Recently, Daniel Chang of the Miami Herald published a piece about the Florida Department of Health's underreporting of Zika cases. Shortly after that piece, the DOH sent out a rebuttal (see below). We spoke with Chang about where he got his information and what questions the state has refused to answer.
What is your take on the DOH's rebuttal of your story?
My take is that it was a defense of their policy to keep information from the public that individuals can use to take precautions against the spread of Zika, and this is according to the public health experts who we spoke with. They [DOH] didn't identify any errors. They didn't request any corrections. They made statements that were clearly uninformative, and in my opinion didn't necessarily refute the story. I'll give you an example: There was a line in their press release where they said that the Florida Department of Health reports on Zika more frequently than any other agency, something along those lines. Nobody was questioning the quantity of information or the quantity of reports that they issue every day. We're talking about the quality of information that they're putting out and that people can use, once again to take precautions, whether that's to drain standing water on their property, use extra repellent, perhaps avoid certain areas. And lastly it also appeared to me they make a big deal out of CDC guidelines, but they appear to cherry-pick the CDC guidelines when it suits them. For instance, they follow CDC guidelines when reporting local Zika infections, which are reported by state of residence. But that doesn't mean that they can't inform the public of the total number of Zika infections that we've had in Florida as opposed to just the ones of Florida residents. They don't follow CDC guidelines when it comes to advising people about which areas to avoid in Wynwood, which we've seen them reduce the size of that zone in Wynwood from one square mile to less than one half square mile. But when you go to the CDC's website, their travel advisory telling pregnant women and their partners to avoid that area remains in effect for the full square mile.
How did you come up with your numbers?
I asked the Department of Health for them. See, this is part of what is confusing, potentially for the public. When they announced on Aug. 19 that mosquitoes were spreading Zika in Miami Beach, they said that this was based on five Zika infections that they had linked back to the city to this 1.5-square-mile zone from Eighth to 28th street. And they said that three of those five people were tourists -- one from Taiwan, one from Texas and one from New York. What they didn't tell us was that those tourists were not going to be included in the local case count. And in fact, the local case count increased by the same number of people who they said had received it. So the assumption would have been that those tourists were included and it wasn't until we asked how many cases were linked to Miami Beach and whether the tourists were included in that number that the Department of Health told us that they do not include those in their accounts. They track them down, they're aware of them but they do not report that information publicly.
What's one or two questions that you still want the Department of Health to answer and they're not answering?
Well, I think the most important one is, what are the locations of the mosquito traps that had the Zika-posiive mosquitoes in Miami Beach? And that may be the Department of Agriculture, but there are agencies that work with the Florida Department of Health and the governor's office and our county officials as part of a concerted sort of response to Zika. And we feel that if the public knew where those mosquitoes were found they could take extra precautions. So for instance, if there was a trap near your home that had Zika-positive mosquitoes and you're already in that one-and-a-half-square-mile area, you might advise a relative or a friend who's pregnant, 'Today's not the best day to come visit me; maybe I should go visit you.' You might use extra repellent when leaving your home. You might take some other action altogether. The point is is that you're providing information that's in the public health best interests. That's what the public health experts who we interviewed for this story said, and it's information that the state is choosing to withhold. We're not saying that the state is legally required to provide that information. What we're saying is the state should provide that information. But what they cite instead are statutes that exempt information gathered during epidemiological investigations that are exempted from public review. And we feel that the public health interest is greater than the privacy of those locations.
I'm trying to figure out who are they serving then because you hear from them one thing, this of course, the issue about transparency and what guidelines are they following. Then you have Gov. Rick Scott who's talking to Congress, trying to get more money to fight Zika and it seems like they're not on the same page.
Well, that's an interesting observation because there are those who wonder whether the state's undercounting of Zika cases and it's withholding of information is sending the wrong message to Congress that things aren't so bad in Florida. Maybe that's the reason that Congress doesn't share Gov. Rick Scott's sense of urgency to pass Zika funding, because they haven't gotten the message clearly up until now that we have a problem. And you know, that's what I guess you could call the double-edged sword of controlling the message.
What are we supposed to believe then is the truth and what are the real numbers?
I think what you should believe about the truth is that Zika is probably more widespread than our own health department is able to tell us. I think that health directors from CDC Director Dr. Tom Friedan, to others, including state surgeon general Celeste Philip, have already said, and these are comments that haven't gotten a lot of attention, that it's very likely that there is Zika being spread by mosquitoes in other parts of Miami-Dade County that they're just not aware of. And this is important to note because this is also something that we brought up in the story. There are 14 active investigations ongoing in this state. There are now, I think at the time we published, maybe there were 12 in Miami-Dade, which has greatest abundance of those local investigations. I want to say there are probably 11 or 12 investigations in Miami-Dade including the Zika zones that are already identified in Wynwood and Miami Beach. That means there are another eight or nine locations in Miami-Dade where people have gotten sick from a mosquito bite. And the state is investigating, The state used to provide a breakdown of each investigation and they would tell you how many people had been tested, how many people found positive, how many tests were pending, how many had they interviewed and other information like that. On Sept. 1, they removed that information from their website and instead they gave us a summary saying there are 14 total investigations -- X-number in Miami-Dade. We feel that there is information that can be helpful to the public. But even beyond that I don't understand why the health department wouldn't give people a better sense of the hard work that they're doing, because it is hard work to do epidemiological investigations, knocking on doors and asking people where they've traveled. Are there other possible ways that they could have gotten Zika? It's hard work. And I think that the Department of Health could do itself a service to communicate to the public how hard it's working by posting that information online.
Response from the Florida Department of Health.
SETTING THE RECORD STRAIGHT: FLORIDA PROVIDES ACCURATE AND TIMELY INFORMATION RELATED TO ZIKA
Tallahassee, Fla.—On Saturday, August 10th, the Miami Herald published “Florida’s Zika undercount hides extent of virus’ spread, experts say,” a story suggesting that Florida is not being forthcoming regarding the burden of Zika in our state. This story is misleading and the claims made in it are inaccurate.
The Zika virus is new to the United States and the Florida Department of Health (DOH) is working daily with our partners and the Centers for Disease Control and Prevention (CDC) to learn more about this virus and take every action to protect the public, especially expectant mothers. Since February, in an effort to keep Florida residents and visitors safe and aware about the status of the Zika virus, DOH has issued daily updates each weekday regarding the Zika virus, even prior to having local mosquito-borne transmission. No other state is sharing information on the Zika virus with the public as frequently as Florida.
CLAIM: “But the information issued by the governor and state agencies has not been timely or accurate — cases announced as “new” are often several weeks old, due to a time lag in diagnosis — and excludes details that public health experts say would allow people to make informed decisions and provide a complete picture of Zika’s foothold in Florida.”
- The department is absolutely committed to transparency as our state continues to combat the Zika virus.
- On a daily basis, our staff work with the public to provide up-to-date information on all of the agency’s Zika response, prevention and education efforts.
- As directed by Governor Scott, the department has operated a Zika Virus Information Hotline since February 12, 2016 to answer questions on the Zika virus and the state’s preparedness efforts. The number for the Zika Virus Information Hotline is 855-622-6735.
- DOH alerts the public to all cases of travel and non-travel related Zika in Florida residents when a case is confirmed through laboratory testing. Sometimes more than one test is required to differentiate between Zika and other mosquito-borne illnesses such as dengue and chikungunya.
- Zika symptoms are mild, including fever, rash, joint pain and red eyes, and could be mistaken for a common virus or different mosquito borne illness like dengue or chikungunya. When a person has Zika symptoms, health care providers must rule out other illnesses and confirm Zika virus through laboratory testing before the department can alert the public.
- Ruling out other modes of transmission is important for accuracy, and sometimes takes a week or two to reach individuals and verify facts. In some instances, consistent and thorough questioning has resulted in identifying a case as travel-related.
- For information on the department’s investigation and testing process, please click HERE.
CLAIM: “And under-reported the number of local Zika infections in Florida by excluding anyone who is not a state resident.”
- The Florida Department of Health follows guidelines set by CDC.
- CDC guidelines state that a Zika case, like ALL other reportable diseases, is reported by state of residence, not by the location of where the virus was acquired. That is why the department did not include eight cases of non-Florida residents in our case counts,per CDC reporting guidelines.
- Information on the number of out of state residents with Zika is available, however, the department, like the CDC, defers to the home state or country on whether they will announce the location of residency. Texas, Taiwan and New York all shared publicly that they had residents who had acquired Zika in Florida, other jurisdictions have not yet shared this information. Governor Scott also announced this on August 19th.
- The out of state residents acquired Zika in an area where the department has already identified ongoing active transmission is occurring so the public is already aware of the risks associated with that area.
- Also, the department identifies more infections than is required by CDC. Florida is identifying and sharing information on all people who have laboratory evidence of Zika but do not have symptoms, whereas CDC cases of Zika are people who have laboratory evidence and symptoms.
CLAIM: “The health department has refused to say how many local infections involve pregnant women.”
- Patient privacy is a priority of the department.
- The department strives to strike a balance between protecting patient privacy while providing the media and the public with information that is critical to protecting public health.
- Knowing the pregnancy status of locally transmitted cases is not necessary information to protect public health.
CLAIM: “The agency also has stopped issuing details of active investigations into local Zika cases. On Sept. 1, the health department began reporting only a summary of the total number of investigations in each county. Previously, the agency had listed each investigation by county, with the number of people tested for Zika and the results of those tests.”
- The department has not stopped providing this information. Information on active investigations, such as the number of people tested, is available to any interested media or member of the public who would like the information and we provide this information to interested parties on a daily basis.
- We’ve adjusted and improved our communication vehicles over the past several months and will likely do so again to ensure we’re achieving our mission of sharing accurate and timely information.
- The department received feedback that the way information was presented on our website was difficult to understand, so we are re-working how the information is displayed in order to make it easier for the any member of the public to easily understand.
For a detailed timeline on Zika preparedness actions taken by Governor Rick Scott, please click HERE.
For information on the department’s investigation and testing process, please click HERE.
For more information on DOH action and federal guidance, please click HERE.
For resources and information on Zika virus, click HERE.
STATE OF FLORIDA
About the Florida Department of Health
The department, nationally accredited by the Public Health Accreditation Board, works to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts.