Large health systems band together on monetize clinical data

https://mailchi.mp/41540f595c92/the-weekly-gist-february-12-2021?e=d1e747d2d8

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Fourteen of the nation’s largest health systems announced this week that they have joined together to form a new, for-profit data company aimed at aggregating and mining their clinical data. Called Truveta, the company will draw on the de-identified health records of millions of patients from thousands of care sites across 40 states, allowing researchers, physicians, biopharma companies, and others to draw insights aimed at “improving the lives of those they serve.” 

Health system participants include the multi-state Catholic systems CommonSpirit Health, Trinity Health, Providence, and Bon Secours Mercy, the for-profit system Tenet Healthcare, and a number of regional systems. The new company will be led by former Microsoft executive Terry Myerson, who has been working on the project since March of last year. As large technology companies like Amazon and Google continue to build out healthcare offerings, and national insurers like UnitedHealth Group and Aetna continue to grow their analytical capabilities based on physician, hospital, and pharmacy encounters, it’s surprising that hospital systems are only now mobilizing in a concerted way to monetize the clinical data they generate.

Like Civica, an earlier health system collaboration around pharmaceutical manufacturing, Truveta’s launch signals that large national and regional systems are waking up to the value of scale they’ve amassed over time, moving beyond pricing leverage to capture other benefits from the size of their clinical operations—and exploring non-merger partnerships to create value from collaboration. There will inevitably be questions about how patient data is used by Truveta and its eventual customers, but we believe the venture holds real promise for harnessing the power of massive clinical datasets to drive improvement in how care is delivered.

Federal system for tracking hospital beds and COVID-19 patients provides questionable data

https://www.sciencemag.org/news/2020/11/federal-system-tracking-hospital-beds-and-covid-19-patients-provides-questionable-data?fbclid=IwAR0E66OcpYN6ZvT4OLRStyaOANpUlDBUbOrnF4xV63icIsYYrYsPMAkH1A0

In mid-November, as the United States set records for newly diagnosed COVID-19 cases day after day, the hospital situation in one hard-hit state, Wisconsin, looked concerning but not yet urgent by one crucial measure. The main pandemic data tracking system run by the Department of Health and Human Services (HHS), dubbed HHS Protect, reported that on 16 November, 71% of the state’s hospital beds were filled. Wisconsin officials who rely on the data to support and advise their increasingly strained hospitals might have concluded they had some margin left.

Yet a different federal COVID-19 data system painted a much more dire picture for the same day, reporting 91% of Wisconsin’s hospital beds were filled. That day was no outlier. A Science examination of HHS Protect and confidential federal documents found the HHS data for three important values in Wisconsin hospitals—beds filled, intensive care unit (ICU) beds filled, and inpatients with COVID-19—often diverge dramatically from those collected by the other federal source, from state-supplied data, and from the apparent reality on the ground.

“Our hospitals are struggling,” says Jeffrey Pothof, a physician and chief quality officer for the health system of the University of Wisconsin (UW), Madison. During recent weeks, patients filled the system’s COVID-19 ward and ICU. The university’s main hospital converted other ICUs to treat the pandemic disease and may soon have to turn away patients referred to the hospital for specialized care. Inpatient beds—including those in ICUs—are nearly full across the state. “That’s the reality staring us down,” Pothof says, adding: The HHS Protect numbers “are not real.”

HHS Protect’s problems are a national issuean internal analysis completed this month by the Centers for Disease Control and Prevention (CDC) shows. That analysis, other federal reports, and emails obtained by Science suggest HHS Protect’s data do not correspond with alternative hospital data sources in many states (see tables, below). “The HHS Protect data are poor quality, inconsistent with state reports, and the analysis is slipshod,” says one CDC source who had read the agency’s analysis and requested anonymity because of fear of retaliation from the Trump administration. “And the pressure on hospitals [from COVID-19] is through the roof.”

Both federal and state officials use HHS Protect’s data to assess the burden of disease across the country and allocate scarce resources, from limited stocks of COVID-19 medicines to personal protective equipment (PPE). Untrustworthy numbers could lead to supply and support problems in the months ahead, as U.S. cases continue to rise during an expected winter surge, according to current and former CDC officials. HHS Protect leaders vigorously defend the system and blame some disparities on inconsistent state and federal definitions of COVID-19 hospitalization. “We have made drastic improvements in the consistency of our data … even from September to now,” says one senior HHS official. (Three officials from the department spoke with Science on the condition that they not be named.)

CDC had a long-running, if imperfect, hospital data tracking system in place when the pandemic started, but the Trump administration and White House Coronavirus Task Force Coordinator Deborah Birx angered many in the agency when they shifted much of the responsibility for COVID-19 hospital data in July to private contractors. TeleTracking Technologies Inc., a small Pittsburgh-based company, now collects most of the data, while Palantir, based in Denver, helps manage the database. At the time, hundreds of public health organizations and experts warned the change could gravely disrupt the government’s ability to understand the pandemic and mount a response

The feared data chaos now seems a reality, evident when recent HHS Protect figures are compared with public information from states or data documented by another hospital tracking system run by the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR). ASPR manages the Strategic National Stockpile of medicines, PPE—in perilously short supply in many areas—and other pandemic necessities. ASPR collects data nationwide, although it is more limited than what HHS Protect compiles, to help states and hospitals respond to the pandemic.

In Alabama, HHS Protect figures differ by 15% to 30% from daily state COVID-19 inpatient totals. Karen Landers, assistant state health officer, said nearly all of the state’s hospitals report data to HHS via the Alabama Department of Public Health. Although reporting delays sometimes prevent the systems from syncing precisely, Landers says, she cannot account for the sharp differences. 

Many state health officials contacted by Science were reluctant to directly criticize HHS Protect or attribute supply or support problems to its data. Landers notes that Alabama relies on its own collected data, rather than HHS Protect’s, for its COVID-19 response. “We are very confident in our data,” she says, because the state reporting system was developed over several years and required little adjustment to add COVID-19. HHS, she adds, has generally been responsive to state requests for medicines and supplies, although Alabama has not always gotten all the PPE it has requested.

Other states, however, say they do rely on HHS Protect. A spokesperson for the Wisconsin Department of Health Services wrote in a response to questions, “When making decisions at the state level we use the HHS Protect data,” but declined to comment about its accuracy. HHS informed Wisconsin officials it distributes scarce supplies based on need indicated by HHS Protect data, the spokesperson wrote.

Pothof says UW’s hospital system has its own sophisticated data dashboard that draws on state, local, and internal sources to plan and cooperate on pandemic response with other hospitals. But small hospitals in Wisconsin—now experiencing shortages of some medicines, PPE, and other supplies—are more dependent on federal support largely based on HHS Protect data. Help might not arrive, Pothof says, if the data show “things look better than they are.”

If the HHS Protect data are suspect, “that’s a very large problem,” says Nancy Cox, former director of CDC’s influenza division and now an affiliated retiree of the agency. If HHS officials use bad data, they will not distribute medicines and supplies equitably, Cox notes, adding: “Undercounting in the hardest hit states means a lower level of care and will result in more severe infections and ultimately in more deaths.”

Birx and the other managers of HHS Protect “really had no idea what they were doing,” says Tom Frieden, CDC director under former President Barack Obama. (Birx declined to comment for this article.) Frieden cautions that ASPR data might also be erroneous—pointing to the need for an authoritative and clear federal source of hospital data. The original CDC system, called the National Healthcare Safety Network (NHSN), should be improved, he said, but it handles nursing home COVID-19 data skillfully and could do the same with hospitals. NHSN is “not just a computer program. It’s a public health program” built over 15 years and based on relationships with individual health facilities, Frieden says. (CDC insiders say HHS officials recently interfered with publication of an analysis showing that NHSN performed well early in the pandemic [see sidebar, below]).

An HHS official says HHS Protect’s data are complex and the department can’t verify any findings in the reports reviewed by Science without conducting its own analysis, which it did not do. But the official says HHS Protect has improved dramatically in the past 2 months and provides consistent and reliable results.

As for the difference between state and HHS Protect data, an HHS official contends state numbers “are always going to be lower” by up to 20%. That’s because hospitals could lose Medicare funding if they do not report to HHS, the official says, but face no penalty for failing to report to the state. So rather than expect identical numbers, HHS looks for state and federal data to reflect the same trajectory—which they do in all cases for COVID-19 inpatient data, according to another confidential CDC analysis of HHS Protect, covering all 50 states.

Yet the same analysis found 27 states recently alternated between showing more or fewer COVID-19 inpatients than HHS Protect—not always just fewer, as HHS says should be the case. Thirty states also showed differences between state and HHS Protect figures that were frequently well above the 20% threshold cited by HHS, and HHS Protect data fluctuated erratically in 21 states (see chart, below).

“Hospital capacity metrics can and should be a national bellwether,” the CDC data expert says. “One important question raised by the discordant data reported by HHS Protect and the states is whether HHS Protect is systematically checking data validity.” HHS has not provided its methodology for HHS Protect data estimates for review by independent experts. But an HHS official says a team of data troubleshooters, including CDC and ASPR field staff, work to resolve anomalies and respond to spikes in cases in a state or hospital.

Out of sync

Tracking hospital inpatients who have COVID-19 has become a crucial measure of the pandemic’s severity. Department of Health and Human Services (HHS) data from the HHS Protect system often diverge sharply from state-supplied data. This chart, drawn from a data analysis from the Centers for Disease Control and Prevention, summarizes some of the similarities and differences for COVID-19 inpatient totals over the past 2 months.

Along with improving trust in its data, HHS Protect needs to make it more accessible, CDC data scientists say. The publicly accessible HHS Protect data are far less complete than the figures in its password-protected database. This effectively hides from public view key pandemic information, such as local supplies of protective equipment.

The site also does not provide graphics highlighting patterns and trends. This might explain, in part, why most media organizations—as well as President-elect Joe Biden’s transition team—instead have relied on state or county websites that vary widely in completeness and quality, or on aggregations such as The Atlantic magazine’s COVID Tracking Project, which collects, organizes, and standardizes state data. (In comparing state and federal data, CDC also used the COVID Tracking Project.)

Frieden and other public health specialists call reliable, clear federal data essential for an effective pandemic response. “The big picture is that we’re coming up to 100,000 hospitalizations within the next few weeks. Hospital systems all over the country are going to be stressed,” Frieden says. “There’s not going to be any cavalry coming over the hill from somewhere else in the country, because most of the country is going to be overwhelmed. We’re heading into a very hard time with not very accurate information systems. And the government basically undermined the existing system.”

Covid-19 Data in the US Is an ‘Information Catastrophe’

https://www.wired.com/story/covid-19-data-in-the-us-is-an-information-catastrophe/#intcid=recommendations_wired-bottom-recirc-personalized_31e95638-88d6-439c-85a2-db8f6235da26_text2vec1-mab

Covid-19 Data in the US Is an 'Information Catastrophe' | WIRED

The order to reroute CDC hospitalization figures raised accuracy concerns. But that’s just one of the problems with how the country collects health data.

TWO WEEKS AGO, the Department of Health and Human Services stripped the Centers for Disease Control and Prevention of control of national data on Covid-19 infections in hospitalized patients. Instead of sending the data to the CDC’s public National Healthcare Safety Network (NHSN), the department ordered hospitals to send it to a new data system, run for the agency by a little-known firm in Tennessee.

The change took effect immediately. First, the hospitalization data collected up until July 13 vanished from the CDC’s site. One day later, it was republished—but topped by a note that the NHSN Covid-19 dashboard would no longer be updated.

Fury over the move was immediate. All the major organizations that represent US public health professionals objected vociferously. A quickly written protest letter addressed to Vice President Mike Pence, HHS secretary Alex Azar, and Deborah Birx, the coordinator of the White House’s Coronavirus Task Force, garnered signatures from more than 100 health associations and research groups. The reactions made visible the groups’ concerns that data could be lost or duplicated, and underlined their continual worry that the CDC is being undercut and sidelined. But it had no other effect. The new HHS portal, called HHS Protect, is up and running.

Behind the crisis lies a difficult reality: Covid-19 data in the US—in fact, almost all public health data—is chaotic: not one pipe, but a tangle. If the nation had a single, seamless system for collecting, storing, and analyzing health data, HHS and the Coronavirus Task Force would have had a much harder time prying the CDC’s Covid-19 data loose. Not having a comprehensive system made the HHS move possible, and however well or badly the department handles the data it will now receive, the lack of a comprehensive data system is harming the US coronavirus response.

“Every health system, every public health department, every jurisdiction really has their own ways of going about things,” says Caitlin Rivers, a senior scholar at the Johns Hopkins Center for Health Security. “It’s very difficult to get an accurate and timely and geographically resolved picture of what’s happening in the US, because there’s such a jumble of data.”

Data systems are wonky objects, so it may help to step back and explain a little history. First, there’s a reason why hospitalization data is important: Knowing whether the demand for beds is rising or falling can help illuminate how hard-hit any area is, and whether reopening in that region is safe.

Second, what the NHSN does is important too. It’s a 15-year-old database, organized in 2005 out of several streams of information that were already flowing to the CDC, which receives data from hospitals and other health care facilities about anything that affects the occurrence of infections once someone is admitted. That includes rates of pneumonia from use of ventilators, infections after surgery, and urinary tract infections from catheters, for instance—but also statistics about usage of antibiotics, adherence to hand hygiene, complications from dialysis, occurrence of the ravaging intestinal infection C. difficile, and rates of health care workers getting flu shots. Broadly, it assembles a portrait of the safety of hospitals, nursing homes, and chronic care institutions in the US, and it shares that data with researchers and with other statistical dashboards published by other HHS agencies such as the Center for Medicare and Medicaid Services.

Because NHSN only collects institutional data, and Covid-19 infections occur both inside institutions such as nursing homes and hospitals, and in the outside world, HHS officials claimed the database was a bad fit for the coronavirus pandemic. But people who have worked with it argue that since the network had already devised channels for receiving all that data from health care systems, it ought to continue to do so—especially since that data isn’t easy to abstract.

“If you are lucky enough to work in a large health care system that has a sophisticated electronic medical record, then possibly you can push one button and have all the data flow up to NHSN,” says Angela Vassallo, an epidemiologist who formerly worked at HHS and is now chief clinical adviser to the infection-prevention firm Covid Smart. “But that’s a rare experience. Most hospitals have an infection preventionist, usually an entire team, responsible for transferring that data by hand.”

There lies the core problem. Despite big efforts back during the Obama administration to funnel all US health care data into one large-bore pipeline, what exists now resembles what you’d find behind the walls of an old house: pipes going everywhere, patched at improbable angles, some of them leaky, and some of them dead ends. To take some examples from the coronavirus response: Covid-19 hospital admissions were measured by the NHSN (before HHS intervened), but cases coming to emergency departments were reported in a different database, and test results were reported first to local or state health departments, and then sent up to the CDC.

Covid-19 data in particular has been so messy that volunteer efforts have sprung up to fix it. These include the COVID Tracking Project—compiled from multiple sources and currently the most comprehensive set of statistics, used by media organizations and apparently by the White House—and Covid Exit Strategy, which uses data from the COVID Tracking Project and the CDC.

Last week, the American Public Health Association, the Johns Hopkins Center, and Resolve to Save Lives, a nonprofit led by former CDC director Tom Frieden, released a comprehensive report on Covid-19 data collection. Pulling no punches, they called the current situation an “information catastrophe.”

The US, they found, does not have national-, state-, county-, or city-level standards for Covid-19 data. Every state maintains some form of coronavirus dashboard (and some have several), but every dashboard is different; no two states present the same data categories, nor visualize them the same way. The data presented by states is “inconsistent, incomplete, and inaccessible,” the group found: Out of 15 key pieces of data that each state should be presenting—things such as new confirmed and probable cases, new tests performed, and percentage of tests that are positive—only 38 percent of the indicators are reported in some way, with limitations, and 60 percent are not reported at all.

“This is not the fault of the states—there was no federal leadership,” Frieden emphasized in an interview with WIRED. “And this is legitimately difficult. But it’s not impossible. It just requires commitment.”

But the problem of incomplete, messy data is older and deeper than this pandemic. Four scholars from the health-policy think tank the Commonwealth Fund called out the broader problem just last week in an essay in The New England Journal of Medicine, naming health data as one of four interlocking health care crises exposed by Covid-19. (The others were reliance on employer-provided health care, financial losses in rural and primary-care practices, and the effect of the pandemic on racial and ethinic minorities.)

“There is no national public health information system—electronic or otherwise—that enables authorities to identify regional variation in the demand for, and supply of, resources critical to managing Covid-19,” they wrote. The fix they recommended: a national public health information system that would record diagnoses in real time, monitor the materials hospitals need, and link hospitals and outpatient care, state and local health departments, and laboratories and manufacturers to maintain real-time reporting on disease occurrence, preventive measures, and equipment production.

They are not the first to say this is needed. In February, 2019, the Council of State and Territorial Epidemiologists launched a campaign to get Congress to appropriate $1 billion in new federal funding over 10 years specifically to improve data flows. “The nation’s public health data systems are antiquated, rely on obsolete surveillance methods, and are in dire need of security upgrades,” the group wrote in its launch statement. “Sluggish, manual processes—paper records, spreadsheets, faxes, and phone calls—still in widespread use, have consequences, most notably delayed detection and response to public health threats.”

Defenders of the HHS decision to switch data away from the CDC say that improving problems like that is what the department was aiming for. (“The CDC’s old hospital data-gathering operation once worked well monitoring hospital information across the country, but it’s an inadequate system today,” HHS assistant secretary for public affairs Michael Caputo told CNN.) If that’s an accurate claim, during a global pandemic is a challenging time to do it.

“We were opposed to this, because trying to do this in the middle of a disaster is not the time,” says Georges Benjamin, a physician and executive director of the American Public Health Association, which was a signatory to the letter protesting moving data from the NHSN. “It was just clearly done without a lot of foresight. I don’t think they understand the way data moves into and through the system.”

The past week has shown how correct that concern was. Immediately after the switch, according to CNBC, states were blacked out from receiving data on their own hospitals, because the hospitals were not able to manage the changeover from the CDC to the HHS system. On Tuesday, Ryan Panchadsaram, cofounder of Covid Exit Strategy and former deputy chief technology officer for the US, highlighted on Twitter that data on the HHS dashboard, advertised as updating daily, was five days old. And Tuesday night, the COVID Tracking Project staff warned in a long analysis: “Hospitalization data from states that was highly stable a few weeks ago is currently fragmented, and appears to be a significant undercount.”

When the Covid-19 crisis is over, as everyone hopes it will be someday, the US will still have to wrestle with the questions it raised. One of those will be how the richest country on the planet, with some of the best clinical care in the world, was content with a health information system that left it so uninformed about a disease affecting so many of its citizens. The answer could involve tearing the public-health data system down and building it again from scratch.

“This is a deeply entrenched problem, where there is no single person who has not done their job,” Rivers says. “Our systems are old. They were not updated. We haven’t invested in them. If you’re trying to imagine a system where everyone reports the same information in the same way and we can push a button and have all the information we might want, that will take a complete overhaul of what we have.”

 

 

 

 

The Fed’s independence helped it save the US economy in 2008 – the CDC needs the same authority today

https://theconversation.com/the-feds-independence-helped-it-save-the-us-economy-in-2008-the-cdc-needs-the-same-authority-today-142593

Centers for Disease Control and Prevention

The image of scientists standing beside governors, mayors or the president has become common during the pandemic. Even the most cynical politician knows this public health emergency cannot be properly addressed without relying on the scientific knowledge possessed by these experts.

Yet, ultimately, U.S. government health experts have limited power. They work at the discretion of the White House, leaving their guidance subject to the whims of politicians and them less able to take urgent action to contain the pandemic.

The Centers for Disease Control and Prevention has issued guidelines only to later revise them after the White House intervened. The administration has also undermined its top infectious disease expert, Dr. Anthony Fauci, over his blunt warnings that the pandemic is getting worse – a view that contradicts White House talking points.

And most recently, the White House stripped the CDC of control of coronavirus data, alarming health experts who fear it will be politicized or withheld.

In the realm of monetary policy, however, there is an agency with experts trusted to make decisions on their own in the best interests of the U.S. economy: the Federal Reserve. As I describe in my recent book, “Stewards of the Market,” the Fed’s independence allowed it to take politically risky actions that helped rescue the economy during the financial crisis of 2008.

That’s why I believe we should give the CDC the same type of authority as the Fed so that it can effectively guide the public through health emergencies without fear of running afoul of politicians.

 

The paradox of expertise

There is a paradox inherent in the relationship between political leaders and technical experts in government.

Experts have the training and skill to apply scientific knowledge in complex biological and economic systems, yet democratically elected political leaders may overrule or ignore their advice for ill or good.

This happened in May when the CDC, the federal agency charged with controlling the spread of disease, removed advice regarding the dangers of singing in church choirs from its website. It did not do so because of new evidence. Rather, it was because of political pressure from the White House to water down the guidance for religious groups.

Similarly, the White House undermined the CDC’s guidance on school reopenings and has pressured it to revise them. So far, it seems the CDC has rebuffed the request.

The ability of elected leaders to ignore scientists – or the scientists’ acquiescence to policies they believe are detrimental to public welfare – is facilitated by many politicians’ penchant for confident assertion of knowledge and the scientist’s trained reluctance to do so.

Compare Fauci’s repeated comment that “there is much we don’t know about the virus” with President Donald Trump’s confident assertion that “we have it totally under control.”

 

Experts with independence

Given these constraints on technical expertise, the performance of the Fed in the financial crisis of 2008 offers an informative example that may be usefully applied to the CDC today.

The Federal Reserve is not an executive agency under the president, though it is chartered and overseen by Congress. It was created in 1913 to provide economic stability, and its powers have expanded to guard against both depression and crippling inflation.

At its founding, the structure of the Fed was a political compromise designed make it independent within the government in order to de-politicize its economic policy decisions. Today its decisions are made by a seven-member board of governors and a 12-member Federal Open Market Committee. The members, almost all Ph.D. economists, have had careers in academia, business and government. They come together to analyze economic data, develop a common understanding of what they believe is happening and create policy that matches their shared analysisThis group policymaking is optimal when circumstances are highly uncertain, such as in 2008 when the global financial system was melting down.

The Fed was the lead actor in preventing the system’s collapse and spent several trillion dollars buying risky financial assets and lending to foreign central banks – decisions that were pivotal in calming financial markets but would have been much harder or may not have happened at all without its independent authority.

The Fed’s independence is sufficiently ingrained in our political culture that its chair can have a running disagreement with the president yet keep his job and authority.

 

Putting experts at the wheel

A health crisis needs trusted experts to guide decision-making no less than an economic one does. This suggests the CDC or some re-imagined version of it should be made into an independent agency.

Like the Fed, the CDC is run by technical experts who are often among the best minds in their fields. Like the Fed, the CDC is responsible for both analysis and crisis response. Like the Fed, the domain of the CDC is prone to politicization that may interfere with rational response. And like the Fed, the CDC is responsible for decisions that affect fundamental aspects of the quality of life in the United States.

Were the CDC independent right now, we would likely see a centralized crisis management effort that relies on the best science, as opposed to the current patchwork approach that has failed to contain the outbreak nationally. We would also likely see stronger and consistent recommendations on masks, social distancing and the safest way to reopen the economy and schools.

Independence will not eliminate the paradox of technical expertise in government. The Fed itself has at times succumbed to political pressure. And Trump would likely try to undermine an independent CDC’s legitimacy if its policies conflicted with his political agenda – as he has tried to do with the central bank.

But independence provides a strong shield that would make it much more likely that when political calculations are at odds with science, science wins.

 

 

 

 

How Many People in the U.S. Are Hospitalized With COVID-19? Who Knows?

https://www.propublica.org/article/how-many-people-in-the-us-are-hospitalized-with-covid-19-who-knows?utm_source=sailthru&utm_medium=email&utm_campaign=dailynewsletter&utm_content=feature

 

The Trump administration told hospitals to stop reporting data to the CDC, and report it to HHS instead. Vice President Mike Pence said the information would continue to be released publicly. It hasn’t worked out as promised.

In mid-July, the Trump administration instructed hospitals to change the way they reported data on their coronavirus patients, promising the new approach would provide better, more up-to-the-minute information about the virus’s toll and allow resources and supplies to be quickly dispatched across the country.

Instead, the move has created widespread confusion, leaving some states in the dark about their hospitals’ remaining bed and intensive care capacity and, at least temporarily, removing this information from public view. As a result, it has been unclear how many people are in hospitals being treated for COVID-19 at a time when the number of infected patients nationally has been soaring.

Hospitalizations for COVID-19 have been seen as a key metric of both the coronavirus’s toll and the health care system’s ability to deal with it.

Since early in the pandemic, hospitals had been reporting data on COVID-19 patients to the U.S. Centers for Disease Control and Prevention through its National Healthcare Safety Network, which traditionally tracks hospital-acquired infections.

In a memo dated July 10, the U.S. Department of Health and Human Services told hospitals to abruptly change course — to stop reporting their data to the CDC and instead to submit it to HHS through a new portal run by a company called TeleTracking. The change took effect within days. Vice President Mike Pence said the administration would continue releasing the data publicly, as the CDC had done.

Almost immediately, the CDC pulled its historical data offline, only to repost it under pressure a couple days later. Meanwhile the website for the administration’s new portal promised to update numbers on a daily basis, but, as of Friday morning, the site hadn’t been updated since July 23. (HHS is posting some data daily on a different federal website but not representative estimates for each state.)

“The most pernicious portion of it is that at the state level and at the regional level we lost our situational awareness,” said Dave Dillon, spokesman for the Missouri Hospital Association. “At the end of this, we may have a fantastic data product out of HHS. I will not beat them up for trying to do something positive about the data, but the rollout of this has been absolutely a catastrophe.”

The Missouri Hospital Association had taken the daily data submitted by its hospitals to the CDC and created a state dashboard. The transition knocked that offline. The dashboard came back online this week, but Dillon said in a follow-up email, “the data is only as good as our ability to know that everyone is reporting the same data, in the correct way, for tracking and comparison purposes at the state level.”

Other states, including Idaho and South Carolina, also experienced temporary information blackouts. And The COVID Tracking Project, which has been following the pandemic’s toll across the country based on state data, noted issues with its figures. “These problems mean that our hospitalization data — a crucial metric of the COVID-19 pandemic — is, for now, unreliable, and likely an undercount. We do not think that either the state-level hospitalization data or the new federal data is reliable in isolation,” according to a blog post Tuesday on the group’s website.

Making matters more complicated, the administration has changed the information that it is requiring hospitals to report, adding many elements, such as the age range of admitted COVID-19 patients, and removing others. As of this week, for instance, HHS told hospitals to stop reporting the total number of deaths they’ve had since Jan. 1, the total number of COVID-19 deaths and the total number of COVID-19 admissions. (Hospitals still report daily figures, just not historical ones.)

“Massachusetts hospitals are continuing to navigate the dramatic increase of daily data requirements,” the Massachusetts Health and Hospital Association said in a newsletter on Monday. “MHA and other state health officials continue to raise concerns about the administrative burden and questionable usefulness of some of the data.”

“Hospitals across the country were given little time to adjust to the unnecessary and seismic changes put forth by the U.S. Department of Health and Human Services, which fundamentally shift both the volume of data and the platforms through which data is submitted,” the association’s CEO, Steve Walsh, said in the newsletter.

A number of state websites also noted problems with hospital data. For days, the Texas Department of State Health Services included a note on its dashboard that it was “reporting incomplete hospitalization numbers … due to a transition in reporting to comply with new federal requirements.” That came just as the state was experiencing a peak in COVID-19 hospitalizations.

California likewise noted problems.

A spokesperson for HHS acknowledged some bumps in the transition but said in an email: “We are pleased with the progress we have made during this transition and the actionable data it is providing. We have had some states and hospital associations report difficulty with the new collection system. When HHS identifies errors in the data submissions, we work directly with the state or hospital association to quickly resolve them.

“Our objective with this new approach is to collaborate with the states and the healthcare system. The goal of full transparency is to acknowledge when we find discrepancies in the data and correct them.”

Last week, HHS noted, 93% of its prioritized list of hospitals, excluding psychiatric, rehabilitation and religious nonmedical facilities, reported data at least once during the week. (The guidance to hospitals asks them to report every day.)

Asked about the lack of timely data on its public website, HHS said it will update the site to “make it clear that the estimates are only updated weekly.” HHS is now posting a date file each day on healthdata.gov with aggregate information on hospitalizations by state.

But unlike the prior releases from CDC, which provided estimates on hospital capacity based on the responses, this file only gives totals for the hospitals that reported data. It’s unclear which hospitals did not report, how large they are, or whether the reported data is representative.

It’s also unclear if it’s accurate. New York state, for instance, reported that fewer than 600 people were currently hospitalized with COVID-19, as of Friday. Federal data released the same day pegged the number of suspected and confirmed COVID-19 hospitalizations at around 1,800.

Louisiana says more than 1,500 people are currently hospitalized with COVID-19. The federal data puts the figure at fewer than 700.

Nationally, The COVID Tracking Project reports that more than 56,000 people were hospitalized around the country with the virus, as of Thursday.

The data released by HHS on Friday puts the figure at more than 70,000.

NPR reported this week that it had found irregularities in the process used by the Trump administration to award the contract to manage the hospital data. Among other things, HHS directly contacted TeleTracking about the contract and the agency used a process that is more often used for innovative scientific research, NPR reported.

An HHS spokesperson told NPR that the contract process it used is a “common mechanism … for areas of research interest,” and said that the system used by the CDC was “fraught with challenges.”

Ryan Panchadsaram, co-founder of the tracking website CovidExitStrategy.org, has been critical of the problems created by the hospital data changeover.

“Without real-time accurate monitoring, you can’t make quick and fast and accurate decisions in a crisis,” he said in an interview. “This is just so important. This indicator that’s gone shows how the health system in a state is doing.”

Dillon of the Missouri Hospital Association said the administration could have handled this differently. For big technology projects, he noted, there is often a well-publicized transition with information sessions, an educational program and, perhaps, running the old system and the new one in parallel.

This “was extremely abrupt,” he said. “That is not akin to anything you would expect from HHS about how you would implement a program.”

 

US coronavirus data will now go straight to the White House. Here’s what this means for the world

https://theconversation.com/us-coronavirus-data-will-now-go-straight-to-the-white-house-heres-what-this-means-for-the-world-142814?utm_medium=email&utm_campaign=Latest%20from%20The%20Conversation%20for%20July%2028%202020%20-%201689316298&utm_content=Latest%20from%20The%20Conversation%20for%20July%2028%202020%20-%201689316298+Version+A+CID_abf5f3d50179e225ba3e81ad0fbb430c&utm_source=campaign_monitor_us&utm_term=US%20coronavirus%20data%20will%20now%20go%20straight%20to%20the%20White%20House%20Heres%20what%20this%20means%20for%20the%20world

US coronavirus data will now go straight to the White House ...

Led by physicians, scientists and epidemiologists, the US Centers for Disease Control and Prevention (CDC) is one of the most reliable sources of knowledge during disease outbreaks. But now, with the world in desperate need of authoritative information, one of the foremost agencies for fighting infectious disease has gone conspicuously silent.

For the first time since 1946, when the CDC came to life in a cramped Atlanta office to fight malaria, the agency is not at the front line of a public health emergency.

On April 22, CDC director Robert Redfield stood at the White House briefing room lectern and conceded that the coronavirus pandemic had “overwhelmed” the United States. Following Redfield at the podium, President Donald Trump said the CDC director had been “totally misquoted” in his warning that COVID-19 would continue to pose serious difficulties as the US moved into its winter ‘flu season in late 2020.

Invited to clarify, Redfield confirmed he had been quoted correctly in giving his opinion that there were potentially “difficult and complicated” times ahead.

Trump tried a different tack. “You may not even have corona coming back,” the president said, once again contradicting the career virologist. “Just so you understand.”

The exchange was interpreted by some pundits as confirmation that the CDC’s venerated expertise had been sidelined as the coronavirus continued to ravage the US.

In the latest development, the New York Times reported this week the CDC has even been bypassed in its data collection, with the Trump administration ordering hospitals to send COVID-19 data directly to the White House.

Diminished role

When facing previous public health emergencies the CDC was a hive of activity, holding regular press briefings and developing guidance that was followed by governments around the world. But during the greatest public health emergency in a century, it appears the CDC has been almost entirely erased by the White House as the public face of the COVID-19 pandemic response.

This diminished role is obvious to former leaders of the CDC, who say their scientific advice has never before been politicised to this extent.

As the COVID-19 crisis was unfolding, several CDC officials issued warnings, only to promptly disappear from public view. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, predicted on February 25 that the virus was not contained and would grow into a pandemic.

The stock market plunged and Messonnier was removed from future White House press briefings. Between March 9 and June 12 there was no CDC presence at White House press briefings on COVID-19.

The CDC has erred during the pandemic, most significantly in its initial efforts to develop a test for COVID-19. The testing kits proved to be faulty – a problem compounded by sluggish efforts to rectify the situation – and then by severe delays in distributing enough tests to the public.

But many public health specialists are nevertheless baffled by the CDC’s low profile as the pandemic continues to sweep the globe.

“They have been sidelined,” said Howard Koh, former US assistant secretary for health. “We need their scientific leadership right now.”

What does it mean for the world?

The CDC being bypassed in the collection of COVID-19 data is another body blow to the agency’s standing.

Hospitals have instead been ordered to send all COVID-19 patient information to a central database in Washington DC.

This will have a range of likely knock-on effects. For starters, the new database will not be available to the public, prompting inevitable questions over the accuracy and transparency of data which will now be interpreted and shared by the White House.

The Department of Health and Human Services, which issued the new order, says the change will help the White House’s coronavirus task force allocate resources. But epidemiologists and public health experts around the world fear the new system will make it harder for people outside the White House to track the pandemic or access information.

This affects all nations, because one of the CDC’s roles is to provide sound, independent public health guidance on issues such as infectious diseases, healthy living, travel health, emergency and disaster preparedness, and drug efficacy. Other jurisdictions can then adapt this information to their local context — expertise that has become even more essential during a pandemic, when uncertainty is the norm.

It is difficult to recall a previous public health emergency when political pressure led to a change in the interpretation of scientific evidence.

What happens next?

Despite the inevitable challenges that come with tackling a pandemic in real time, the CDC remains the best-positioned agency – not just in the US but the entire world – to help us manage this crisis as safely as possible.

In the absence of US leadership, nations should start thinking about developing their own national centres for disease control. In Australia’s case, these discussions have been ongoing since the 1990s, stymied by cost and lack of political will.

COVID-19, and the current sidelining of the CDC, may be the impetus needed to finally dust off those plans and make them a reality.

 

 

 

One question still dogs Administration: Why not try harder to solve the coronavirus crisis?

https://www.washingtonpost.com/politics/trump-not-solve-coronavirus-crisis/2020/07/26/7fca9a92-cdb0-11ea-91f1-28aca4d833a0_story.html?utm_source=ActiveCampaign&utm_medium=email&utm_content=Republicans+Roll+Out+%241+Trillion+Coronavirus+Relief+Plan&utm_campaign=TFT+Newsletter+07272020

Questions to ask students in class to help them deal with the ...

Both President Trump’s advisers and operatives laboring to defeat him increasingly agree on one thing: The best way for him to regain his political footing is to wrest control of the novel coronavirus.

In the six months since the deadly contagion was first reported in the United States, Trump has demanded the economy reopen and children return to school, all while scrambling to salvage his reelection campaign.

But allies and opponents agree he has failed at the one task that could help him achieve all his goals — confronting the pandemic with a clear strategy and consistent leadership.

Trump’s shortcomings have perplexed even some of his most loyal allies, who increasingly have wondered why the president has not at least pantomimed a sense of command over the crisis or conveyed compassion for the millions of Americans hurt by it.

People close to Trump, many speaking on the condition of anonymity to share candid discussions and impressions, say the president’s inability to wholly address the crisis is due to his almost pathological unwillingness to admit error; a positive feedback loop of overly rosy assessments and data from advisers and Fox News; and a penchant for magical thinking that prevented him from fully engaging with the pandemic.

In recent weeks, with more than 145,000 Americans now dead from the virus, the White House has attempted to overhaul — or at least rejigger — its approach. The administration has revived news briefings led by Trump and presented the president with projections showing how the virus is now decimating Republican states full of his voters. Officials have also set up a separate, smaller coronavirus working group led by Deborah Birx, the White House coronavirus response coordinator, along with Trump son-in-law and senior adviser Jared Kushner.

For many, however, the question is why Trump did not adjust sooner, realizing that the path to nearly all his goals — from an economic recovery to an electoral victory in November — runs directly through a healthy nation in control of the virus.

“The irony is that if he’d just performed with minimal competence and just mouthed words about national unity, he actually could be in a pretty strong position right now, where the economy is reopening, where jobs are coming back,” said Ben Rhodes, a deputy national security adviser to former president Barack Obama. “And he just could not do it.”

Many public health experts agree.

“The best thing that we can do to set our economy up for success and rebounding from the last few months is making sure our outbreak is in a good place,” said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. “People are not going to feel comfortable returning to activities in the community — even if it’s allowed from a policy perspective — if they don’t feel the outbreak is under control.”

Some aides and outside advisers have tried to stress to Trump and others in his orbit that before he could move on to reopening the economy and getting the country back to work — and life — he needed to grapple with the reality of the virus.

But until recently, the president was largely unreceptive to that message, they said, not fully grasping the magnitude of the pandemic — and overly preoccupied with his own sense of grievance, beginning many conversations casting himself as the blameless victim of the crisis.

In the past couple of weeks, senior advisers began presenting Trump with maps and data showing spikes in coronavirus cases among “our people” in Republican states, a senior administration official said. They also shared projections predicting that virus surges could soon hit politically important states in the Midwest — including Michigan, Minnesota and Wisconsin, the official said.

This new approach seemed to resonate, as he hewed closely to pre-scripted remarks in a trio of coronavirus briefings last week.

“This could have been stopped. It could have been stopped quickly and easily. But for some reason, it wasn’t, and we’ll figure out what that reason was,” Trump said Thursday, seeming to simultaneously acknowledge his predicament while trying to assign blame elsewhere.

In addition to Birx and Kushner, the new coronavirus group guiding Trump includes Kushner advisers Adam Boehler and Brad Smith, according to two administration officials. Marc Short, chief of staff to Vice President Pence, also attends, along with Alyssa Farah, the White House director of strategic communications, and Stephen Miller, Trump’s senior policy adviser.

The working group’s goal is to meet every day, for no more than 30 minutes. It views its mission as half focused on the government’s response to the pandemic and half focused on the White House’s public message, the officials said.

White House spokeswoman Sarah Matthews defended the president’s handling of the crisis, saying he acted “early and decisively.”

“The president has also led an historic, whole-of-America coronavirus response — resulting in 100,000 ventilators procured, sourcing critical PPE for our front-line heroes, and a robust testing regime resulting in more than double the number of tests than any other country in the world,” Matthews said in an email statement. “His message has been consistent and his strong leadership will continue as we safely reopen the economy, expedite vaccine and therapeutics developments, and continue to see an encouraging decline in the U.S. mortality rate.”

For some, however, the additional effort is too little and far too late.

“This is a situation where if Trump did his job and put in the work to combat the health crisis, it would solve the economic crisis, and it’s an instance where the correct governing move is also the correct political move, and Trump is doing the opposite,” said Josh Schwerin, a senior strategist for Priorities USA, a super PAC supporting former vice president Joe Biden, the presumptive Democratic nominee.

Other anti-Trump operatives agree, saying he could make up lost ground and make his race with Biden far more competitive with a simple course correction.

“He’s staring in the mirror at night: That’s who can fix his political problem,” said John Weaver, one of the Republican strategists leading the Lincoln Project, a group known for its anti-Trump ads.

One of Trump’s biggest obstacles is his refusal to take responsibility and admit error.

In mid-March, as many of the nation’s businesses were shuttering early in the pandemic, Trump proclaimed in the Rose Garden, “I don’t take responsibility at all.” Those six words have neatly summed up Trump’s approach not only to the pandemic, but also to many of the other crises he has faced during his presidency.

“His operating style is to double- and triple-down on positions and to never, ever admit he’s wrong about anything,” said Anthony Scaramucci, a longtime Trump associate who briefly served as White House communications director and is now a critic of the president. “His 50-year track record is to bulldog through whatever he’s doing, whether it’s Atlantic City, which was a failure, or the Plaza Hotel, which was a failure, or Eastern Airlines, which was a failure. He can never just say, ‘I got it wrong and let’s try over again.’ ”

Another self-imposed hurdle for Trump has been his reliance on a positive feedback loop. Rather than sit for briefings by infectious-disease director Anthony S. Fauci and other medical experts, the president consumes much of his information about the virus from Fox News and other conservative media sources, where his on-air boosters put a positive spin on developments.

Consider one example from last week. About 6:15 a.m. that Tuesday on “Fox & Friends,” co-host Steve Doocy told viewers, “There is a lot of good news out there regarding the development of vaccines and therapeutics.” The president appears to have been watching because, 16 minutes later, he tweeted from his iPhone, “Tremendous progress being made on Vaccines and Therapeutics!!!”

It is not just pro-Trump media figures feeding Trump positive information. White House staffers have long made upbeat assessments and projections in an effort to satisfy the president. This, in turn, makes Trump further distrustful of the presentations of scientists and reports in the mainstream news media, according to his advisers and other people familiar with the president’s approach.

This dynamic was on display during an in-depth interview with “Fox News Sunday” anchor Chris Wallace that aired July 19. After the president claimed the United States had one of the lowest coronavirus mortality rates in the world, Wallace interjected to fact-check him: “It’s not true, sir.”

Agitated by Wallace’s persistence, Trump turned off-camera to call for White House press secretary Kayleigh McEnany. “Can you please get me the mortality rates?” he asked. Turning to Wallace, he said, “Kayleigh’s right here. I heard we have one of the lowest, maybe the lowest mortality rate anywhere in the world.”

Trump, relying on cherry-picked White House data, insisted that the United States was “number one low mortality fatality rates.”

Fox then interrupted the taped interview to air a voice-over from Wallace explaining that the White House chart showed Italy and Spain doing worse than the United States but countries like Brazil and South Korea doing better — and other countries that are doing better, including Russia, were not included on the White House chart. By contrast, worldwide data compiled by Johns Hopkins University shows the U.S. mortality rate is far from the lowest.

Trump is also predisposed to magical thinking — an unerring belief, at an almost elemental level, that he can will his goals into existence, through sheer force of personality, according to outside advisers and former White House officials.

The trait is one he shares with his late father and family patriarch, Fred Trump. In her best-selling memoir, “Too Much and Never Enough,” the president’s niece, Mary L. Trump, writes that Fred Trump was instantly taken by the “shallow message of self-sufficiency” he encountered in Norman Vincent Peale’s 1952 bestseller, “The Power of Positive Thinking.”

Some close to the president say that when Trump claims, as he did twice last week, that the virus will simply “disappear,” there is a part of him that actually believes the assessment, making him more reluctant to take the practical steps required to combat the pandemic.

Until recently, Trump also refused to fully engage with the magnitude of the crisis. After appointing Pence head of the coronavirus task force, the president gradually stopped attending task force briefings and was lulled into a false sense of assurance that the group had the virus under control, according to one person familiar with the dynamic.

Trump also maintained such a sense of grievance — about how the virus was personally hurting him, his presidency and his reelection prospects — that aides recount spending valuable time listening to his gripes, rather than focusing on crafting a national strategy to fight the pandemic.

Nonetheless, some White House aides insist the president has always been focused on aggressively responding to the virus. And some advisers are still optimistic that if Trump — who trails Biden in national polls — can sustain at least a modicum of self-discipline and demonstrate real focus on the pandemic, he can still prevail on Election Day.

Others are less certain, including critics who say Trump squandered an obvious solution — good governance and leadership — as the simplest means of achieving his other goals.

“There is quite a high likelihood where people look back and think between February and April was when Trump burned down his own presidency, and he can’t recover from it,” Rhodes said. “The decisions he made then ensured he’d be in his endless cycle of covid spikes and economic disruption because he couldn’t exhibit any medium- or long-term thinking.”

 

 

 

Tracking Our COVID-19 Response. Each state’s progress towards a new normal.

https://www.covidexitstrategy.org/

July 10 – Updated Color Scale
As a country we’ve reached a record number of cases. We’ve added a new color to the scale: “Bruised Red”. There were extremes that were not captured in our original scale. Our scale also has been adjusted to put more weight on “new cases per million” and “positivity”.
July 15 – ICU and Bed Occupancy – Not Publicly Reported by CDC Anymore
Unfortunately our data source for ICUs and beds has been removed by the CDC. Our hope is this loss of critical public health information is temporary. HHS is instituting a new process for collecting information from hospitals. The aggregate data from that system should be made public.

 

 

 

U.S. blows past coronavirus record with more than 70,000 new cases in one day

https://www.washingtonpost.com/nation/2020/07/17/coronavirus-live-updates-us/?utm_campaign=wp_post_most&utm_medium=email&utm_source=newsletter&wpisrc=nl_most

FirstFT: Today's top stories | Financial Times

There was a time in the United States when 40,000 coronavirus cases in a day seemed like an alarming milestone. That was less than three weeks ago.

Now, the number of new infections reported each day is reaching dizzying new heights. On Thursday, the daily U.S. caseload topped 70,000 for the first time, according to data tracked by The Washington Post.

Record numbers of covid-19 fatalities were reported in Florida, Texas and South Carolina on Thursday, and officials throughout the Sun Belt are worried that hospitals could soon reach a breaking point.

Here are some significant developments:

  • Masks are now mandatory in more than half of U.S. states — with the governors of Arkansas and Colorado the latest to issue face-covering orders. Major retailers phased in new mask policies, and Maryland Gov. Larry Hogan (R), chairman of the National Governors Association, said that masks should be mandated in states across the country.
  • Larry Fink, the chief executive of investment firm BlackRock, said that if states moving forward with reopening plans required masks, the economy would recover much sooner.
  • Atlanta Mayor Keisha Lance Bottoms (D) blasted Georgia’s Republican governor, Brian Kemp (R), for suing to stop block her city’s mask ordinance, accusing him of “putting politics over people.”
  • An unpublished report from the White House Coronavirus Task Force suggests that nearly 20 hard-hit states should enact tougher public health measures.
  • Real-time coronavirus tracking data temporarily disappeared from the Centers for Disease Control and Prevention’s website, sparking an outcry.
  • President Trump faces rising disapproval and widespread distrust on coronavirusaccording to a new Post-ABC poll.
  • India on Friday surpassed 1 million confirmed coronavirus cases, becoming the third country to cross that threshold, behind the United States and Brazil..

 

 

 

 

Disappearance of covid-19 data from CDC website spurs outcry

https://www.washingtonpost.com/health/2020/07/16/coronavirus-hospitalization-data-outcry/?utm_campaign=wp_main&utm_medium=social&utm_source=facebook&fbclid=IwAR2ONMOtMxy2LFUw0qKhDZwb1n5yFRv2oCTZlrr49_YpdO8WTzkSC90JjY0

Disappearance of covid-19 data from CDC website spurs outcry ...

Governors join calls for delay of administration plan to shift control from the CDC as Trump administration pledges to make data available to the public.

On the eve of a new coronavirus reporting system this week, data disappeared from a Centers for Disease Control and Prevention website as hospitals began filing information to a private contractor or their states instead. A day later, an outcry — including from other federal health officials — prompted the Trump administration to reinstate that dashboard and another daily CDC report on the pandemic.

And on Thursday, the nation’s governors joined the chorus of objections over the abruptness of the change to the reporting protocols for hospitals, asking the administration to delay the shift for 30 days. In a statement, the National Governors Association said hospitals need the time to learn a new system, as they continue to deal with this pandemic.

The governors also urged the administration to keep the information publicly available.

The disappearance of the real-time data from the CDC dashboard, which was taken down Tuesday night before resurfacing Thursday morning, was a ripple effect of the administration’s new hospital reporting protocol that took effect Wednesday, according to a federal health official who spoke on the condition of anonymity to discuss internal deliberations.

Without receiving the data firsthand, CDC officials were reluctant to maintain the dashboard — which shows the number of patients with covid-19, the disease caused by the virus, and hospital bed capacity — and took it down, the federal health official said. The CDC dashboard states that its information comes directly from hospitals and does not include data submitted to “other entities contracted by or within the federal government.” It also says the dashboard will not be updated after July 14.

The dashboard “was taken down in a fit of pique,” said Michael R. Caputo, the assistant secretary for public affairs at the Department of Health and Human Services. “The idea CDC scientists cannot rely upon their colleagues in the same department for data collection, or any other scientific work, is preposterous.”

This week, the CDC, the government’s premier public health agency whose medical epidemiologists analyze the hospital data, also stopped producing reports about trends in the pandemic that had gone twice a week to states, and six days a week to officials at multiple federal agencies. Adm. Brett Giroir, an assistant secretary in the HHS who oversees coronavirus testing, was unhappy that the CDC hospital report stopped Wednesday and Thursday mornings, according to the federal health official.

Caputo said that the administration’s goal is to maintain transparency, adding that conversations were still taking place between HHS officials and the CDC on a plan to keep producing the dashboard updates and the reports. “We expect a resolution,” he said.

Another HHS spokesperson said the CDC might create a new dashboard, based on a wider set of information.

During a conference call for journalists Thursday on coronavirus testing, Giroir did not acknowledge his displeasure with the reports’ discontinuation. But he said: “Those data are really critical to all of us. … I wake up in the morning and first thing I do, I look at the data. I look at midday. I look at it at night before I go to bed. … We drive the response based on that.”

The CDC site had been one of the few public sources of granular information about hospitalizations and ICU bed capacity. About 3,000 hospitals, or about 60 percent of U.S. hospitals, reported their data to the CDC’s system.

The president of the American Medical Association, Susan R. Bailey, spoke out Thursday on the uncertainties about access to data. “[W]e urge and expect that the scientists at the CDC will continue to have timely, comprehensive access to data critical to inform response efforts,” she said.

Governors, hospital officials and state health officers were given scant notice of the change in the reporting system. Two top administration health officials said in a letter to governors early this week that some hospitals were not complying with the previous protocols, suggesting that states might want to consider bringing in the National Guard to help gather the information. Hospital industry leaders vehemently protested that characterization, as well as the idea that they should be assisted by the National Guard in the midst of a pandemic.

HHS and CDC officials have said the protocol was changed to streamline reporting of data that is used, among other things, to determine the federal allocation of therapeutics, testing supplies and protective gear. Instead of reporting to the long-standing CDC system, hospitals must send data about covid-19 patients and other metrics to a recently hired federal contractor, called TeleTracking, or to their state health departments.

At least some state health departments that have been collecting data for their hospitals and sending it to Washington have already said the switch will make it impossible for them to continue, at least for now. The changed protocol includes a requirement that hospitals send several additional types of data that some state systems are not equipped to handle, state health officials said.

The Pennsylvania Department of Health sent a notice to hospitals Tuesday night saying that its platform was not ready to accommodate the new federal requirements, so that hospitals needed to report every day to both the state and to TeleTracking.

Charles L. Gischlar, spokesman for the Maryland Department of Health, said the reporting change “is a heavy lift for hospitals.”

The new system “exceeds the capacity of the current statewide system” to which hospitals had been reporting, he said, so the state no longer can send consolidated information to the federal government. As a result, he said in a statement, hospitals must provide data individually to the government.