According to the Centers for Disease Control and Prevention (CDC), there were 39,831,318 confirmed coronavirus cases in the U.S. as of August 5. The CDC map of COVID transmission rates is a solid red, with high transmission rates across the country. However, that data isn't as robust as it should be, and the number doesn't represent an accurate count of cases.

In states like Tennessee, underreporting of COVID cases has occurred every day since the beginning of the pandemic according to a report from the state's health department. While underreporting cases is common, another problem is the lack of information provided with the cases that are reported. The CDC maintains a count of COVID-19 cases based on states' reporting, but additional socioeconomic information has been missing almost in its entirety.

"You need good data to do proper planning to understand what the risk is, how the risk is changing," Epidemiologist Nancy Krieger told NPR. "And you need that to be real data that are publicly available and accessible."

Some states haven't been sending any information regarding who is actually catching COVID. Information like race, gender, age, or the location of the hospitalization or death of the patient is gathered voluntarily by states, but Texas, Missouri, Louisiana, Wyoming, and West Virginia have sent in data on less than one-tenth of their cases. In Texas, 3 million people have had COVID-19, but only 81,000 are shown in the detailed data sets, less than 3% of the state's cases.

"That is ludicrous. It is shameful. It is wrong," Krieger said. "We should have these data at this point."

A complete set of data is needed to accurately track the demographic trends in order to create new and necessary health guidance for at-risk groups. The data that is reported isn't even across types: while only 1% of data on gender is missing from the set, 36% of cases have no identified ethnicity or race. States have also failed to report which of the 15 symptoms detailed by the CDC the patient suffered from for more than 90% of cases.

"It's not because the states are not sharing those data with us. It's because the states don't have those data themselves," Paula Yoon, an epidemiologist studying coronavirus trends for the CDC told NPR.

Across the country, many counties are using their own outdated disease-tracking systems to get information from hospitals to public health agencies regarding patient demographics. These records often can't be transferred directly from the county to the state or CDC and many public health offices still use faxes. Thousands of records are being copied by hand, one answer at a time.

According to public health officials, many health departments didn't want interference from outside systems that they weren't familiar with in their county. Making this decision is up to each county and can't be regulated by the state or CDC.

"I wouldn't touch that with a 10-foot pole," former Texas State Health Department supervisor Diana Cervantes told NPR. "We don't want to start getting in power struggles with the locals."

Cervantes told NPR that county officials don't care what the state has to say because they don't have to answer to them. Some counties simply refuse to provide data.

"We've done a successful job in mitigating a suburban county's spread. And at this point, we're ready to move on with our lives and experience the freedom that all Texans get to experience on a daily basis. We're ready to move on," Judge Todd Little told NPR regarding his county's decision to give up on getting accurate COVID data.

"It can be loud, angry, violent screaming and those kinds of things," manager of the Jackson County Health Department near Kansas City, MO, Chip Cohlmia told NPR about attempting to conduct investigations into Kansas City COVID cases. "There have been death threats on our office. There have been protests outside."

A spokesperson for the Missouri Department of Health and Senior Services estimated that the state should be able to duplicate its records in order to send them to the CDC by the end of September. Texas says it should have its case data set by October. The data each state sends will be limited based on what was collected at the county level.