Hospitals have been ordered to bypass the Centers for Disease Control and Prevention and send all patient information to a central database in Washington, raising questions about transparency.A scientist at Houston Methodist Hospital last month preparing patient samples to be tested for the coronavirus. Credit... Erin Schaff/The New York Times
WASHINGTON — The Trump administration has ordered hospitals to bypass the Centers for Disease Control and Prevention and send all Covid-19 patient information to a central database in Washington beginning on Wednesday. The move has alarmed health experts who fear the data will be politicized or withheld from the public.
The new instructions were posted recently in a little-noticed document on the Department of Health and Human Services website. From now on, the department — not the C.D.C. — will collect daily reports about the patients that each hospital is treating, the number of available beds and ventilators, and other information vital to tracking the pandemic.
Officials say the change will streamline data gathering and assist the White House coronavirus task force in allocating scarce supplies like personal protective gear and remdesivir, the first drug shown to be effective against the virus. But the Health and Human Services database that will receive new information is not open to the public, which could affect the work of scores of researchers, modelers and health officials who rely on C.D.C. data to make projections and crucial decisions.
“Historically, C.D.C. has been the place where public health data has been sent, and this raises questions about not just access for researchers but access for reporters, access for the public to try to better understand what is happening with the outbreak," said Jen Kates, the director of global health and H.I.V. policy with the nonpartisan Kaiser Family Foundation.
“How will the data be protected?” she asked. “Will there be transparency, will there be access, and what is the role of the C.D.C. in understanding the data?”
News of the change came as a shock at the C.D.C., according to two officials who spoke on the condition of anonymity because they were not authorized to discuss the matter. Michael R. Caputo, a Health and Human Services spokesman, called the C.D.C.’s system inadequate and said the two systems would be linked. The C.D.C. would continue to make data public, he said.
“Today, the C.D.C. still has at least a week lag in reporting hospital data,” Mr. Caputo said. “America requires it in real time. The new, faster and complete data system is what our nation needs to defeat the coronavirus, and the C.D.C., an operating division of H.H.S., will certainly participate in this streamlined all-of-government response. They will simply no longer control it.”
But the instructions to hospitals in the department guidance are explicit and underscored: “As of July 15, 2020, hospitals should no longer report the Covid-19 information in this document to the National Healthcare Safety Network site,” the C.D.C.’s system for gathering data from more than 25,000 medical centers around the country.
Public health experts have long expressed concerns that the Trump administration is politicizing science and undermining its health experts, in particular the C.D.C.; four of the agency’s former directors, spanning both Republican and Democratic administrations, said as much in an opinion piece published Tuesday in The Washington Post. The data collection shift reinforced those fears.
“Centralizing control of all data under the umbrella of an inherently political apparatus is dangerous and breeds distrust,” said Dr. Nicole Lurie, who served as assistant secretary for preparedness and response under former President Barack Obama. “It appears to cut off the ability of agencies like C.D.C. to do its basic job.”
The shift grew out of a tense conference call several weeks ago between hospital executives and Dr. Deborah L. Birx, the White House coronavirus response coordinator. After Dr. Birx said hospitals were not adequately reporting their data, she convened a working group of government and hospital officials who devised the new plan, according to Dr. Janis Orlowski, the chief health care officer of the Association of American Medical Colleges, who participated in the group’s meetings.
While she said she understood Dr. Lurie’s concern, Dr. Orlowski said the administration had pledged in “a verbal discussion” to make the data public — or at least give hospitals access to it.
“We are comfortable with that as long as they continue to work with us, as long as they continue to make the information public, and as long as we’re able to continue to advise them and look at the data,” she said, calling the switch “a sincere effort to streamline and improve data collection.’’
The change exposes the vast gaps in the government’s ability to collect and manage health data — an antiquated system at best, experts say. The C.D.C. has been collecting coronavirus data through its National Healthcare Safety Network, which was expanded at the outset of the pandemic to track hospital capacity and patient information specific to Covid-19.
In its new guidance, Health and Human Services said that going forward, hospitals should report detailed information on a daily basis directly to the new centralized system, which is managed by TeleTracking, a health data firm with headquarters in Pittsburgh. However, if hospitals were already reporting such information to their states, they could continue to do so if they received a written release saying the state would handle reporting.
Senator Patty Murray of Washington, the top Democrat on the Senate health committee, has raised questions about the TeleTracking contract, calling it a “noncompetitive, multimillion-dollar contract” for a “duplicative health data system.”
Both the C.D.C. network and the TeleTracking system set up by Health and Human Services rely on so-called push data, meaning hospital employees must manually enter data, rather than the government tapping into an electronic system to obtain the information.
“The whole thing needs to be scrapped and started anew,” said Dr. Dan Hanfling, an expert in medical and disaster preparedness and a vice president at In-Q-Tel, a nonprofit strategic investment firm focused on national security. “It is laughable that this administration can’t find the wherewithal to bring 21st-century technologies in data management to the fight.”
Dr. Hanfling and others agree that information does need to be centralized, but they disagree on how that should happen. Dr. Hanfling called for a new “national data coordination center” that would be used for “forecasting, identifying, detecting, tracking and reporting on emerging diseases.”
Updated July 7, 2020
The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Representative Donna E. Shalala of Florida, who served as health secretary under former President Bill Clinton, said the C.D.C. was the proper agency to gather health data. If there were flaws in the C.D.C.’s systems, she said, they should be fixed.
“Only the C.D.C. has the expertise to collect data,” Ms. Shalala said. “I think any move to take responsibility away from the people who have the expertise is politicizing.”
Hospitals say the previous reporting requirements were cumbersome, partly because they frequently changed.
“It has been an administrative hassle and confusing to constantly be shifting gears on reporting while hospitals are on the front lines during a pandemic,” Carrie Williams, a spokeswoman for the Texas Hospital Association, wrote in an email.
At Rush University Medical Center in Chicago as the pandemic raged, the hospital had four full-time employees reporting coronavirus data to four different agencies, said Dr. Bala N. Hota, the hospital’s chief analytics officer. Rush collected more than 100 different measures, some of which determined how much money it would receive under different federal programs.
But while Dr. Hota said he supported streamlining the process and the involvement of state and local agencies in reporting, he was also concerned that months into the pandemic, the United States still did not have an established system of collecting the kind of information it needed to seamlessly move patients from a full hospital to one with available beds.
“The C.D.C. is the right agency to be at the forefront of collecting the data,” Dr. Hota said.
The C.D.C. has been criticized for its data collection, however. In May, the agency acknowledged that in tracking the spread of the virus, it had been combining tests that detect active infection with those that detect recovery from Covid-19. That system muddied the picture of the pandemic but raised the percentage of Americans tested as President Trump was boasting about the number of tests the United States was conducting.
Similar complaints about coronavirus data have bubbled up around the country.
In Florida, a former data manager for the Health Department accused one of her superiors of directing her to “manipulate” data used in the state’s plan to lift stay-at-home orders this spring. Ms. Shalala said the mayor of Miami-Dade County “was so concerned about the state data that he has the hospitals reporting their data directly to him as well.”
And Arizona ended its partnership with a university modeling team whose projections showed a rising caseload, prompting pushback from Will Humble, the executive director of the Arizona Public Health Association and a former director of the state’s Health Services Department.
“Trust and accountability and transparency — all three go together,” Mr. Humble said. Of the federal government’s new system, he said: “They’d better keep it transparent, or else people are going to think that it was an ulterior motive.”
Reed Abelson contributed reporting from New York.