Updated July 16, 9:40 a.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 disputes that there was a significant time delay. "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."
NOEL KING, HOST:
Up until now, hospitals have been collecting data about COVID-19, like the number of cases, and sending it to the CDC so health officials can make decisions based on that data. But the Trump administration has told hospitals to stop sending it to the CDC and send it to a different database at the Department of Health and Human Services. The change went into effect yesterday. NPR's Pien Huang has been following this story. Good morning, Pien.
PIEN HUANG, BYLINE: Good morning, Noel.
KING: So what had hospitals been doing exactly? And what is the change?
HUANG: OK. Well, since the beginning of the pandemic, hospitals have been reporting directly to the CDC things like how many COVID patients they have and how many beds are available and whether they have enough masks and gloves and ventilators. And suddenly this week, many hospitals got an email from the American Hospital Association, which said don't report this information to the CDC anymore. Instead, it should go into a new system set up by a private company that routes this data directly to HHS. Or as a second option, hospitals can send the information directly to state health departments. But either way, CDC will no longer get this data directly. And a lot of people aren't very happy about that. So we spoke with Dr. Georges Benjamin, director of the American Public Health Association, who has worked in a lot of health emergencies.
GEORGES BENJAMIN: One thing that I've learned is never, ever, ever change processes in the middle of a disaster. It does not go well when you do that. No one knows what to do. And it basically confuses your response.
HUANG: Especially since it's a whole new system for many hospitals, and they were only given a day or two to make the change.
KING: In the middle of a literal pandemic, why would the Trump administration want to make this change with such haste?
HUANG: Well, HHS issued a statement saying that the CDC's reporting system was slow. And CDC Director Robert Redfield said there's a need to modernize their data collection systems. But the timing for the move is unclear. And recently, the Trump White House has been openly critical of the advice they're getting from federal scientists. So some researchers, like epidemiologist Saskia Popescu from University of Arizona, says it looks like it could be part of a pattern.
SASKIA POPESCU: It's really hard not to see this as some kind of interference or, like, snub at the CDC. It's hard not to see it that way. And I think with so many concerns over politicization of data right now, this is concerning.
HUANG: And she says that the timing for the change is awful because many hospitals are struggling to handle their COVID cases.
KING: You talked to someone inside the CDC?
HUANG: Yeah, absolutely. I spoke with Dr. Daniel Pollock. He's been with the CDC for 36 years. And his title is surveillance branch chief for the Division of Healthcare Quality Promotion. That's the group that was in charge of getting and analyzing all that hospital data. Pollock says that their data collection system wasn't slow. It was processing data as quickly as any of the other reporting methods. And he also says that the CDC has longstanding relationships with the hospitals that go back for decades. And they have a lot of experience analyzing that data. So he's not sure that the new system will be able to replicate what the CDC does.
DANIEL POLLOCK: They've been stood up relatively recently. And they don't have the track record and the expertise that we're able to provide.
HUANG: And one other big concern that others in the public health community have been raising is whether this data will be publicly available. Here's Dr. Ashish Jha. He's a global health professor at Harvard.
ASHISH JHA: We absolutely need to see a commitment from the administration for transparency and making sure that that data and information is public and verifiable.
HUANG: The administration says it'll be posting the data on an HHS platform that CDC will still have access to. And the data reporting change just went into effect yesterday.
KING: It was a private company that set up the new database. It wasn't a federal agency. What do you know about that company?
HUANG: Yeah, so the company is called TeleTracking. It's based in Pennsylvania. And it was awarded a $10 million contract back in April. Senator Patty Murray, Democrat from Washington, has pointed out that it was a non-competitive contract, which means that no other companies got to vie for it, so she's been asking why. She also says that it collects the same information and has the same capabilities as the CDC system, so she's been asking why it was needed.
KING: NPR's Pien Huang. Pien, thanks so much.
HUANG: Thanks for having me. Transcript provided by NPR, Copyright NPR.