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Several days after the federal government barred hospitals from reporting COVID-19 data to the Centers for Disease Control and Prevention (CDC), public health experts and epidemiologists continue to be perplexed at the suddenness of the move and are concerned that it may result in delayed responses to outbreaks and erroneous distribution of resources.
The US Department of Health and Human Services (HHS) posted a guidance document outlining the new data reporting changes on July 10 and held a media briefing on July 15.
At the briefing, CDC Director Robert Redfield, MD, said that data was being submitted by hospitals and states through too many sources and it would be more efficient to remove the COVID-19 reporting from the CDC’s National Healthcare Safety Network (NHSN) and funnel it all directly to a new platform created in April, HHS Protect.
“This reduces their reporting burden, it reduces the confusion and duplication of reporting, streamlines reporting, and enables us to distribute scarce resources using the best possible approach,” Redfield told reporters.
But public health officials said they were not consulted about the change — which requires hospitals to report daily to HHS Protect. And, unlike the CDC data, the HHS Protect data is not available to the public, although Redfield said it can be accessed by the CDC and thousands of its partners. HHS had not responded by publication time to a request for comment on who can access the data now and when it might be more widely accessible to the public.
On Wednesday night, the data on the CDC’s coronavirus dashboards disappeared, according to multiple news reports. The dashboards included data on hospital capacity — occupied inpatient beds, inpatient beds occupied by patients with COVID-19, and occupied intensive care unit (ICU) beds. After a public outcry, the data were restored Thursday afternoon, but only through July 14.
The department has furnished few details on the new data platform. Former CDC Director Tom Frieden, MD, who is currently president and CEO of Resolve to Save Lives, said he had many questions. “What data will be collected, how, by whom, with what standards, under what authority? What quality checks and privacy safeguards will be implemented? How will the institutions collecting the data be supported?” he asked in a Tweet. “How will accuracy and completeness of data be assured? With whom will data be shared, and for what will it be used?”
“People feel totally blindsided by this and they had no time to work with their hospitals or prepare or do the things that we in public health really like to do,” said Janet Hamilton, MPH, executive director of the Council of State and Territorial Epidemiologists (CSTE), which represents public health epidemiologists.
Hamilton told Medscape Medical News that CSTE members first found out about the data switch on July 13, and it was through a letter that had been sent to state governors — not to state health departments. Now, instead of working on COVID-19 response, “you’re going to scramble to figure out how to use this new system,” she said.
State health officials also have not gotten guidance on who will be able to view the HHS Protect data, and whether they will be receiving twice-weekly reports as they did from the CDC.
Overall, Hamilton said, “I think with this change we’re preserving fragmentation rather than eliminating it.”
“A Bad Odor”
“This new directive was issued abruptly and presents some significant challenges for Idaho to continue to monitor the number of hospitalizations in the state,” said Niki Forbing-Orr, a spokesperson for the Idaho Department of Health and Welfare.
“We’re in the process of reviewing the details of the new process to determine exactly how it will impact our ability to view and report the information on coronavirus.idaho.gov for the public to view, but it will certainly have a short-term impact on our awareness of the number of people in hospitals, in the ICU, and on ventilators,” Forbing-Orr told Medscape Medical News.
Georges Benjamin, MD, executive director of the American Public Health Association, said it appears that HHS “had no plan to make the transition — they gave people no guidance on what to do,” and just decided to switch the data collection activity to a private contractor without training hospitals or helping them with new programming.
Benjamin told Medscape Medical News he’s not against improving health data systems, but questions the wisdom of this change now. “Why wouldn’t the data also be on the CDC site?” Benjamin asked, noting that the NHSN will not be further updated with COVID-19 information.
“Why can’t the CDC site be upgraded, since that’s where most of the world gets their data from?” he asked.
“There’s a bad odor around the fact that the data is being shifted away from CDC,” said Jason Salemi, PhD, MPH, associate professor at the University of South Florida College of Public Health. Salemi has been relying on Florida state health department data to compile his Florida-centric COVID-19 dashboard.
But he has also been trying to scour state health department data to put together a national picture of how COVID-19 is impacting children. The states all collect data differently, which means it would be helpful to have aggregated data, such as the CDC might be able to provide. “It’s been immensely challenging to get a national perspective on pregnant women and children,” Salemi told Medscape Medical News.
He questions why HHS would keep the data hidden. “If they’re not making the data accessible, it’s going to be a big challenge,” he said, adding, “It’s not useful in helping to plan for the pandemic.”
Ryan Panchadsaram, a data analyst who runs covidexitstrategy.org, said in the MIT Technology Review that he has relied on the CDC data as it is the “only publicly available source of aggregated state-level hospital capacity data in the US.”
He was especially concerned that the data would not be available to private and academic researchers. “Sharing reliable data is one of the most economical and effective interventions the United States has to confront this pandemic,” Panchadsaram writes.
The American Medical Association (AMA) also objected. “We await additional details and information from the Administration on how data collection and sharing will be operationalized, but we urge and expect that the scientists at the CDC will continue to have timely, comprehensive access to data critical to inform response efforts,” said AMA President Susan R. Bailey, MD, in a statement. “Additionally, state-level aggregate data must continue to be publicly accessible, as it is used to guide reopening and closing decisions,” she said.
The National Governors Association (NGA) also took issue with the change in reporting requirements. It issued a statement on behalf of governors in all 55 states and territories requesting a 30-day delay so that hospitals can learn the new system. The NGA also urged the administration to make the data publicly available.
Reports Will Be Used to Divvy Up Resources
The CDC’s Redfield noted during the media briefing that the new platform will be used to allocate resources such as personal protective equipment and therapies in a timely way to hospitals. “I see this as an exciting addition to really make sure we can move those therapeutics to where they need to be as quickly as we can, he said.
The American Hospital Association (AHA) would not comment on the data switch, but has been sending bulletins to its members urging them to comply with the new HHS requirements.
The AHA noted in a July 13 bulletin that hospitals must report daily if they expect to be the recipient of federal supplies.
“The daily reporting is the only mechanism used for the distribution calculation,” the AHA said.