVID-19. Other information changes daily as some patients are removed from ventilators or ICU in one facility while patients in other facilities are being placed on ventilators or in ICU. Thus, data would be inaccurate. Alabama is looking at ways to report patients who no longer have symptoms at the time of interview or are asymptomatic at the time of interview as measures of improvement. The term ‘recovered’ does not have a uniform definition in COVID-19 as of the moment.”

“The Alabama Department of Public Health is constantly reviewing and reassessing processes including data reported and its format,” the spokesperson said.

The COVID-19 Data and Surveillance Dashboard does not reveal information beyond the county level.

“When providing zip code and additional information, especially in rural areas with small populations, considerations regarding patient identity and privacy have to be taken into account. Additionally, zip code data does not give a true picture of where a person may have contracted the disease since people do no remain in one zip code,” the spokesperson said.

For the most updated figures, visit the dashboard at https://alpublichealth.maps.arcgis.com.

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