While there are a lot of articles about the difficulties of accurately determining the number of COVID-19 deaths, there are far fewer that get into the nuts and bolts of why this is so. As some asshole with a blog noted:
…this is a result of massive underfunding of public data collection, and also the failures of privatized data collection. We excel at using ‘big data’ to determine what needless crap you will be more likely to buy–and by “excel”, I mean dump tons of money and personnel into that (this is a substantial part of the tech economy, which is to say, advertising). At the same time, we have massively underfunded public data collection, to the point, where most of these systems are run on shoestring budgets with too few personnel. Those personnel are almost always tasked with simultaneously keeping existing systems from collapsing, while somehow also developing new systems, while underpaid and given too few resources for the amount of work they’re expected to do ([personnel] retention is an issue).
A recent article expands on this further (boldface mine):
We sought to identify barriers to hospital reporting of electronic surveillance data to local, state, and federal public health agencies and the impact on areas projected to be overwhelmed by the COVID-19 pandemic. Using 2018 American Hospital Association data, we identified barriers to surveillance data reporting, and combined this with data on the projected impact of the COVID-19 pandemic on hospital capacity at the hospital referral region (HRR) level. Our results find the most common barrier was public health agencies lacked the capacity to electronically receive data, with 41.2% of all hospitals reporting it. We also identified 31 HRRs in the top quartile of projected bed capacity needed for COVID-19 patients in which over half of hospitals in the area reported that the relevant public health agency was unable to receive electronic data. Public health agencies’ inability to receive electronic data is the most prominent hospital-reported barrier to effective syndromic surveillance. This reflects the policy commitment of investing in information technology for hospitals without a concomitant investment in IT infrastructure for state and local public health agencies…
The most prevalent barrier, reported by 41.2% of hospitals, was that public health agencies lacked the capacity to electronically receive data. Interface-related issues (e.g. costs, complexity) were the next most common, reported by 31.9% of hospitals. Other barriers included difficulty extracting data from the EHR (14.7% of hospitals), different vocabulary standards (14.2%), hospitals lack the capacity to electronically send data (8.3%), or hospitals do not know to which public health agencies they should send data (3.3%)…
At the same time, labs shouldn’t be let off the hook either (boldface mine):
In the area of lab reporting, the report noted up to half of lab reports submitted to public health can lack a patient address or zip code, often key demographic data elements used in identifying infection clusters and localizing disease hotspots.
We are getting what we do (and don’t) pay for.