Until a few days ago, hospitals had been reporting COVID-related data—including number of beds and ventilators available and number of COVID-19 patients—to CDC’s National Healthcare Safety Network (NHSN), a longstanding system for tracking healthcare-associated infectious diseases. Now, per a guidance document that was largely unnoticed until the New York Times’s Sheryl Gay Stolberg reported on it, the Department of Health and Human Services (HHS) has directed hospitals to instead report their data to an “HHS Protect” database managed by the private contractor TeleTracking (a contract that Senator Patty Murray requested answers about in early June).
A key difference between the old CDC system and the new HHS system is that CDC’s NHSN makes data publicly available, whereas HHS Protect is not sharing data with the public. This is a problem for the government officials and researchers who relied on NHSN data to track the spread of COVID-19, anticipate hospital demands in the days ahead, and build and refine models that can inform future prevention and response activities. “Overall, this is vital information to help understand severity of the pandemic & make decisions,” University of Arizona epidemiologist Saskia Popescu tweeted.
White House coronavirus response coordinator Deborah Birx reportedly spearheaded the abrupt transition with the stated goal of streamlining and improving data collection. Although CDC’s reporting infrastructure is older and slower than it should be, public health experts have expressed alarm about the lack of transparency and thoughtful planning. Former CDC director Tom Frieden posted some key unanswered questions on Twitter:
What data will be collected, how, by whom, and with what standards, under what authority? What quality checks and privacy safeguards will be implemented? How will the institutions collecting the data be supported? How will accuracy and completeness of data be assured? With whom will data be shared, and for what will it be used?
American Public Health Association Georges Benjamin and the leaders of several other public health organizations issued a statement warning that the shift is counterproductive and will increase concerns about political interference with data:
In the midst of the worst public health crisis in a century, it is counter-productive to create a new mechanism which will be extremely complicated to build and implement. Another area of concern is that the planning for this new approach did not substantively involve officials at the local, state, tribal and/or territorial levels. This is a time to support the public health system not take actions which may undermine its authority and critical role.
Americans must have confidence in the integrity of health data and its insulation from even the suggestion of political interference. Sending these sensitive data to a newly created entity overseen directly by the White House will not eliminate such concerns, it will increase them.
Benjamin and the others note that the shortcomings in CDC’s current system result from a fragmented and underfunded public health system and state, “That underfunding should be corrected rather than bypassed.”
CDC initially removed NHSN data from its website, then restored it with notices stating “Dashboards last updated as of July 14, 2020” and “IMPORTANT: Data displayed on this page was submitted directly to CDC’s National Healthcare Safety Network (NHSN) and does not include data submitted to other entities contracted by or within the federal government.” The Washington Post’s Lena Sun and Amy Goldstein report that CDC officials were reluctant to maintain the dashboard without receiving the data firsthand. It’s not clear whether CDC will resume updates in the future.
Concerns about hospital personnel’s ability to update their reporting procedures while also handling a growing COVID-19 caseload are proving to be well-founded. On July 18, the COVID Tracking Project noted that some states had not reported hospitalization numbers and gave the new HHS reporting requirements as a reason. Project managing editor Erin Kissane tweeted that they hope to see reports stabilize, and that this is likely a temporary loss. But it still raises the question of why HHS would make such an abrupt shift with so little notice.
Politics and trust
Even if hospitals are able to transition to the new system and its backers are able to assure the necessary quality, transparency, and public availability of hospital COVID-19 data, public trust in the data source, or HHS’s motives for changing it, may not recover. Michael Halpern of the Union of Concerned Scientists writes:
The president has indicated multiple times his desire to curtail testing and hide or manipulate the data to downplay the seriousness of this pandemic and bully states and localities into doing what he wants. Indeed, the Trump White House has a well-established track record of suppressing or manipulating data for political purposes on all kinds of issues, including and especially during the COVID-19 pandemic. “We ran the CDC,” wrote four former Republican and Democratic CDC directors last week. “No president ever politicized its science the way Trump has.”
… Data collection processes need to be carried out by independent experts. It is very easy for biases to negatively influence how data are collected, analyzed, and cleaned up in a way that can manipulate the results. HHS staff will undoubtedly be under immense political pressure to utilize misguided methods or engage in full-on manipulation of the COVID-19 data in a way that scientists and the public may not be able to detect.
Hospitals’ COVID data plays an essential role in responding effectively to the pandemic. The Trump administration has taken it out of the hands of trusted scientists who shared it with the public and made it the responsibility of a more-political agency and a private contractor. Given what we know about this administration’s disregard for science, even in the face of a global pandemic, this move is cause for great alarm.