I do not do disease investigation as my regular job. I do have experience in it from other roles before my actual job. I've been pulled in because, if you haven't heard, there is a minor pandemic going on outside and I do have experience doing this stuff. They didn't have to train me, they could just throw me in. I was familiar with the state's reporting system which is old and ugly and doesn't work well, so I was an early adoption. The teams, both regular investigation and long term care investigation continue to grow and new teams are being actively started including a food facility team.
I can only speak to my state and their protocols, and even then, there will be things I can't answer.
I will not divulge the state I live in. Sorry.
The day I'm posting this I am not working, so I am taking the day for myself and trying not to ponder work stuff too much. I will likely answer some stuff today, but ask away and if I don't get to you the day you ask, I will get to you eventually.
Alright, so onward. I work at a local health department assisting with long-term care outbreaks and investigation. I help guide facilities on how to best reduce spread of disease. Some fun resources I've posted in Chat and Pubski include CDC's disease surveillance website and the Council of State and Territorial Epidemiologists' (CSTE) case definition for COVID-19, because as of April 28th, CDC hasn't posted a surveillance definition.
Some fun things I posted in Chat, literally copy and pasted below, because some people are dismayed chat disappears over time.
KB's WaPo Article that kicked this whole thing off: https://www.washingtonpost.com/investigations/2020/04/27/covid-19-death-toll-undercounted/?arc404=true
I never put this in Chat, but one of the concepts of death I want people to consider -- Someone has a heart attack while driving. They crash their car. They die. Did they die from the heart attack or the car crash? Is this person's cause of death heart disease, or accident? How do we keep statistics as accurate as possible? There's no right or wrong answer, it's simply a though-experiment to ponder. We can bring this to COVID too. We have a 98 year old on hospice. All of a sudden, they get COVID-19 as the cherry on top. Poor bastard. They die. Expected, they were already on hospice. Did COVID-19 kill them and do they get counted in that, or are they counted as what was already killing them even if COVID might have killed them vaguely prematurely. There's no answer which is why this whole thing is so difficult. Alright, back to regularly scheduled programming, the Chat copy-pastes.
So on KB's WaPo article... I think a big reason is the way deaths are counted. I know in my area, we need a death certificate noting a cause of death of COVID-19 to put into the state system that yes, COVID-19 was a contributing factor in the death. That gives the state the option to only count deaths with death certificates, and not necessarily include deaths in people diagnosed with COIVD-19. I will admit I don't know if the state is considering that "did condition contribute to death" question in their count, but it's a question in the system and something they can filter by. And I think a big reason on why states are underreporting deaths is to make them look better. No state wants NJ's issue of a nursing home where everyone is presumed positive, or where the morgues are too full and they're just throwing bodies in the basement. So if they can keep that number artificially low, it keeps the eyes on other states. It's all a massive shitshow.
@am_Unition : Oh it gets even more fun. Welcome to the wonderful world of Disease Investigation. Alright, so every reportable disease has a case definition. For the most part, they're on the CDC's website. It's buried deep, but the state system links to it and I'm sure other state systems do as well. That website is here: https://wwwn.cdc.gov/nndss/conditions/. Okay, so now that you've looked through that, you'll see COVID-19 isn't even on there! Fortunately, we have our friends over at The Council for State and Territorial Epidemiologists (CSTE) to thank, because they've released a defintion that we are using. We being my area, others within the state and other states, who knows. Again, I can only speak for what we are doing. So CSTE's definition is available in this ten page PDF document: https://www.med.ohio.gov/Portals/0/CSTE%20COVID-19%20Case%20Definition_1.pdf. It boils down to -- Confirmed is PCR test through an EUA lab. Probable is other types of tests, including antibody, again from an approved lab, but that person also has to be exhibiting specific symptoms or have an epidemiologic link. Then Probable can also be the same set of specific symptoms and an epi link. The last probable is death certificate (remember that one? Ha). So now we get to what is actually happening, especially with respect to asymptomatic people. We see a massive facility. 150 people. They decide to test everyone. Whoops, they don't do their research and use a lab under EUA review, but not with EUA approval yet. FDA has even said if you're a lab in good standing, whatever that means, and if you validate your test in some magic way, again super vague, that you're fine and don't need anything more. But this specific lab is not EUA approved. As such, right away no case from the facility can be "confirmed" per the definition. Now due to the way we're dealing with healthcare facilities, you live or work in one, you have epi link. So that's not a concern. The problem is symptoms at this point. Every case with a positive result from a test under EUA review who is asymptomatic or not showing the correct symptoms gets counted as "Not a case". We don't even waste time putting it in the system. If that test gets EUA approval, we will not go back and change anything, because we aren't putting them in the system and we're told not to put them in the system at a later date. Now one of my facilities decided to test the entire population. 60-75% of the reports I've recieved so far don't meed clinical defintion, and as such aren't even a case. This way, state gets to say look, we have cases, but we're keeping case counts in facilities low. There's a massive ordeal around long term care facilites and COVID. Being able to keep case counts low but not too low is a good thing. It feels like that's what they're trying to do.