Health Experts Warn About Perils of New Virus Data Collection System

WASHINGTON — Nearly three dozen current and former members of a federal health advisory committee, including nine appointed or reappointed by the health secretary, Alex M. Azar II, are warning that the Trump administration’s new coronavirus database is placing an undue burden on hospitals and will have “serious consequences on data integrity.”

The advisers, all current or former members of the Healthcare Infection Control Practices Advisory Committee, issued their warning in a previously unpublished letter shared with The New York Times.

The letter was made public as both hospital officials and independent data experts around the country were reporting kinks in the new system, which critics say is undermining the government’s ability to understand the course of the pandemic. The Covid Tracking Project, a respected and widely used resource, identified “major problems” with the new Department of Health and Human Services system in late July, and reported this week that “the federal data continue to be unreliable.”

The concern grows out of an order, issued last month by Mr. Azar, for hospitals to send daily reports about virus cases to a private vendor that transmits them to a central database in Washington instead of the Centers for Disease Control and Prevention, which had previously housed the data.

The information, including patient and hospital bed counts, helps guide the government’s response to the pandemic, informing critical health care decisions like how to allocate scarce supplies, including ventilators or the drug Remdesivir, approved as a treatment for Covid-19 patients.

The order raised alarm that the data could be politicized or withheld from the public. But the authors of the letter expressed additional concerns. They said that the transition from the C.D.C. to the private vendor, TeleTracking Technologies, has left hospitals “scrambling to determine how to meet daily reporting requirements” and that C.D.C. data experts had been sidelined.

“The U.S. cannot lose their decades of expertise in interpreting and analyzing crucial data,” the authors wrote, adding that the C.D.C.’s experts, from its Division of Healthcare Quality Promotion, must “be allowed to continue their important and trusted work.”

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Updated 2020-08-12T10:58:18.105Z

The letter amounts to a sharp rebuke to Mr. Azar. And it exposes what appears to be a deep rift between the C.D.C. and its parent agency, the Department of Health and Human Services, which Mr. Azar leads. At issue is who should collect, analyze — and ultimately control — data that the officials and the public use to keep tabs on the worst public health crisis in a century.

The letter’s 34 signatories are doctors, nurses and public health experts, and include the current co-chairs of the panel, Dr. Lisa Maragakis of the Johns Hopkins Hospital and Dr. Hilary Babcock, a professor in the Infectious Disease Division at the Washington University School of Medicine in St. Louis. Both were reappointed by Mr. Azar.

“These are the elite of the infection control personnel from hospitals all over the country,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University, who is not affiliated with the group. Another expert, Michael T. Osterholm of the University of Minnesota, said the letter should be taken “very seriously.”

At the outset of the pandemic, the C.D.C. expanded its National Healthcare Safety Network, which for several decades has collected information on hospital infections, to begin collecting hospital data related to the virus. Hospitals around the country are familiar with the network, which the authors of the letter described as a “robust” surveillance system. The C.D.C. published estimates of hospital bed capacity, based on the information it collected.

But officials at the health and human services agency felt the C.D.C. was not moving quickly enough. This year, they set up their own data tracking system — H.H.S. Protect — and hired TeleTracking Technologies, a Pittsburgh firm, to take over the C.D.C.’s duties. Mr. Azar made the switch official in a notice to hospitals issued on July 10, and on July 14, the C.D.C. stopped publishing its estimates.

The C.D.C. referred questions about the letter to the Department of Health and Human Services, where officials say the new system was necessary to streamline and improve data collection. A spokesman for Mr. Azar, Michael R. Caputo, said that the C.D.C.’s health care network “was unable to keep up with the fast-paced data collection demands of the Covid-19 pandemic” and that the C.D.C. still had access to the data.

“If the writers of that letter want the C.D.C. to be more involved in the hospital data, they should tell the C.D.C., because the C.D.C. has refused to be involved in something that they don’t control,” Mr. Caputo said. When the shift occurred, he added, “they had a tantrum.”

After critics raised concerns about access to the data under the new system, the health and human services agency created a new website, the H.H.S. Protect Public Data Hub, to make its analyses of the data public. The website also includes a link to the underlying data, which is far less user friendly than the analyses.

While health department officials say the underlying data is updated daily, The Wall Street Journal reported Wednesday that outside experts who are tracking the pandemic say there has been a lag of a week or more in reporting key indicators that flow from the analyses, such as estimates of the share of inpatient beds occupied by Covid-19 patients.

In comparing state hospitalization data with the new federal data this week, the Covid Tracking Project noticed major discrepancies. In some states, the Department of Health and Human Services’s figure was higher, and in others, it was lower.

“Hospitalization data used to be a reliable metric demonstrating the stress Covid-19 is causing state health systems,” the group wrote. “Now, these data are spotty and difficult to interpret.”

The group found, for example, that the health department’s counts on Aug. 6 were “very low across the board,” which suggests inaccuracies in the reporting, said Jennifer Nuzzo, an epidemiologist at Johns Hopkins University.

“Either hospitals are reporting fewer hospitalizations, or fewer hospitals are reporting, but it just doesn’t seem sensical,” she said in an interview.

The new database requires more detailed reporting, which Department of Health and Human Services officials say is necessary to better guide the response. By closely following hospital admissions, they say, they can more accurately pinpoint patients in need of therapeutics like Remdesivir, and they can allocate the drug to states and territories accordingly.

But additional requirements have made reporting more time-consuming, the metrics are continually shifting and the TeleTracking support teams do not have access to individual hospital reports, which makes it difficult for hospitals to verify that their data is accurate, said Marjorie Smallwood, the director of emergency management for UCSF Health in San Francisco.

“Adjusting to these changes mid-midstream in the course of a disaster, I don’t necessarily think is always advised,” she said, adding that she hopes the health agency can come up with a “consistent framework for reporting, consistent data metrics and a consistent source of support with full access to our data.” In a statement, Tom Nickels, executive vice president of the American Hospital Association, said the association was “working closely with H.H.S. and others in the administration to help hospitals work through any issues that are preventing them from reporting data in a timely and consistent manner as the reporting switchover continues.”

The contract with TeleTracking has drawn scrutiny on Capitol Hill, where top Democrats have demanded more information.

Officials at the Department of Health and Human Services have said little about how or why TeleTracking was chosen and have refused to provide information about other bids it received. Federal records show that the contract was awarded under a year-old initiative, ASPR Next, created last August by Dr. Robert Kadlec, the assistant secretary for preparedness and response.

ASPR Next says its mission is “revolutionizing disaster care with next-generation technology.” But critics say that there are few controls on how ASPR Next spends its money and that it duplicates another program overseen by Dr. Kadlec, the Biomedical Advanced Research and Development Authority, or BARDA.

Chris Hamby contributed reporting.

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