As Orange County moves to re-open more businesses in the coming days, officials are relying largely on hospitalization numbers to see if coronavirus trends are getting better, worse, or stabilizing.
Yet in the past few months, getting a sense of how many people are actually in the hospital on any given day in Orange County has been a challenge.
County numbers on hospitalizations are lower than those tracked by the state.
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After being questioned by Voice of OC, Orange County Health Care Agency officials now say they’re now looking at publishing a more consistent picture of coronavirus hospitalizations, after weeks of posting optional data that’s missing some hospitals on most days.
Under the county’s data stream, which is what’s been reported so far on its public website, the number of hospitals that report fluctuates each day, from 21 hospitals on some days to 25 on others. The county asks all 25 hospitals with emergency rooms to file the optional reports.
The county’s hospitalization numbers often drop on days when hospitals miss the daily reporting deadline and then shoot back up on days when all hospitals file their reports.
The county is now looking at instead publishing a state dataset that is mandatory from hospitals, and includes all 32 acute care hospitals in the county.
“We were talking about, coincidentally, changing it over and reporting that [state] data,” said Dr. Gagandeep Grewal, the county’s associate director of emergency medical services, in an interview this week.
“Unfortunately we’re kind of looking at two data sets that are unfortunately faulty. One is more consistent, which is the state data – you’ll more consistently see the full complement of hospitals reporting, but not always,” Grewal added.
“Sometimes it dips down to two of [the hospitals] are missing, or three of them are missing” among the 32 hospitals in the state data, he said.
But the swings of 25 to 21 hospitals in the county data “is a pretty significant swing,” Grewal added, calling it “an issue.”
Regarding why the county hasn’t been showing the state data from more hospitals in OC, Grewal said, “It’s not a bad question, and it’s a fair question, and it’s something that might very well happen.”
If the county does decide to post the state data, he said, it probably would replace the existing county data, so that the trends over time are based on the same data source.
Hospitalization data is now a key part of state standards for counties to re-open faster. Under the new threshold released Monday, counties are expected to have less than a 5 percent growth in weekly hospitalizations for COVID-19 before advancing further into re-opening.
In their application to open up more quickly, Orange County officials are using the state data to calculate the change in local hospitalizations over time.
On some days, when more hospitals are reporting, the county data is similar to the state data, with has 2 fewer patients than the state data. On other days, particularly when fewer hospitals file their reports to the county, the county data has 50 fewer patients than the state data. On May 16, for example, the county reported 201 people hospitalized with coronavirus, while the state data reported 251.
Grewal said the county asks the 25 hospitals with emergency rooms for data because those are the hospitals the public would go to if they sought emergency medical care. The state dataset includes about 32 hospitals, including both those with emergency rooms and other acute care hospitals that don’t have emergency rooms but do treat COVID-19 patients. The state reports are mandatory from hospitals, and the county data is voluntary.
Having complete hospitalization data is important for medical providers to make good decisions, said Dr. Paul Yost, chairman of the CalOptima, the public agency that is the largest health insurer in Orange County.
“The most consistent and complete data that we can get out to the public and the healthcare professionals is incredibly critical for us to make good decisions,” Yost said this week.
The county “absolutely” should be posting the more complete, consistently-collected data on its website, he said.
State Sen. Tom Umberg (D-Santa Ana) Umberg has been raising questions about the county data and why the number of hospitals that report changes day to day.
“My wife pointed out to me about two weeks ago, maybe a little bit longer, that you can’t compare apples to apples” with the county data, when on some days 21 hospitals are reporting, and on others 25 are.
Umberg said he wants to see “that we report consistent, accurate data. And as I look at the county’s chart, it’s hard for me to be able to assess.”
When hospitals miss the daily deadline for their voluntary report, county officials previously said they did not ask hospitals to report those figures and they do not end up in the voluntary data.
“We do not request prior days data, but we do send the list of ‘non-responders’ to the hospital association who follows up with the executives in order to encourage compliance,” Health Care Agency officials said in an emailed response to questions last month.
Grewal said the overall trend is what’s most important, and that they’re similar in both the county and state datasets.
“The trends are similar” in both datasets, Grewal said.
“If we have an exponential rise in patients, and we keep reporting this flat curve, then we’re doing a disservice. But I’m very confident we’re not doing that.”
Andrew Noymer, an associate professor of public health at UC Irvine, said the big-picture trend in both datasets are indeed similar.
“This doesn’t look like anything that I would consider untoward,” Noymer said. “I’m not seeing anything in here that’s like a red flag.”
While county data shows fewer hospitals and is inconsistent in how many report, the state data has issues like the number of intensive care and non-intensive care patients not adding up to the totals, Grewal said.
“We’re kind of dealing with imperfect data from the get-go,” said Grewal. “And whatever dataset we decide to use, previously now and in the future, is flawed. And that’s just based on who enters the data, not based on anything” the county or state do wrong.
The mandatory hospital data that the county doesn’t currently report is published online by the California Department of Public Health. It’s available on this page by clicking the blue “Download” button, opening the downloaded spreadsheet, sorting by county, scrolling to Orange County and viewing the numbers under “COVID-19 Positive Patients.” These numbers show the number of patients each day with confirmed COVID-19 infections based on laboratory test results, according to the state.
Nick Gerda covers county government for Voice of OC. You can contact him at email@example.com.