A new directive from the Trump administration has cut the Centers for Disease Control and Prevention out of the loop for data from hospitals treating patients with COVID-19, a move which could have significant effects on what information about the pandemic is made public and how it is presented and used.
The updated instructions from the Department of Health and Human Services (PDF), dated July 10, go into effect today. Under the new mandate, the CDC "will no longer control" data reported by hospitals about admissions, capacity, resource utilization, ventilator use, staffing—or COVID-related deaths. Hospitals are instead required to make their reports directly to HHS, to have a third party make the report to HHS, or to make reports to their states if their states are certified to receive it.
The instructions also explicitly bar hospitals from reporting to the CDC in addition to HHS: "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 document explains, referring to the CDC's system.
The federal government will use the data provided "to inform decisions at the federal level, such as allocation of supplies, treatments, and other resources," the document explains. "We will no longer be sending out one-time requests for data to aid in the distribution of Remdesivir or any other treatments or supplies. This daily reporting is the only mechanism used for the distribution calculations, and the daily is needed daily to ensure accurate calculations."
In other words, for hospitals to receive federal aid, including access to one of the few known beneficial drugs for treating COVID-19, they will have to comply with the administration's data directive.
Public health experts expressed concern about the move. "Historically, CDC 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," Jen Kates of the Kaiser Family Foundation told The New York Times, which was first to report the new policy.
Ryan Panchadsaram, one of the team behind popular COVID-19 data visualization site Covid Exit Strategy, said the site is already unable to gather data for ICU beds in use following the change. In series of Tweets posted very early this morning, he indicated, "a critical indicator is missing… with @HHSGov as the only source, they need to aggregate this data and make it public. With daily briefings over, the public needs it more than ever."
The directive echoes moves made by Brazilian President Jair Bolsonaro in June, when his administration removed almost all data relating to COVID-19 from Brazil's government websites and made it unavailable to researchers. Two days later, however, Brazil's Supreme Court ordered the restoration of the public data—perhaps presaging the kind of legal fighting we may soon see in the United States.
New fronts, old war
Rather than pulling together federal resources to swim in one direction, the White House for several months has instead apparently been at war with US public health experts, including the CDC, over how to handle the COVID-19 crisis.
On February 26, the White House named Vice President Mike Pence as the head of the administration's official coronavirus task force. Within a few weeks, the CDC all but vanished from the national scene. Its regular public briefings, led by Dr. Nancy Messonnier, ended March 9, and the agency did not hold another public press conference on COVID-19 until June 12.
In more recent days, the CDC and the administration have been at odds over guidance for how to safely reopen the US economy, particularly schools. President Donald Trump on July 8 publicly trashed the CDC's proposed guidelines for schools, saying they were "very tough and expensive" and threatening to withhold federal funding from schools that refused to reopen.
An internal document containing more detailed CDC guidance about opening schools leaked to the public over the weekend. That document specifically calls out "full sized, in-person classes, activities, and events" as being "highest risk" for transmission of the novel coronavirus, and suggests local authorities use customized approaches, hybrid models, and distance learning where appropriate.
That, however, is apparently still not what the administration wants to hear, and the White House is spreading a different message. Pence, speaking yesterday, explicitly dismissed CDC guidance. "To be very clear, we don't want CDC guidance to be a reason why people don't reopen their schools," Pence said, according to local media.
The same day, CDC director Dr. Robert Redfield warned that things are likely to get harder from here, not easier, saying, "I do think the fall and the winter of 2020 and 2021 are going to be probably one of the most difficult times we've experienced in American public health."