No, we’re not done talking about HHS hospitalization data

The HHS is still collecting and publishing COVID-19 hospitalization data, and I, personally, feel as though I know both more and less than I did when I wrote last week’s newsletter. This week’s issue is already rather long, so here, I will focus on outlining the main questions I have right now.

Why are HHS’s COVID-19 hospitalization numbers higher than states’? While HHS’s most public-facing dataset is the HHS Protect hospital utilization dataset, last updated on July 23, the department also reports daily counts of the hospital beds occupied in every state. This dataset includes counts of all currently hospitalized patients with confirmed and suspected COVID-19. Local public health departments in all 50 states and D.C. also report the same datapoint; the COVID Tracking Project collects, standardizes, and reports these local counts daily.

According to analysis by the COVID Tracking Project, over the week of July 20 to July 26, HHS reported an average of 24% more hospitalized COVID-19 patients across the U.S. than the states did. Figures for some states show even more variation. In Florida, for example, HHS’s count nearly doubled from July 26 to July 27 (from about 11,000 patients to about 21,500 patients). The state reported about 9,000 hospitalized COVID-19 patients both days.

In Arkansas, meanwhile, the state has reported about 500 hospitalizations each day for the past week, while HHS has reported about 1,600. Overall, for 28 out of 53 states and territories, there is at least one day in the past week when HHS’s count of currently hospitalized COVID-19 patients is at least 50% higher than the state public health department’s count.

The COVID Tracking Project suggests several potential reasons for this discrepancy. Some hospitals may report to HHS, but not to their state public health departments, either because they are federally-run hospitals (such as hospitals run by the Veteran’s Association) or because HHS’s tie to federal supplies such as remsidivir provides a greater incentive for complete reporting. State definitions for who counts as a COVID-19 patient differ from place to place, and may be narrower than the federal categorization, which includes all confirmed and suspected cases. And some hospitals might also be inputting data entry errors or double-counting their patient numbers as they adjust to the new reporting system. As I noted in last week’s issue, we do not know how HHS is screening for and removing data entry errors in their dataset.

How did the CDC-to-HHS switch impact local public health departments? The COVID Tracking Project’s blog post on hospitalization data also explains that several states had delays or errors in reporting current hospitalization numbers because the states previously relied on the CDC’s database for these values. Public health departments in Idaho, Missouri, South Carolina, Wyoming, Texas, and California have all documented issues with compiling hospitalization data at the state level thanks to the CDC-to-HHS system change. Similar issues may be going unreported in other states.

As I described last week, changing database systems in the middle of a pandemic can be particularly challenging for already-overburdened hospitals. It can take multiple hours a day to enter data into both HHS and state reporting systems, and that’s on top of the technological and bureaucratic hurdles that hospitals must clear. Public health departments are scrambling to help their hospitals, as hospitals are scrambling to report the correct data—to say nothing of actually taking care of their patients.

Why should I trust a database built by a tech company that got the job through suspicious means? According to an investigation by NPR, TeleTracking Technologies received its federal contract to build HHS’s data system for collecting hospital data under some unusual circumstances. For one thing, HHS claimed that TeleTracking’s contract was won through competitive bidding, but none of 20 competitors contacted by NPR knew about this opportunity. For another, the process HHS used to award that contract is typically used for scientific research and new technology, not database building. And finally, Michal Zamagias, TeleTracking’s CEO, is a real estate investor and long-time Republican donor with ties to the Trump Organization.

Rep. Clyburn—you know, that chair of the congressional coronavirus subcommittee—has launched an investigation into TeleTracking and its CEO. Other Congressmembers are asking questions, too. I, for one, am excited to see what they find.

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