Updated 4:05 p.m. ET
The Trump Administration has mandated that hospitals sidestep the Centers for Disease Control and Prevention and send critical information about COVID-19 hospitalizations and equipment to a different federal database.
From the start of the pandemic, the CDC has collected data on COVID-19 hospitalizations, availability of intensive care beds and personal protective equipment. But hospitals must now report that information to the Department of Health and Human Services, which oversees the CDC.
The change sparked concerns among infectious disease and health care experts that the administration was hobbling the ability of the nation's public health agency to gather and analyze crucial data in the midst of a pandemic.
Michael Caputo, HHS Assistant Secretary for Public Affairs, defended the administration's decision and said that CDC's system was too slow.
"The CDC's old data gathering operation once worked well monitoring hospital information across the country, but it's an inadequate system today," Caputo said in a statement shared with reporters. "The President's Coronavirus Task Force has urged improvements for months, but they just cannot keep up with this pandemic."
Public health experts expressed dismay and confusion over the reporting change because of how it could disrupt public access to the data. It also comes at a time when the Trump White House has openly sparred with CDC Director Robert Redfield and other federal scientists about the pandemic response.
"It's really hard not to see this as some kind of interference or snub [to] the CDC," says University of Arizona epidemiologist Saskia Popescu. "With so many concerns over the politicization of data right now, this is concerning."
Redfield defended the change in a call with reporters Wednesday, saying it was designed to "streamline reporting."
"No one is taking access or data away from CDC," Redfield said.
But a top career scientist at the CDC in charge of collecting and analyzing COVID-19 data from hospitals says the new reporting system ignores the agency's valuable expertise and disrupts CDC's decades-long relationships with hospitals.
"We have high confidence in the consistency and completeness of the data that hospitals are reporting using the [existing] system," says Dr. Daniel Pollock, a medical epidemiologist and surveillance branch chief for CDC's Division of Healthcare Quality Promotion. "We have a long standing working relationship with the hospitals, we have means to do quality checks over the incoming data, as well as rapidly getting to hospitals where we have identified data gaps."
Since March, hospitals have reported daily information on the availability of hospital beds, ventilators, and personal protective equipment to an established data collection network run by CDC called the National Healthcare Safety Network or NHSN, which has operated for years.
As of Wednesday, July 15, hospitals are being instructed by HHS to shelve that system, and instead to report to a new site set up by HHS using a private contractor.
Pollock of CDC says switching to this new platform disregards the relationships with hospitals CDC has developed over the years, since it has "been stood up relatively recently" and adds that it also lacks "the track record and the expertise that we're able to provide."
The new system was set up by TeleTracking, a private company based in Pennsylvania, which was awarded the $10 million contract in a non-competitive bid in April. In June, Senator Patty Murray (D-Wash.), the ranking member of the Senate health committee wrote a letter to CDC Director Robert Redfield, asking why TeleTracking was awarded the contract on a non-competitive basis.
"It's entirely unclear why the Trump Administration has asked states and hospitals to upend their reporting systems in the middle of a pandemic — in 48 hours nonetheless — without a single explanation as to why this new system is better or necessary," Murray wrote in a statement to NPR. "The Trump Administration is going to have to give a full justification for this, because until they do, it's hard to see how this step won't further sideline public health experts and obscure the severity of this crisis."
Hospitals have left been scrambling, given only a few days to prepare for the new reporting system.
"It was very surprising — shocking even, I would say — for many of us to realize yesterday that we would be now required to report to HHS on [this new] platform," says Cassandra Pierre, acting hospital epidemiologist at Boston Medical Center.
On Monday, an email flagged "Special Bulletin" from the American Hospital Association and obtained by NPR, informed hospitals of the data reporting change, and indicated that distribution of remdesivir, a drug that's been used to treat hospitalized COVID patients, would be tied to the daily data reported into the TeleTracking portal. "The daily reporting is the only mechanism used for the [remdesivir] calculations," the email from AHA reads.
HHS could not immediately confirm if failure to switch to the new HHS system means that a hospital will no longer get this key drug therapy from the federal government.
In a call with reporters, José Arrieta, the chief information officer at HHS said that easing the reporting burden on hospitals was one of the goals of the new system. "We're making it as easy as possible for them to report to us," he said.
Pierre says she does not think that this change will make things easier for hospitals. "No matter how user-friendly and innocuous the system is, there will be a period of time where we have to learn about it, how to use it, how to integrate it into our normal daily workflows," she says. "Regardless of how low of a burden they're trying to create, it really will only add work [for] us."
She adds that the existing system that went to the CDC seemed to be working well. "NHSN is a system that we trust," Pierre says. "It's been around for a long time. It functions very well. It's been built to accommodate all sorts of hospital or health care associated infections, including COVID-19."
Dr. Grace Lee, a pediatric infectious disease physician and associate chief medical officer at the Lucile Packard Children's Hospital at Stanford, agrees that the CDC system has been working well.
"I'm very surprised that we are being mandated to report into a parallel system when hospitals have gotten used to reporting into NHSN. It's adding burden at a time when hospitals again are now responding to the surge of COVID-19," she adds, "The timing couldn't be worse, to be honest."
Jennifer Nuzzo, senior scholar at the Johns Hopkins Center for Health Security, says she worries the new mandate is an end-run around the CDC. She notes that separating out the hospital data from other coronavirus case and death data reported to health departments could present problems.
"Surveillance benefits from being integrated — to be able to see multiple data streams in the same place, to be able to be able to compare them," she explains. "When they're captured by completely separate systems by completely separate agencies [...] it will be harder to make comparisons and to do the deeper analysis — trying to understand if, say, rising cases are contributing to rising hospitalisations or vice versa."
Caputo of HHS said in a statement the new system was faster than the CDC system, which has "at least a week lag in reporting hospital data," and that the CDC "will certainly participate in this streamlined all-of-government response. They will simply no longer control it."
Pollock at CDC expressed doubts that a new system will improve the time lag. "I think we are readily capable of receiving data on a daily basis and reporting those daily data out in a very timely way and making those data available at a pace that is no quicker via the other means of reporting," he said.
Of major concern for public health experts with this new change is how transparent and available the data will be once it's submitted to HHS and TeleTracking.
"We absolutely need to see a commitment from the administration for transparency in making sure that that data and information is public and verifiable," says Ashish Jha, director of the Harvard Global Health Institute.
On Wednesday, online pandemic dashboard COVID Exit Strategy noted that the CDC data it had been using to monitor ICU and hospital bed occupancy was no longer available. "Our hope is this loss of critical public health information is temporary," an update on the site reads. "HHS is instituting a new process for collecting information from hospitals. The aggregate data from that system should be made public."
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