>The real problem is if/when scope begins to increase these processes are sufficient until they aren't, and the tools aren't flexible enough to gracefully manag

>The real problem is if/when scope begins to increase these processes are sufficient until they aren't, and the tools aren't flexible enough to gracefully manage the transition. That's a good point. I'd also add that, at least in the US, we don't have any sort of national standard for such things. Each public health department (and there are >1,000 of them in the US) has their own set of processes and procedures. I'd expect that the CDC has a proper database system and that data from those 1000+ entities is collated into that system. However, state and local laws/rules require specific handling of such data and can differ significantly from state to state, county to county or even town to town. Attempting to stand up an integrated nationwide system isn't a bad idea. But doing so while trying to manage a pandemic isn't reasonable. That many places used Excel spreadsheets for storing testing data is neither surprising or necessarily a bad thing. Until March, no one needed to have huge databases of test results -- now we do. Complaining that places which had , at most, a few dozen cases of reportable infectious diseases should have implemented a database that can support thousands (tens of thousands?) of test results seems rather silly to me.