A general view of the Centers for Disease Control and Prevention Edward R. Roybal campus in Atlanta, Georgia on April 23, 2020. - The worldwide death toll from the novel coronavirus pandemic rose to 186,462 on April 23, according to a tally from official sources compiled by AFP at 1900 GMT.
White House orders hospitals to bypass CDC with data reporting
02:05 - Source: CNN

Editor’s Note: Kent Sepkowitz is a CNN medical analyst and a physician and infection control expert at Memorial Sloan Kettering Cancer Center in New York. The views expressed in this commentary are his own. View more opinion at CNN.

CNN  — 

The White House disclosed on Tuesday that it is shifting the collection and analysis of certain Covid-19 data from the historic recipient, the Centers for Disease Control and Prevention, to the Department of Health and Human Services (HHS).

When Michael Caputo, the assistant secretary for public affairs at the department, confirmed the decision, he said in a statement that a “new faster and complete data system is what our nation needs to defeat the coronavirus and the CDC, an operating division of HHS, will certainly participate in this streamlined all-of-government response. They will simply no longer control it. … The CDC’s old hospital data gathering operation once worked well monitoring hospital information across the country, but it’s an inadequate system today.”

This sudden change – which anonymous officials told The New York Times came as a shock to the CDC – has raised concerns from many that the centralization in Washington, DC, might allow deliberate misrepresentation of the Covid-19 data for political purposes.

I share the concern (strongly).

We have seen the governors of Georgia and Florida be accused of inaccurately reporting data to show it in the cheeriest light. Candice Broce, a spokeswoman for Georgia Gov. Brian Kemp, apologized in a May 11 tweet for a graph of new confirmed cases that was misleading and caused confusion. The graph has since been taken down.

The alleged interference in Florida was so heavy handed that the lead data analyst for the state, Rebekah Jones, claims she was fired for refusing to manipulate data. Gov. Ron DeSantis has disputed Jones’ claims, calling the situation a “non-issue.”

And governments led by autocrats admired by President Donald Trump, including Brazil (Jair Bolsonaro) and Russia (Vladimir Putin), have also been accused of having their fingers in the data jar, trying to fictionalize the pandemic. In Russia, an unexpectedly low Covid-19-related fatality rate sparked much international suspicion, but little has changed in the methods used to define a Covid-19 associated death, and the country continue to deny it has manipulated data.

In Brazil, the Supreme Court had to step in to stifle Bolsonaro’s plans at complete data suppression. But their current reporting remains, to my eye, suspicious. As with Russia, the amount of reported cases and deaths have dipped at times despite a lack of sufficient resources or governmental attention applied to the problem.

It is easy to imagine that this sort of tough-guy domination of the data is increasingly appealing to President Trump as the US struggles with the realities of a disastrously mismanaged, raging pandemic.

But I have a hunch that the White House will have buyer’s remorse much sooner than later. Ironically, it is the lack of a single payer health care system in the United States that likely will thwart any efforts to suppress and misrepresent data. Medical care here is composed of a series of sort-of-interlocking-on-a-good-day groups that have no standardized way of doing much of anything.

An attempt by free marketeers to impose a classic single payer process onto the Rube Goldberg system we use now seems doomed to fail.

Caputo and other administration officials likely have no idea just how big a task it is to collect tens of thousands of cases a day, organize them, display them graphically and wake up again the next day to do the exact same thing. HHS has selected TeleTracking, a well-regarded company from Pittsburgh that has expertise in smoothing out hiccups and bumps in any hospital’s data collection. Months ago, the company also developed a handsome Covid-19 tracking dashboard.

Before getting into the business of displaying Covid-19 data, TeleTracking was known for developing systems to assure efficient electronic information flow. This could be used to help a hospital rapidly determine when, for example, a room on the ward is clean and ready to receive an ER patient.

But placing them into the hot seat during the height of a historic pandemic is essentially like deciding on April 14 (July 14 this year) that TurboTax will take over the functions of the Internal Revenue Service – in the name of efficiency.

Though it is likely that TeleTracking has been preparing for this task for several weeks, effective now, at the current daily infection rate of more than 50,000 new cases a day, they will receive information on more than a million cases a month and daily administrative reports from thousands of health care centers.

They quickly will realize that there are large differences in serving private clients who have reached out to them versus the avalanche of publicly reported information they are about to receive. After all, previous hospitals that could afford to call in TeleTracking for help are the sort of hospitals with enough staff to report clean, polished data.

But many hospitals are cash-strapped and do not have the personnel to devote adequate time for the task, especially during a raging pandemic that has strained resources and morale. In making the shift, Caputo and HHS have addressed a real problem in data quality. But the issue is not, as Caputo suggested in his statement, that the CDC can’t handle the data, it is that most health care systems simply cannot provide it in a timely fashion.

Knowing how arduous the task of collecting data on each case and each hospital bed can be, the CDC prepared and updated education modules before they were recently removed.

According to the announcement by Caputo (a political operative installed to head the HHS program) and the 13-page HHS how-to guidance, the TeleTracking program will feature different (and more streamlined!) forms, with slightly different definitions and processes. Training people to use them … that’s another matter.

Plus, it is not clear that Caputo knows what he wants. The HHS guidance issued is for “Hospitals, Hospital Laboratory, and Acute Care Facility Data Reporting.” But no new guidance is given for collecting information on the vast majority of patients with Covid-19: those diagnosed in clinics, drive-through testing sites, and, hopefully soon, using home test kits. To actually improve the situation, the “all-in-government” response also will need to track the trends in new cases since that is what drives hospital utilization.

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    Furthermore, there is no guidance regarding what large private labs, which run the majority of diagnostic tests, are to do with their results. And what about insurance companies that will be collecting all of this data for their purposes and undertakers and the team of vital statistics experts who record the fate of each human?

    There is also the odd end-run built into the HHS guidance that allows hospitals the “right” to report data directly to the state, not the federal government, a local waystation that will conform to scientific, not political standards.

    Caputo’s declaration that, with this shift, the CDC will “no longer control” critical data is chilling. But in truth, the CDC never controlled the data – and neither will the HHS. The data is everywhere; or in political-speak, the system is extremely leaky. With illness, the truth will come out and sooner than the administration realizes. Death is impossible to conceal; tragedy cannot be “streamlined.”

    Perhaps the White House is aware of all of this and the real plan then is to simply create more chaos and more distrust of facts as a means to benumb the entire population, as has been suggested.

    However, the one lesson of the pandemic learned by everyone, except it seems by those in the White House, is this: Covid-19 is not a problem with a political solution, it is a tragedy of historic proportions.

    Misdirection, brutal dominance, chaos for its own sake, blaming the other guy – all of it falls flat in the face of thousands of sick and dying Americans. HHS would be well advised to put their full efforts into controlling the pandemic, rather than the news about the pandemic.