The Trump administration has ordered hospitals to send data on coronavirus patients to the Department of Health and Human Services in Washington rather than to the US Centers for Disease Control and Prevention in Atlanta.
The change was confirmed by Michael Caputo, a former Trump campaign strategist who is now the assistant secretary for public affairs at HHS. He said in a statement: “The CDC’s old hospital data gathering operation once worked well monitoring hospital information across the country, but it’s an inadequate system today.”
But former CDC acting director Dr. Richard Besser on Wednesday said rerouting hospital data is a “step backwards” for the country’s coronavirus response.
“It’s another example of CDC being sidelined. Not only should the data be coming to CDC, but CDC should be talking to the public through the media every day,” Besser told CNN chief medical correspondent Dr. Sanjay Gupta in an interview.
CNN also spoke with Dr. Amira Roess, a professor of Global Health and Epidemiology at George Mason University and former CDC Epidemic Intelligence Service officer, about how the system works and what the change might mean for the US coronavirus response.
The conversation, conducted over the phone and lightly edited for flow, is below.
CNN: The hospital data on coronavirus patients is now going to be rerouted to the Trump administration instead of first being sent to the CDC. What is your reaction to that move?
AR: Right away, my first concern is what this means for the system that has been established over the last several years, if not decades. By shifting suddenly, you’re really disrupting the process that took a very long time to establish. And you’re also setting a precedent that can be very harmful down the road.
CNN: Can you expand on that a little?
AR: Basically, I think every time you make changes to these systems that are so difficult to establish to begin with, and that do take time to put together – every time you make changes to this you could be really damaging the integrity of the data and the system as a whole.
I don’t think many people fully understand how complex it is to move data from clinics or hospitals into a usable format that a large entity like the CDC can then curate, check for quality and make it usable for tracking, for surveillance and for understanding what’s happening in the country in terms of health.
So you could be doing some substantial damage to the system that we’ve had in place and that’s taken a while to build up. Any high-income country or any – what we call sometimes any developed country – depends on having timely surveillance and usable data to help the country really promote health and have the best possible health care system and public health system. So when you start to dismantle things or to move things around like this, you’re actually creating a lot of chaos and potentially setting up your future system for failure.
CNN: It sounds like this would be a difficult process in a normal times, never mind in the middle of a pandemic.
AR: Absolutely. It is a complex process. Because every hospital has a point person or a department that curates the data and then forwards it on. And then the receiver at the CDC, they have systems in place to receive the data, to check its quality, to communicate back to the hospital if there are data that are either missing or if there are data that don’t make any sense, to get clarification and to really get the data in the best quality shape that it can be in. And that’s not an easy task.
We have these systems in place for a number of different health conditions and pathogens. And when you start picking and choosing which pathogen or which health condition is going to be reported to CDC vs. HHS, you’re really creating more of a burden on the hospital system and on the departments or the individuals who are trying to figure out which reports go to whom.
CNN: There’s obviously concerns with transparency here. Can you explain why transparency is so important when you’re dealing with hospital data, particularly right now?
AR: If you use the established system, we do know that there are checks, and there’s quality control where we’re verifying the data and we’re making sure that it’s clean. So we understand that when we are looking at our usual system for tracking hospital data. That’s really important. When you start to establish a new system, a new movement of data, right away, there’s going to be some growing pains. You have to get the databases up and running. People have to be retrained to understand how to interpret the data, how to figure out the quality control issues, who to communicate with when you have a question, all of that takes time.
Is there really a reason to do this now in the middle of the pandemic? That’s unclear to me.
It seems that maybe it would be more reasonable to let the CDC use the procedures that it has in place to get the data together, the hospital data, and then send it over to HHS or the administration. That seems to be a more reasonable and transparent way to do this rather than signaling that you’re going to create a new process.
CNN: Michael Caputo, the assistant secretary for public affairs at HHS, said in a statement that the CDC’s old hospital data-gathering operation is an inadequate system today. Is there any truth to that?
AR: We know in this country that we have let the public health system and our health care system deteriorate. We know that a lot of our systems aren’t as good as what you would see in northern Europe or in parts of Asia. We know that. But this is a deeper problem that does need to be addressed – but again, don’t take apart what has been functioning and try to recreate it. What we should be doing in this pandemic is building up our public health systems or rebuilding them in some cases.
In 2008, when we had the Great Recession, one of the consequences was that a lot of public health systems and local health departments, they really lost a lot of their resources. And a lot of their staff was furloughed – one day a week of furlough. And what ultimately ended up happening was that you lost a lot of talent and then now you have to rebuild it, right? So things like that have been happening in this country for a long time. And in this country, we seem to have this reaction that if everything is fine, meaning we are not having outbreaks and we don’t have excessive infant or maternal mortality or diseases due to contaminated water, what we tend to do is then take resources away from those systems that are actually protecting our health.
And so the consequence is systems that are not as robust as they could be. And certainly they’re not as good as what we see in other countries, but that’s also a problem that we have in the resource allocation and policies. So that’s something fundamental that they should be addressing, not moving how we do the data collection or the data gathering from one agency or one part of the government to another. It doesn’t seem to really address the issue that we have.
If you really want to make the system robust, then put the resources towards it, and continue to build up the system, but don’t remove one disease from the hospital reporting mechanism and move that somewhere else, because what you’re fundamentally doing is really damaging the system overall.
CNN: There is a larger issue of mixed messaging between public health experts and a lot of people in government and at the White House. Where should people look when they’re seeking out trusted information on the coronavirus?
AR: The best place to look is going to be at the state and local health department websites and at the CDC website. That is traditionally where we have the most up to date, verified, trusted information. It’s taken years – decades – to build that system. And we have mechanisms in place whereby there’s a collaboration between local, state and the CDC.
So that’s taken a long time to build, and the CDC should be an independent agency that’s purpose is to really protect the American people’s health. It should never be politicized. Frankly, I don’t understand why we have political appointees in and out of CDC.
I think this is one agency where you should have career people running the show. The politics should never have been introduced to begin with and now it seems to be here to stay and that’s really problematic.
In all of the other recent pandemics or large scale national outbreaks, it has been the job of the CDC to curate the data, to present the information. Every other administration has looked to the CDC dashboards and the data sets.
I think a lot of individuals or the general public who are consuming the data, they don’t understand that the information that’s feeding into these dashboards and these private university websites and these other university websites, that information is ultimately coming from state, local and federal health agencies. That’s typically where that information is coming from.
H1N1 and MERS, coronavirus, Ebola – all of those outbreaks, and there’s so many others, we’ve always gone back to the CDC as the trusted source of information. And it’s really problematic that in this one outbreak, the CDC has become even more politicized than it has been in the last few years or last couple of administrations. I think that’s one of the other things that a lot of people are just completely missing. It doesn’t seem to be in the discourse, but it does need to be addressed.
CNN: Does the appearance of politics playing a role at the CDC concern you long term?
AR: The long term damage of what’s happening right now – it will damage the trust, I believe, between those of us who consume CDC data and information from the CDC. I think it’s dangerous. I think we are at a point where we might be eroding the trust to a point that we’re going to further rapidly deteriorate our public health system.
What we’ve seen in this outbreak is we need to be doing exactly the opposite. We should be building up our systems and, like it or not, it’s very clear, we do need some sort of a central national health agency, and that is the CDC. So by politicizing the CDC and really destroying the trust taking away their role to a large extent, you’re just going to set this country up for failure. The next outbreak won’t have the benefit of a national public health agency. And that’s what you want to avoid.
Now, no agency is perfect. The CDC certainly isn’t perfect. They’ve obviously every part of this pandemic response has been fraught with issues globally. And we’ve also had some mistakes happen here nationally and at local levels, state levels, but that’s also the nature of dealing with an emergency.
This is, again, unprecedented. We haven’t seen anything this large since 1918. And so I think we also have to recognize that, yes, there have been mistakes, but a lot of it has to do with the larger system and you really can’t just point to the CDC and say, ‘Oh, you know, the mistakes with testing it was their fault or it was only this person’s fault.’ A lot of decisions were made in larger committees and the CDC was just one of many that were involved in the decision making. So I think we have to be careful that we’re not simplifying things and just choosing an easy target which – human nature – it’s the easiest thing to do, just pick one scapegoat. And so those are some of the deeper conversations and analysis that needs to happen.
CNN: Anything else you’d like to add?
AR: I mean one of the biggest issues with how we function in terms of response and preparedness is we really are very much reactive – not about prevention which is a key problem. I think we have to really consider how to depoliticize this and make CDC independent again so that it can do its job and do its job well because we’ve seen if you start to take resources away from the public health infrastructure, and if you start to politicize it, all you’re doing is shooting yourself in the foot.
The data will be of poor quality, which means that you won’t be able to make really good decisions based on sound data. And that’s exactly what we need to avoid.