Hospitals Can No Longer Report COVID-19 Data Directly To CDC : Short Wave Data are so more than just a bunch of numbers, especially when it's the data hospitals are reporting about COVID-19. Earlier this month, the Trump Administration made a sudden change to the way that information is shared. The process bypasses the Centers for Disease Control and Prevention, raising concern among some public health officials. NPR's Pien Huang explains the recent controversy, and why the way COVID-19 hospital data are reported is such a big deal.
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The Controversy Around COVID-19 Hospital Data

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The Controversy Around COVID-19 Hospital Data

The Controversy Around COVID-19 Hospital Data

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MADDIE SOFIA, HOST:

You're listening to SHORT WAVE from NPR. Maddie Sofia here with global health and development reporter Pien Huang. Hey, Pien.

PIEN HUANG, BYLINE: Hey, Maddie. How you doing?

SOFIA: I mean, that's a rude question. I think you know that right now. But...

HUANG: (Laughter).

SOFIA: What do you got for me today, Pien?

HUANG: Well, Maddie, I am here today to talk about data.

SOFIA: Oh. So just, you know, the way we observe and measure the great mysteries of the universe?

HUANG: LOL, yes.

(LAUGHTER)

HUANG: I totally agree with you. You know, Maddie, data are so much more important than just a bunch of numbers. And in this case, Maddie, the data I want to talk about is particularly important. It's the data that hospitals have been reporting about COVID-19.

SOFIA: So we're talking stuff about number of cases, how many hospital beds are available, how much PPE they have, that kind of stuff?

HUANG: Yeah, exactly. And a couple weeks ago, the Trump administration made a pretty big change to the way that hospitals report that data.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #1: Information on COVID-19 cases at hospitals will no longer go directly to the CDC.

HUANG: All of this has been pretty controversial.

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UNIDENTIFIED PERSON #2: The move made by the Trump administration is raising concerns from health experts.

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UNIDENTIFIED PERSON #3: Some say it's part of a bigger fight between politics and science.

SOFIA: So today on the show, the controversy around COVID-19 hospital data and why the way that information is reported is such a big deal. This is SHORT WAVE, NPR's daily science podcast.

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SOFIA: OK, Pien. Let's walk through the chronology of what happened over the last couple of weeks.

HUANG: So on July 15, the Trump administration super abruptly changed the way that hospitals were mandated to report their COVID-19 data. Again, this is the stuff like, you know, number of cases, available beds, whether or not they had enough PPE or ventilators. Basically, this is information that health officials use to inform a lot of their decision making.

SOFIA: What were hospitals doing before this change? How were they reporting all of their data?

HUANG: OK. So back in March, when the pandemic was first declared, the Trump administration sent a letter to hospitals telling them to report this data to the CDC, the Centers for Disease Control and Prevention, using a system that a lot of them had already been using for years. It's called the National Healthcare Safety Network. And it's something they were already familiar with and knew how to use.

SOFIA: Right.

HUANG: Now, hospitals also had two other options. They could either report to their state health departments, or they could report it through a portal built by a private company called TeleTracking. Both of these options end up funneling the data directly to the Department of Health and Human Services. And Health and Human Services, by the way, oversees the CDC, which is a relationship that's important to the story.

SOFIA: OK, got it. So hospitals could basically pick from these three options how they reported their data, using whichever they felt made the most sense for them.

HUANG: Exactly. And the CDC system was getting the bulk of that hospital data. And they were analyzing it and using it to post hospital capacity estimates pretty regularly, like, a few times a week.

SOFIA: Right. Yeah, yeah. I've seen some of those. OK. So what was the big change in terms of how hospitals can now report their data as of mid-July?

HUANG: So the Trump administration argued that CDC was processing and reporting this data too slowly, and they weren't adding new reporting requirements quickly enough. And you had a spokesperson for the Department of Health and Human Services call the CDC system a, quote, "old data gathering operation" that just cannot keep up with this pandemic.

SOFIA: Oh, OK. Dang.

HUANG: Yeah. So the administration issued federal guidance telling hospitals to stop sending their COVID-19 data directly to CDC. HHS says the new system, which involves the TeleTracking portal I mentioned earlier, will be faster and that they'll get more hospitals report to it. So they'll get more complete data.

SOFIA: Wow, OK. So this is a big change.

HUANG: Yeah. But a lot of people are not convinced that this change was necessary or even a good idea. And the bottom line is that the CDC is not getting this data directly anymore. HHS will have more control over it. And some people are very worried about that.

SOFIA: I mean, what do people at the CDC say, Pien? Like, are they like, yeah, we're slow? Or no, we're not?

HUANG: Yes. So Robert Redfield - he's the head of CDC - was out there supporting the change. He was saying that the new reporting system streamlines the reporting from hospitals. He described it as a rapid way to get this data. But, of course, other people who work at CDC disagree. I spoke with a guy named Dr. Daniel Pollock. He's been with the CDC for 36 years, and he's the surveillance branch chief for something called the Division of Healthcare Quality Promotion, which is the group that was in charge of getting and analyzing all that hospital data.

SOFIA: Oh, OK. So he's being pretty directly impacted by this.

HUANG: Yeah, absolutely. And Pollock says that their data collection system wasn't slow. He says it was processing data just as quickly as any of the other reporting methods. And he also says that there are some important relationships that the CDC has with hospitals that go back for decades that actually really help them collect this information. So he's just not sure that the new system will be able to actually replicate what CDC has been doing.

DANIEL POLLOCK: They've been stood up relatively recently. And they don't have the track record, the expertise that we're able to provide.

HUANG: And he says that expertise includes checking the data for errors and presenting it in a way that's useful for policymakers.

SOFIA: And so I know that people have criticized specifically the timing of this change, right?

HUANG: Yeah. Right. This change was super sudden. Hospitals were not expecting it. And on top of that, a lot of experts are saying you just don't make a change like this during a pandemic. So we spoke with Dr. Georges Benjamin. He's director of the American Public Health Association. And he's worked in a lot of health emergencies.

GEORGES BENJAMIN: One thing that I've learned is never, ever, ever change processes in the middle of a disaster. It does not go well when you do that. No one knows what to do. And it basically confuses your response.

HUANG: Especially since it's a new way of doing things for many hospitals, and they were only given a few days to make the switch. And any kind of confusion can cause delays in reporting when it's essential right now to know this information ASAP.

SOFIA: So OK. How are the changes working out so far? Is it any better or faster than when the CDC was involved? Is it too, you know - too soon to say?

HUANG: Yeah, I mean, it's still a very new system it's only been in operation for a couple weeks at this point. But as far as we've been able to tell, it's a mixed bag. You know, I've heard from a couple hospitals around the country. Some have said the reporting switch has been OK. And others have said that it's really hard and confusing. HHS, which is where all the data is heading now, says that more hospitals have been reporting since the change, and they've started to post that data on a site that they launched. But there's a lot of gaps and missing information in the data that they've posted so far.

And that's something that Lisa Lee is really worried about. She is the former chief science officer of the CDC's Public Health Surveillance Center, and she's now at Virginia Tech. She told me that if the hospital data is wrong or incomplete, there could be some very real-world consequences to that.

LISA LEE: If we know, for example, that all ICU beds are taken up with patients - that we're going to be able to make - do action, like say, OK, emergency medical personnel, you know, you've got to take them to the next town over or to the next county or so. So there are very real things that happen as a result of these data. And if they're not accurate, that could cost lives.

SOFIA: Yeah. OK. So it sounds like she's bringing up two concerns here - right? - the quality of the data and whether or not the right data will get to the right people.

HUANG: Yeah, exactly, Maddie. And there's another layer to this too. And it's about transparency in general. So a lot of the critics of this policy change are not just worried about, you know, the pragmatics of hospitals adjusting and making sure the data is still reported in the right way. There's also concern that politics might be at play here, too.

LEE: If this were in the hands of surveillance scientists who've been doing this for many years, they look objectively at the data, report them as objectively as they can to develop plans for action. The worry is that that's not going to be the case at HHS because there is a political stake. And we happen to be in an election year. And we happen to be in the middle of something that does not look great for our current president. And all of that fear of the ways in which the data can be spun or manipulated are not present when the data are reported to, analyzed by and reported by an objective party like CDC.

SOFIA: Yeah. I mean, there - is anybody objective, Pien? You know what I mean?

HUANG: True, true.

SOFIA: So now the situation is that all the data is going to HHS. And generally, HHS is seen as more political than the CDC.

HUANG: Yeah that's right. So CDC is the nation's public health agency. It basically provides science-based guidance about public health. And as an agency within HHS, they're somewhat insulated from political influence. So the general concern is that the people who now have control over a lot of the data are policymakers under a great deal of political pressure. And that could set up a situation in which data are withheld or misrepresented in order to fit a particular policy driven by politics rather than evidence.

SOFIA: OK, Pien Huang. I know that you will be following this, that this is developing. Keep us updated.

HUANG: Absolutely, Maddie. I sure will.

(SOUNDBITE OF MUSIC)

SOFIA: This episode was produced by Brit Hanson and edited by Viet Le. Facts were checked by Buehrle McCoy (ph). Special Thanks to Selena Simmons-Duffin, who co-reported the story with Pien. I'm Maddie Sofia. Thanks for listening to SHORT WAVE from NPR.

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