Question: Last night the NY Times reported, “ Trump Administration Strips C.D.C. of Control of Coronavirus Data.” This news was alarming to read at first, but I see that some of the data sites you refer to in yesterday’s Q&A get their figures directly from each state health department. What are your thoughts on this move from the administration? How concerned should we be?

Answer: I was also alarmed when I read this news. CDC’s mission to protect the public’s health. Surveillance, including collecting and sharing key health data, is a key component of achieving its mission. Stripping CDC of its role in hospital surveillance for COVID-19 *seems* punitive and politically motivated. Do I *know* if it is punitive or politically motivated? No, I don’t. Am I concerned? Absolutely. So much of our COVID response has been politicised. The idea of key data now being reported outside of traditional systems via the private sector concerns me (and others) — will the data be manipulated?; will the data be available and accessible?; who is accountable? The NY Times article does a nice job of describing these concerns. Read on for additional background and details not provided in the Times article.

Role of NHSN

Typically, more than 16,000 health facilities across all 50 states + DC and Puerto Rico report a bevvy of data to CDC’s National Healthcare Safety Network (NHSN), the nation’s most widely used healthcare-associated infection tracking system. On March 27, NHSN launched its COVID-19 tracking module for hospitals to report COVID-related data and on March 29, VP Pence sent a letter to hospital administrators asking them to participate in sharing daily reports with NHSN. (Note: in May, NHSN launched a tracking module for reporting by nursing homes.) The hospital data reported to NHSN include information on hospital capacity and patient load, healthcare worker staffing, and healthcare supply. The data come either directly from the hospitals, from vendors hospitals hire to do their reporting, or from States who are authorized to collect the data and reporting on behalf of all hospitals in their jurisdiction. Local data are made available in real-time to local health departments for monitoring the outbreak and health systems needs. The data are also used by CDC and HHS, and are synthesized into public-facing data dashboards.

Friction between the White House and CDC

Back in mid-May, The Washington Post reported, “Growing friction between White House and CDC hobbles pandemic response.” In that report, the Post described how CDC’s data was continually questioned and viewed as flawed with Dr. Birx stating, “There is nothing from the CDC that I can trust.” Note: we discussed CDC’s processes for reporting COVID deaths in our Q&A of 5/5 and there is a time delay in death reporting and the deaths reported are likely an undercount. I have seen reports of data quality and completeness issues with the nursing home data CDC collects, and there are still many data gaps in other types of data CDC collects (how long did it take us to get data on race(?!)) In my opinion, it is fair to criticize CDC. The odd thing that happened (in my opinion) was that rather than trying to work with CDC to improve its systems, the federal government invested in a new, duplicative system to collect hospital data run by a private company, TeleTracking.

Non-competitive award to TeleTracking

As the Post reported, the $10.2 million, 6-month contract to TeleTracking was awarded by the Secretary of Preparedness and Response at HHS (outside of CDC) non-competitively back on April 6 with the mandate that TeleTracking collect the same data NHSN is collecting! On April 10, Secretary Azar wrote hospital administrators again asking them to report daily information via the above described avenues + TeleTracking. And now, July 15, HHS has advised hospitals to stop reporting data to CDC altogether. As the Post back on May 15 summed up, “a senior administration official said Trump’s son-in-law and senior advisor, Jared Kushner, and many of his allies do not trust the government agencies and prefer to work with officials in the private sector.”