It Already Has. How the Trump Administration Is Denying Access to Critical COVID-19 Information.
On July 10, 2020, the US Department of Health and Human Services (HHS) ordered hospitals, hospital laboratories, and acute care facilities as of July 15 to stop reporting COVID-19 data to the Centers for Disease Control and Prevention (CDC) (the primary repository of the nation’s public health data), and instead transmit data directly to HHS through TeleTracking, a new software system. HHS indicated that by the following week, federal shipments of crucial life-saving supplies, including Personal Protective Equipment (PPE) and the therapeutic drug Remdesivir, would be based on TeleTracking data.
As reasons for this sudden switch, HHS claims that CDC’s software for tracking infectious disease hospitalizations, the National Healthcare Safety Network (NHSN), is antiquated and that HHS needs real-time information to make decisions about COVID-19 testing supplies, PPE, and medicines. CDC’s NHSN hospital data dashboards vanished on July 15 but then, after public outcry, were restored the next day, with July 14 the last date of reported data.
Nursing homes, long-term care homes for the developmentally disabled, and assisted living facilities, however, continue to report COVID-19 data to NHSN, requiring that the separate HHS and CDC systems be somehow reconciled if America’s public health needs are to be met.
Will the HHS Directive Improve America’s Public Health Response to the COVID-19 Pandemic? The Short Answer Is a Resounding “NO.”
NHSN has played an essential role in public health tracking for 15 years, and is used in over 25,000 healthcare facilities in the United States. The NHSN COVID-19 module, launched on March 27, enabled facilities to submit data on cases as well as on personnel and supply shortages. By mid-May, over 60 percent of the nation’s hospitals were reporting COVID-19 data daily through NHSN. As a result, many states built their own COVID-19 data management systems based on the NHSN data feed.
Meanwhile, in early April, HHS awarded a $10.2 million contract to a private firm, TeleTracking, to develop and operate a hospital COVID-19 data collection system, with at least an additional $25 million sourced to other outside vendors.
Wasteful spending? Most likely, considering that the TeleTracking system, also known as HHS Protect:
- duplicates NHSN, except that it establishes an alternative direct pathway to HHS, bypassing CDC;
- does not appear to be any more technologically advanced than NHSN;
- relies on manual data entry, with its associated human errors and inherent delays; and
- does not automatically share hospital data with CDC or NHSN, nor with state, territorial, local, and tribal public health agencies.
As a result of the HHS directive, public health agencies, healthcare providers, scientists and researchers, reporters, and the public have already lost access to hospital data at a time when cases are surging, and are denied access to most future data.
The HHS Protect Public Data Hub, which provides only state-level estimates of the total number of inpatient beds occupied, inpatient beds occupied by COVID-19 patients, and ICU beds occupied, is wholly inadequate for researching, planning, or responding to the COVID-19 crisis.
According to the nonpartisan National Academy for State Health Policy, “State and local health departments and healthcare systems have historically had immediate access to NHSN COVID-19 data for hospitals in their jurisdictions, which include bed occupancy, health care worker staffing and personal protective equipment (PPE) supply status and availability. States have used this critical information to shape local responses and for planning. . . . However, unlike the NHSN data, the TeleTracking data will not be publicly available.”
The National Governors Association, on behalf of all 55 state and territorial governors, is calling for the Trump Administration to make hospital data publicly available.
The National Association of County and City Health Officials finds the “newly announced order for hospitals to bypass CDC and send coronavirus patient information directly to Washington likely to worsen pandemic response.” NACCHO reports, “planning for this new approach did not substantially involve officials at the local, state, tribal and/or territorial levels.”
On July 17, concerned that the “Administration has taken a fully operational, critically important public health reporting system offline and abruptly replaced it with a new system in the midst of a public health emergency,” the US House Select Committee on the Coronavirus Crisis wrote to HHS Secretary Alex Azar and CDC Director Robert Redfield, urging HHS to reverse its directive, restore CDC’s data collection role, and ensure that data is collected and reported free from political interference. The Subcommittee also requested by July 31 documents and information about how HHS made its “troubling decision.”
The same day, 69 House Democrats, including Representatives Ruben Gallego and Raul Grijalva, joined in a letter urging the administration to rescind its directive, noting, “This is another unethical and irresponsible effort to hinder public access to data and remove transparency and accountability from the administration’s poor management of the pandemic.”
And 46 Senators wrote to Vice President Pence and Coronavirus Task Force Coordinator Dr. Deborah Birx, requesting their response by July 31 to a series of questions regarding the directive and urging its immediate withdrawal.
Since then, Representative Don Beyer (D-VA) introduced HR 7674, the COVID-19 Data Transparency Act, which would require CDC to develop a standardized method by which states, tribes, and local public health authorities would report COVID-19 data to CDC on daily, with the data made publicly available on CDC’s website. The bill currently has 34 co-sponsors, including Representative Grijalva.
Stay tuned to find out how the Trump Administration responds to Congress, and whether it will succeed in disappearing America’s COVID-19 data.
Notes:
stop reporting: https://www.hhs.gov/sites/default/files/covid-19-faqs-hospitals-hospital-laboratory-acute-care-facility-data-reporting.pdf
NHSN hospital data dashboards: https://www.cdc.gov/nhsn/covid19/report-patient-impact.html
Nursing homes, long-term care homes for the developmentally disabled, and assisted living facilities: https://www.cdc.gov/nhsn/ltc/covid19/index.html
outside vendors: https://www.politico.com/news/2020/07/20/coronavirus-hhs-hospital-data-373269
HHS Protect Public Data Hub: https://protect-public.hhs.gov
National Academy for State Health Policy: https://www.nashp.org/states-raise-concerns-about-moving-critical-covid-19-reporting-data-from-cdc-to-hhs/
National Governors Association: https://www.nga.org/news/press-releases/governors-call-on-the-administration-to-delay-changes-to-hospital-reporting-requirements/
National Association of County and City Health Officials: https://www.naccho.org/blog/articles/statement-newly-announced-order-for-hospitals-to-bypass-cdc-and-send-coronavirus-patient-information-directly-to-washington-database-likely-to-worsen-pandemic-response
US House Select Committee on the Coronavirus Crisis: https://coronavirus.house.gov/sites/democrats.coronavirus.house.gov/files/2020-07-17.Clyburn%20CBM%20RK%20%20to%20Azar-%20HHS%20and%20Redfield-CDC%20re%20Hospitalization%20Data.pdf
69 House Democrats: http://jayapal.house.gov/wp-content/uploads/2020/07/COVID19-Data-CDC-HHS.pdf
46 Senators: https://www.help.senate.gov/imo/media/doc/071720%20NHSN%20TeleTracking%20caucus%20letter_FINAL.pdf
HR 7674 – Bill Text: https://beyer.house.gov/uploadedfiles/covid-19_data_transparency_act.pdf
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