COVID-19 Data Dispatch

Tag: HHS

  • Federal data source updates, Nov. 8

    As cases spike, the Department of Health and Human Services (HHS) is focusing on rapid testing as a means to control the pandemic. But data on this type of testing continue to be widely unavailable.

    • HHS funds new COVID-19 tests: On October 31, HHS and the Department of Defense announced a $12.7 million contract with InBios International, a Seattle-based diagnostic testing company. The contract aims to help InBios increase its production capacity for two COVID-19 tests: a rapid antigen test called the SCoV-2 Ag Detect Kit and an antibody test called the SCoV-2 Detect IgM/IgG Food & Drug Administration (FDA).
    • HHS distributes antigen tests to HBCUs: At the end of September, the Trump administration announced that Historically Black Colleges and Universities (HBCUs) would be one category of priority sites for the distribution of Abbott BinaxNOW antigen tests, of which the administration has purchased 150 million. This promise is now coming to fruition; HHS announced on October 31 that 389,000 BinaxNow tests have been distributed to 83 HBCUs in 24 states, at no cost to the schools. How these schools will use the tests and report their testing data, however, remains to be seen.
    • FDA reminds antigen test providers to use them properly: The FDA issued a letter to clinical laboratory staff and health care providers on November 3, reminding them that antigen tests may incur false positives when the instructions for these tests’ use are not correctly followed. FDA recommendations include using antigen tests for symptomatic individuals, handling tests correctly, and using PCR tests to confirm results in low incidence counties. As I’ve discussed in this newsletter before, incorrect use of antigen tests may lead to misleading results that waste clinical resources or instill false confidence in people who receive false negatives.
    • HHS needs better testing oversight and data: Two new articles in STAT News this past week have discussed COVID-19 test regulation and reporting. An investigation by Kathleen McLaughlin finds that laboratory developed tests, diagnostic tools developed by and for specific facilities, fall in a “regulatory gray area” which makes it easy for innacuracies to slip past the FDA and HHS. Meanwhile, an op-ed by OB-GYN Joia Crear-Perry points out the public health danger in allowing demographic data on testing to be lost when rapid tests are not incoporated into reporting pipelines.
    more federal data

  • HHS changes may drive hospitalization reporting challenges

    This past week, the Department of Health and Human Services (HHS) opened up a new area of data reporting for hospitals around the country. In addition to their numbers of COVID-19 patients and supply needs, hospitals are now asked to report their numbers of influenza patients, including flu patients in the ICU and those diagnosed with both flu and COVID-19.

    The new reporting fields were announced in an HHS directive on October 6. They became “available for optional reporting” this past Monday, October 19; but HHS intends to make the flu data fields mandatory in the coming weeks. The move makes sense, broadly speaking—as public health experts worry about double flu and COVID-19 outbreaks putting incredible pressure on hospital systems, collecting data on both diseases at once can help the federal public health agencies quickly identify and get aid to the hospitals which are struggling.

    However, it seems likely that the new fields have caused both blips in HHS data and challenges for the state public health departments which rely upon HHS for their own hospitalization figures. As the COVID Tracking Project (and this newsletter) reported over the summer, any new reporting requirement is likely to strain hospitals which are understaffed or underprepared with their in-house data systems. Such challenges at the hospital level can cause delays and inaccuracies in the data reported at both state and federal levels.

    This week, the COVID Tracking Project’s weekly update called attention to gaps in COVID-19 hospitalization data reported by states. Missouri’s public health department specifically linked their hospitalization underreporting to “data changes from the US Department of Health and Human Services.” Five other states—Kansas, Wisconsin, Georgia, Alabama, and Florida—also reported significant decreases or partial updates to their hospitalization figures. These states didn’t specify reasons for their hospitalization data issues, but based on what I saw over the summer, I believe it is a reasonable hypothesis to connect them with HHS’s changing requirements.

    Jim Salter of the Associated Press built on the COVID Tracking Project’s observations by interviewing state public health department officials. He reported that, in Missouri, some hospitals lost access to HHS’s TeleTracking data portal:

    Missouri Hospital Association Senior Vice President Mary Becker said HHS recently implemented changes; some measures were removed from the portal, others were added or renamed. Some reporting hospitals were able to report using the new measures, but others were not, and as a result, the system crashed, she said.

    “This change is impacting hospitals across the country,” Becker said in an email. “Some states collect the data directly and may not yet be introducing the new measures to their processes. Missouri hospitals use TeleTracking and did not have control over the introduction of the changes to the template.”

    As the nation sets COVID-19 records and cases spike in the Midwest, the last thing that public health officials should be worrying about right now is inaccurate hospitalization data. And yet, here we are.

    more hospitalization data

  • CDC’s failure to resist political takeover

    This past week, two outlets published major investigations of the Centers for Disease Control & Prevention (CDC). The first story, by Science’s Charles Piller, focuses on White House Coronavirus Task Force Coordinator Dr. Deborah Birx and her role in the hospitalization data switch from the CDC to the Department of Health and Human Services (HHS). The second story, by ProPublica’s James Bandler, Patricia Callahan, Sebastian Rotella, and Kristen Berg, provides a broader view of internal CDC dynamics and challenges since the start of the pandemic.

    These stories do not focus on data specifically, but I wanted to foreground them this week as crucial insights into how the work of science and public health experts is endangered when powerful leaders prioritize their own narratives. Both stories describe how Dr. Birx disrespected and overrode CDC experts. She wanted data from every hospital in the country, every day, and failed to understand why the CDC could not deliver. The ProPublica story quotes an anonymous CDC scientist:

    Birx expected “every hospital to report every piece of data every day, which is in complete defiance of statistics,” a CDC data scientist said. “We have 60% [of hospitals] reporting, which was certainly good enough for us to have reliable estimates. If we got to 80%, even better. A hundred percent is unnecessary, unrealistic, but that’s part of Birx’s dogma.”

    As I explained in this newsletter’s very first issue, in July, the CDC’s hospital data reporting system was undercut in favor of a new system, built by the software company TeleTracking and managed by the HHS. Hospitals were told to stop reporting to the CDC’s system and start using TeleTracking instead. The two features published this week tie that data switch inexorably to Dr. Birx’s frustration with the CDC and her demand for more frequent data at any cost.

    Public health experts across the country worried that already-overworked hospital staff would face significant challenges in switching to a new data system, from navigating bureaucracy to, in some cases, manually entering numbers into a form with 91 categories. Initial data reported by the new HHS system in July were fraught with errors—such as a report of 118% hospital beds occupied in Rhode Island—and inconsistencies when compared to the hospital data reported out by state public health departments. I co-wrote an analysis of these issues for the COVID Tracking Project.

    But at least, I thought at the time, the HHS system was getting more complete data. The HHS system quickly increased the number of hospitals reporting to the federal government by about 1,500, and by October 6, Dr. Birx bragged at a press briefing that 98% of hospitals were reporting at least weekly. As Piller’s story in Science describes, however, such claims fail to mention that the bar for a hospital to be included in that 98% is very low:

    At a 6 October press briefing, Birx said 98% of hospitals were reporting at least weekly and 86% daily. In its reply to Science, HHS pegged the daily number at 95%. To achieve that, the bar for “compliance” was set very low, as a single data item during the prior week. A 23 September CDC report, obtained by Science, shows that as of that date only about 24% of hospitals reported all requested data, including protective equipment supplies in hand. In five states or territories, not a single hospital provided complete data.

    Piller goes on to describe how HHS’s TeleTracking data system allows errors—such as typos entered by overworked hospital staff—to “flow into [the] system” and then (theoretically) be fixed later. This method further makes HHS’s data untrustworthy for the public health researchers using it to track the pandemic. The agency is working on improvements, certainly, and public callouts of the hospital capacity numbers have slowed since TeleTracking’s rollout in July. Still, the initial political media storm created by this hospitalization data switch, combined with the details about the switch revealed by these two new features, has led me to be much warier of future data releases by both the HHS and the CDC than I was before 2020.

    Just as the White House boasted, “Our staffers get tested every day,” in response to critiques of President Trump’s flaunting of public health measures, the head of the White House Coronavirus Task Force wanted to boast, “We collect data every day,” in response to critiques of the country’s overburdened healthcare system. But testing and collecting data should both be only small parts of the national response to COVID-19. When scientists see their expertise ignored in favor of recommendations that will fit a chosen political narrative, public trust is lost in the very institutions they represent. And rebuilding that trust will take a long time.

    more hospitalization data
  • I am once again asking: why are journalists doing this?

    I am once again asking: why are journalists doing this?

    President Trump and the First Lady tested positive for COVID-19 in the early morning on Friday, October 2. As I draft this newsletter on Sunday morning, at least 15 other people connected to the President have tested positive, ranging from Bill Stepien, Trump’s campaign manager, to New York Times Washington correspondent Michael Shear.

    You might expect me to source this number and these names from a federal public health agency, which is conducting all of these tests and making their results public. Not in this pandemic! My source is, of course, a dashboard compiled by volunteer journalists and science communicators.

    This dashboard, called the COVID-19 At The White House Contact Tracker, is attempting to trace over 200 contacts in connection with the President and his staff. The team behind it includes Benjy Renton, independent reporter on COVID-19 in higher education, Peter Walker, data visualization lead at the COVID Tracking Project, and Jesse O’Shea, MD, infectious disease expert at Emory University.

    The Contact Tracker is an incredible public service. In its current form, the dashboard lists 235 White House contacts who should get tested for COVID-19, along with their positions, test results (if known), symptoms (if they test positive), and the date of their most recent test. You can also view the data as a timeline, based on each person’s last contact with the President, and as a map based on the Rose Garden ceremony, the debate, and two other potential spreading events.

    It is not surprising, after months of poor data reporting from the federal government that, instead of the CDC or the HHS, the best source of data on this high-profile outbreak is—as Dr. O’Shea puts it— “three awesome dudes [contact tracing] from our homes.” But it is worth emphasizing.

    https://twitter.com/JesseOSheaMD/status/1312644102027177985

    What are federal public health agencies prioritizing right now, you might ask? The HHS is planning a $300 million-plus ad campaign with the goal of “defeating despair” about the coronavirus. And this money came out of the CDC’s budget. I was planning to devote a bigger section to this campaign before COVID-19 hit the White House, but instead, I will direct you to an excellent (and terrifying) POLITICO feature on the subject. Dan Diamond also discusses his investigation of the campaign on his podcast, POLITICO’s Pulse Check.

  • Issue #10: reflecting and looking forward

    Issue #10: reflecting and looking forward

    Candid of me reading Hank Green’s new book (very good), beneath some fall foliage. It sure is great to go outside!

    I like to answer questions. I’m pretty good at explaining complicated topics, and when I don’t know the answer to something, I can help someone find it. These days, that tendency manifests in everyday conversations, whether it’s with my friend from high school or a Brooklyn dad whose campsite shares a firepit with my Airbnb. I make sure the person I’m talking to knows that I’m a science journalist, and I invite them to ask me their COVID-19 questions. I do my best to be clear about where I have expertise and where I don’t, and I try to point them to sources that will fill in my gaps.

    I want this newsletter to feel like one of those conversations. I started it when hospitalization data switched from the auspices of the Centers for Disease Control and Prevention (CDC) to the Department of Health and Human Services (HHS), and I realized how intensely political agendas were twisting public understanding of data in this pandemic. I wanted to answer my friends’ and family members’ questions, and I wanted to do it in a way that could also become a resource for other journalists.

    This is the newsletter’s tenth week. As I took a couple of days off to unplug, it seemed a fitting time to reflect on the project’s goals and on how I’d like to move forward.

    What should data reporting look like in a pandemic?

    This is a question I got over the weekend. How, exactly, have the CDC and the HHS failed in their data reporting since the novel coronavirus hit America back in January?

    The most important quality for a data source is transparency. Any figure will only be a one-dimensional reflection of reality; it’s impossible for figures to be fully accurate. But it is possible for sources to make public all of the decisions leading to those figures. Where did you get the data?  Whom did you survey?  Whom didn’t you survey?  What program did you use to compile the data, to clean it, to analyze it?  How did you decide which numbers to make public?  What equations did you use to arrive at your averages, your trendlines, your predictions?  And so on and so forth. Reliable data sources make information public, they make representatives of the analysis team available for questions, and they make announcements when a mistake has been identified.

    Transparency is especially important for COVID-19 data, as infection numbers drive everything from which states’ residents are required to quarantine for two weeks when they travel, to how many ICU beds at a local hospital must be ready for patients. Journalists like me need to know what data the government is using to make decisions and where those numbers are coming from so that we can hold the government accountable; but beyond that, readers like you need to know exactly what is happening in your communities and how you can mitigate your own personal risk levels.

    In my ideal data reporting scenario, representatives from the CDC or another HHS agency would be extremely public about all the COVID-19 data they’re collecting. It would publish these data in a public portal, yes, but this would be the bare minimum. This agency would publish a detailed methodology explaining how data are collected from labs, hospitals, and other clinical sites, and it would publish a detailed data dictionary written in easily accessible language.

    And, most importantly, the agency would hold regular public briefings. I’m envisioning something like Governor Cuomo’s PowerPoints, but led by the actual public health experts, and with substantial time for Q&A. Agency staff should also be available to answer questions from the public and direct them to resources, such as the CDC’s pages on childcare during COVID-19 or their local registry of test sites. Finally, it should go without saying that, in my ideal scenario, every state and local government would follow the same definitions and methodology for reporting data.

    Why am I doing this newsletter?

    The CDC now publishes a national dataset of COVID-19 cases and deaths, and the HHS publishes a national dataset of PCR tests. Did you know about them?  Have you seen any public briefings led by health experts about these data?  Even as I wrote up this description, I realized how deeply our federal government has failed at even the basics of data transparency.

    Neither the CDC nor HHS even published any testing data until May. Meanwhile, state and local public health agencies are largely left to their own devices, with some common definitions but few widely enforced standards. Florida publishes massive PDF reports, which fail to include the details of their calculations. Texas dropped a significant number of tests in August without clear explanation. Many states fail to report antigen test counts, leaving us with a black hole in national testing data.

    Research efforts and volunteer projects, such as Johns Hopkins’ COVID-19 Tracker and the COVID Tracking Project, have stepped in to fill the gap left by federal public health agencies. The COVID Tracking Project, for example, puts out daily tweets and weekly blog posts reporting on the state of COVID-19 in the U.S. I’m proud to be a small part of this vital communication effort, but I have to acknowledge that the Project does a tiny fraction of the work that an agency like the CDC would be able to mount.

    Personally, I feel a responsibility to learn everything I can about COVID-19 data, and share it with an audience that can help hold me accountable to my work. So, there it is: this newsletter exists to fill a communication gap. I want to tell you what state and federal agencies are doing—or aren’t doing—to provide data on how COVID-19 is impacting Americans. And I want to help you attain some data literacy along the way. I don’t have fancy PowerPoints like Cuomo or fancy graphics like the COVID Tracking Project (though my Tableau skills are improving!). But I can ask questions, and I can answer them. I hope you’re reading this because you find that useful, and I hope this project can become more useful as it grows.

    What’s next?

    America is moving into what may be a long winter, with schools open and the seasonal flu incoming. (If you haven’t yet, this is your reminder: get your flu shot!)  I’m in no position to hypothesize about second waves or vaccine deployment, but I do believe this pandemic will not go away any time soon.

    With that in mind, I’d like to settle in this newsletter for the long haul. And I can’t do it alone. In the coming months, I want this project to become more reader-focused. Here are a couple of ideas I have about how to make that happen; please reach out if you have others!

    • Reader-driven topics: Thus far, the subjects of this newsletter have been driven by whatever I am excited and/or angry about in a given week. I would like to broaden this to also include news items, data sources, and other topics that come from you.
    • Answering your questions: Is there a COVID-19 metric that you’ve seen in news articles, but aren’t sure you understand?  Is there a data collection process that you’d like to know more about?  Is there a seemingly-simple thing about the virus that you’ve been afraid to ask anywhere else?  Send me your COVID-19 questions, data or otherwise, and I will do my best to answer.
    • Collecting data sources: In the first nine weeks of this project, I’ve featured a lot of data sources, and the number will only grow as I continue. It might be helpful if I put all those sources together into one public spreadsheet to make a master resource, huh?  (I am a little embarrassed that I didn’t think of this one sooner.)  I’ll work on this spreadsheet, and share it with you all next week.
    • Events??  One of my goals with this project is data literacy, and I’d like to make that work a little more hands-on. I’m thinking about potential online workshops and collaborations with other organizations. I’m also looking into potential funding options for such events; there will hopefully be more news to come on this front in the coming weeks.

  • No, hospitalization data isn’t switching back to the CDC

    I mean, it is. But not right now. Or is it?

    Last Thursday, the Wall Street Journal published an article headlined, “Troubled COVID-19 Data System Returning to CDC.” At first glance, the article reports that the tracking of COVID-19 hospitalization data is returning to the CDC’s charge after numerous concerns were raised about data accuracy and integrity under Department of Health and Human Services (HHS) control.

    Readers, I cannot lie: when I first saw this headline, I lay down on the floor of my apartment and cursed for several minutes. Why would they change it back, I thought. The HHS is already collecting data from more hospitals than the CDC did. It made sense with remdisivir distribution. Why make everyone go through another system switch.

    And then I got up, sent some incredulous messages in the COVID Tracking Project Slack server, and actually read the full article. What is actually happening, according to WSJ reporter Robbie Whelam, is this: the CDC is developing a new data system which will be more efficient for both hospitals and data users. After the new system is complete, the CDC will once again collect and report hospitalization data.

    “CDC is working with us right now to build a revolutionary new data system so it can be moved back to the CDC, and they can have that regular accountability with hospitals relevant to treatment and PPE,” Dr. Birx said, referring to personal protective equipment used by doctors and nurses.

    The article, however, fails to report any meaningful details about this new CDC data system. What is the proposed timeline for the system? What makes it “revolutionary?” Who is developing it? What new metrics will it collect? How will it address challenges that hospitals with fewer staff or lower technological capacity currently face in making daily reports? I could go on, but you get the idea.

    Also, there’s this insight, from POLITICO reporter Dan Diamond:

    Within a few hours, the WSJ had changed their headline to “COVID-19 Data Will Once Again Be Collected by CDC, in Policy Reversal.”

    It continues to be unclear when or how the HHS-back-to-CDC hospitalization data switch will occur, if it does occur. As COVID-19 Tracking Project lead Erin Kissane points out, federal IT development happens very slowly. It will likely be months before definitive information is available on the CDC’s new database.

    Meanwhile, the HHS is proceeding with its own new data system effort: an overhaul called the Modernizing Public Health Reporting and Surveillance project, POLITICO reported this past Wednesday. The project plans to improve data technology and data quality at state and local public health departments over the next several years. It’s an ambitious initiative, considering that HHS is still working on fixing its hospital reporting:

    HHS says that 85 percent of the nation’s hospitals report daily — a mark that is improving, and that includes more metrics the government uses to allocate scarce resources during the pandemic, like the drug remdesivir. But federal officials say they receive only half of the required clinical information on average, a gap that could distort the scope of the pandemic and obscure who’s getting sick where.

    I may be optimistic, but I’m hoping that at least one of these new data systems will be ready to go before the next pandemic hits.

    more hospitalization data
  • HHS hospitalization data: more questions arise

    HHS hospitalization data: more questions arise

    Last Tuesday, the post on COVID-19 hospitalization data that I cowrote with Rebecca Glassman was published on the COVID Tracking Project’s blog. We pointed out significant discrepancies between the Department of Health and Human Services (HHS)’s counts of currently hospitalized COVID-19 patients and counts from state public health departments. You can read the full post here, or check out the cliff notes in this thread:

    That same day, the Wall Street Journal published an article on HHS’s estimates of hospital capacity in every state—which, as you may recall from my first newsletter issue, have been plagued with delays and errors. These hospital capacity estimates are based on the raw counts that Rebecca and I analyzed. It appears that errors in hospital reprots are causing errors in HHS’s raw data, which in turn makes it more difficult for HHS analysts to estimate the burden COVID-19 is currently placing on healthcare systems. When the CDC ran this dataset, estimates were updated multiple times a week; now, under the HHS, they are only updated once a week.

    On Wednesday, the New York Times reported that 34 current and former members of a federal health advisory committee had sent a letter opposing the move of hospital data from the CDC to the HHS. These medical and public health experts cited new burdens for hospitals and transparency concerns as issues for HHS’s new data collection system. (The New York Times article references Rebecca’s and my blog post, which is pretty cool.)

    In an earlier issue, I reported that several congressmembers had opened an investigation into TeleTracking, the company HHS contracted to build its new data collection system. Well, the New York Times reported on Friday that TeleTracking is refusing to answer congressmembers’ questions because the company signed a nondisclosure agreement.

    And finally, HHS chief information officer José Arrieta resigned on Friday. I’m tempted to hop on the next bus to Pittsburgh and start banging on the door of TeleTracking’s headquarters if we don’t get answers soon.

    more hospitalization data

  • HHS hospitalization data: still questionable

    I’m starting to think I should make HHS hospitalization data a weekly section of this newsletter.

    In case you haven’t read my previous two issues, here’s the situation: in mid-July, hospitals stopped reporting their counts of COVID-19 patients to the CDC, and instead began reporting to the HHS. Since then, HHS’s national hospitalization dataset has been unreliable. HHS’s counts of currently hospitalized COVID-19 patients are far higher than the concurrent counts reported by state public health departments, and HHS’s numbers often rise and fall significantly from day to day without clear explanation.

    I, along with other COVID Tracking Project (CTP) volunteers, have been monitoring both hospitalization counts daily—the two counts being, HHS’s numbers and state-reported numbers compiled by CTP. Rebecca Glassman (data entry volunteer and resident Florida expert) and I have drafted a blog post for CTP about the biggest discrepancies we’ve seen, which will be published in the next few days.

    Here’s a little preview of the issues we’re calling out:

    • In six states, HHS’s counts of currently hospitalized COVID-19 patients are, on average, at least 150% higher than the state’s counts. These states include Maine, Arkansas, New York, Connecticut, New Hampshire, and Delaware.
    • Both Florida and Nevada saw unexplained spikes in their HHS counts which were not matched by corresponding spikes in state counts.
    • The state of Louisiana actually reports more currently hospitalized COVID-19 patients than HHS does, even though the definitions used by both sources suggest that this discrepancy should be the other way around.
    • Many states do not have publicly available or easy-to-find definitions for how currently hospitalized COVID-19 patients are classified.
    • HHS’s counts on August 6 were very low across the board, with significant drops in the number of hospitals reporting in every state.

    If you are a local reporter in any of the states mentioned here and would like to investigate the discrepancies in your area, please reach out to me! I’m happy to share the data underlying this analysis.

    more hospitalization data

  • 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.

    https://twitter.com/NotoriousRSG/status/1288513607316250626

    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.

    more hospitalization data
  • “Is Dr. Anthony Fauci on Cameo?”

    “Is Dr. Anthony Fauci on Cameo?”

    NIAID Director Dr. Anthony Fauci testifies before House Select Subcommittee on the Coronavirus Crisis on July 31. Screenshot retrieved from the hearing’s livestream.

    In the most recent episode of comedy podcast My Brother, My Brother and Me (approx. timestamp 23:50), youngest brother Griffin McElroy solemnly asks, “Is Dr. Anthony Fauci on Cameo?”

    McElroy’s question, asked in the context of a rather silly and unscientific discussion on contaminated basketballs, refers to a video-sharing service in which fans can pay celebrities to send personalized messages. Dr. Fauci is, of course, not on Cameo. But he did make a public appearance this past Friday: he testified before the House Subcommittee on the Coronavirus Crisis. This was Dr. Fauci’s first Congressional appearance in several weeks; Democrats have claimed that the White House blocked him from testifying earlier in the summer.

    Dr. Fauci was joined on the witness stand by Centers for Disease Control and Prevention (CDC) Director Dr. Robert Redfield and Assistant Secretary for Health Admiral Brett Giroir, who leads policy development at the Department of Health and Human Services (HHS). All three witnesses answered questions about their respective departments, covering COVID-19-related topics from test wait times to the public health implications of Black Lives Matter protests.

    For comprehensive coverage of the hearing, you can read my Tweet thread for Stacker:

    But here, I will focus on five major takeaways for the COVID-19 data world.

    First: the results of scientific studies on the pandemic are publicly shared. In his opening statement, Dr. Fauci cited four top priorities for the National Institute of Allergy and Infectious Diseases (NIAID): improving scientific knowledge of how the novel coronavirus works, developing tests that can diagnose the disease, characterizing and testing methods of treating patients, and developing and testing vaccines. The Congressmembers on the House subcommittee were particularly interested in this last priority; Dr. Fauci reassured several legislators that taking vaccine development at “warp speed” will not come at the cost of safety.

    Rep. Jackie Walorski, a Republican from Indiana, was especially concerned about Chinese interference in vaccine development. She repeatedly asked Dr. Fauci if he believed China was “hacking” American vaccine research, and if he believed this was a threat to the progress of such work. Dr. Fauci replied that all clinical results from NIAID work are shared publicly through the usual scientific process, to invite feedback from the greater medical community.

    Clinical studies in particular are listed in a National Institutes of Health (NIH) database called ClinicalTrials.gov. On this site, any user can easily search for studies relating to COVID-19; there are2,844 listed at the time I send this newsletter. 256 of these studies are marked as “completed,” and two of those have results posted. I see no reason to doubt that, if Rep. Walorski were to visit this database in the coming months, she would find the results of vaccine trials here as well.

    Dr. Fauci also publicized the COVID-19 Prevention Network, a website on which Americans can volunteer for vaccine trials. According to Dr. Fauci, 250,000 individuals had registered by the time of the hearing.

    Second: nursing homes are getting COVID-19 antigen tests, big time. Dr. Redfield, Admiral Giroir, and several of the House representatives at the hearing highlighted a recent initiative by HHS to distribute rapid diagnostic COVID-19 tests to nursing homes in hotspot areas. In his opening remarks, Dr. Redfield stated that, by the end of this week, federal health agencies will have delivered “nearly one million point-of-care test kits to 1,019 of the highest risk nursing homes, with 664 nursing homes scheduled for next week.”

    The tests being distributed identify antigens, protein fragments on the surface of the novel coronavirus. Like polymerase chain reaction (PCR) tests, antigen tests determine if a patient is infected at the time they are tested; unlike PCR tests, they may be produced and distributed cheaply, and return results in minutes. Antigen tests have lower sensitivity, however, meaning that they may miss identifying patients who are in fact infected.

    The antigen test distribution initiative is great news for the nursing homes across the country that will be able to test and treat their residents more quickly. But from a data perspective, it poses one major question: how will the results of these tests be reported? While antigen tests may be diagnostic, their results should not be lumped in with PCR test results because they have a different accuracy level and serve a different purpose in the pandemic.

    The Nursing Home COVID-19 Public File, a national dataset run by the Center for Medicare and Medicaid Services, reports “confirmed” and “suspected” COVID-19 cases in the nation’s nursing homes. The dataset does not specify what types of tests were used to identify these cases, or the total tests conducted in each home. Similarly, state-reported datasets on COVID-19 in nursing homes typically report only cases and deaths, not testing numbers. And, as of the most recent COVID Tracking Project analysis, the only state currently reporting antigen tests in an official capacity is Kentucky. But more states may be including antigen test numbers in their counts of “confirmed cases” or “molecular tests,” as several states lumped PCR and serology tests this past spring. As hundreds of nursing homes across the country begin to use the antigen tests so graciously distributed by the federal government, we must carefully watch to identify where those numbers show up.

    Third: Admiral Giroir doesn’t know what data his agency publishes.

    If you watch just five minutes from Friday’s hearing, I highly recommend the five minutes in which Rep. Nydia Velázquez (a Democrat from New York) interrogates Admiral Giroir about COVID-19 test wait times. Here’s my transcript of a key moment in the conversation:

    Rep. Velázquez: Dr. Redfield, I’d like to turn to you. Does the CDC have comprehensive information about the wait times for test results in all 50 states?

    Dr. Redfield: I would refer that question back to the Admiral.

    Rep. Velázquez: Sir?

    Admiral Giroir: Yes, we have comprehensive information on wait times in all 50 states, from the large, commercial labs.

    Rep. Velázquez: And do you publish this data? These data?

    Admiral Giroir: Uh… we talk about it. Always. I mean, I was on… I was with 69 journalists yesterday, and we talk about that frequently.

    He went on to claim that decisionmakers at the state and city level have data on test wait times from commercial labs. But where are these data? HHS has collected testing data since the beginning of the pandemic; these data were first published on a CDC dashboard in early May and are now available on HealthData.gov.

    The HealthData.gov dataset includes test results from CDC labs, commercial labs, state public health labs, and in-house hospital labs. For each test, the dataset includes geographic information, a date, and the test’s outcome. It does not include the time between the test being administered and its results being reported to the patient. In fact, that “date” can either be a. the date the test was completed, b. the date the result was reported, c. the date the specimen was collected, d. the date the test arrived at a testing facility, or e. the date the test was ordered. So, if there’s another, secret dataset which includes more precise dating, I personally would love to see it made public.

    Also, who are those 69 journalists, Admiral Giroir? How do I join those ranks? I have some questions about HHS hospitalization data.

    Fourth: everyone wants to reopen schools. Dr. Redfield said, opening schools is “in the best public health interest of K-12 students.” Dr. Fauci said, schools should reopen so that schools can access health services, teachers can identify instances of child abuse, and to avoid “downstream unintended consequences for families.” Rep. Steve Scalise, the subcommittee’s Ranking Member (and a Republican from Louisiana, home to one of the country’s most annoying COVID-19 dashboards), said, “Don’t deny these children the right to seek the American dream that everybody else has deserved over the history of our country.” Rep. James Clyburn, the subcommittee’s Chair (a Democrat from South Carolina), said that school reopening must not be a “one size fits all approach,” but it should be done for the good of students and their families.

    Clearly, reopening schools is a popular political opinion. But does the country have the data we need to determine if schools can reopen safely? Reopening, as Dr. Fauci explained in response to an early question from Rep. Clyburn, is most safely done when COVID-19 is no longer circulating widely in a community. School districts can determine whether the disease is circulating widely through looking at case counts over time, but for those case counts to be accurate, the region must be doing enough testing and contact tracing to catch all cases.

    And testing data, while they are certainly collected at the county and zip code levels by local public health departments, are not standardized at all. HHS doesn’t publish county-level testing data. Nor does the COVID Tracking Project. This lack of standardization for any geographic region smaller than a state is troubling, as public health leaders and journalists alike cannot currently assess the scope of local outbreaks with any kind of broad comparison. To put it simply: I would love to do a story on how many school districts can safely reopen right now, based on their case counts and test metrics. But the data I would need to do this story do not exist.

    Fifth: all data are political; COVID-19 data are especially political. I know, I know. Data have been political since humans started collecting them. One of America’s most comprehensive data sources, the U.S. Census, started as a way to enforce the Three-Fifths Compromise.

    But watching this Friday’s hearing hammered home for me how the mountains of data produced by this pandemic, coupled with the complete lack of standards across the institutions producing them, has made it particularly easy for politicians to quote random numbers out of context in order to advance their agendas. Rep. Clyburn said, “At least 11 states… are currently performing less than 30% of the tests they need to control the virus.” (Which states? How many tests do they need to perform? Where di that benchmark come from? What other metrics should the states be following?) And, on the other side of the aisle, Rep. Scalise held up a massive stack of paper and waved it right at the camera, claiming that the high number of tests that have been conducted in this country is evidence of President Trump’s national plan. (But how many tests have we conducted per capita? What are the positivity rates? What statistics can we actually correlate to President Trump’s plan?)

    In fact, after the hearing, the White House put out a press release claiming that America has “the best COVID-19 testing system in the world.” The briefing includes such claims as, “the U.S. has already conducted more than 59 million tests,” and, “the Federal Government has distributed more than 44 million swabs and 36 million tubes of media to all 50 States.” None of the statistics in the briefing are put into terms reflecting how many people have actually been tested, compared to the country’s total population. And none of the statistics are contextualized with public health information on what targets we should be meeting to control the pandemic.

    The experts who might have been consulted on that brief—Dr. Fauci, Dr. Redfield, and Admiral Giroir—all sat before Congressional Representatives on Friday morning, quietly nodding when Representatives asked if their respective departments were doing everything possible to protect America. If they had answered otherwise, they may not have returned for future hearings. The whole thing felt very performative to me: the Democrats threw veiled jibes at President Trump, the Republicans bemoaned China and Black Lives Matter protests, and Dr. Fauci fact-checked such basic statements as, “Children are not immune to COVID-19.”

    And almost everyone in the room—including all three witnesses—removed their mask when they spoke.

    If Dr. Fauci were available to commission on the video service Cameo, I would pay him good money to send a personal message to every Congressmember on that subcommittee telling them, confidentially, exactly what he thinks of their questions. And then I would ask him for Admiral Giroir’s personal cell phone number.

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