The Trump administration issued a new rule this month requiring hospitals to shift reporting their daily data on COVID-19 hospitalizations directly to the Trump administration, instead of reporting it to the Centers for Disease Control and Prevention.
As physicians and licensed health care providers who have taken an oath to do no harm, we oppose this rule. During a pandemic, a robust public health response is critical to our ability to provide the best possible care to our patients. The CDC’s decades of experience, established infrastructure and apolitical nature position it to lead our COVID-19 response. When people continue to die from COVID-19, attempting to exclude the CDC from effective decision-making is not only misguided, it may cause more deaths that were otherwise preventable.
As an non-political agency, the CDC has played a key role in promoting the health of Americans since its inception in the 1940s, when it was established to work on malaria eradication. Over the past several decades, the CDC helped contain the Legionella outbreak in the 1970s, aided in the discovery that hepatitis B could be sexually transmitted, identified the emergence of drug resistance in tuberculosis, and reported the first ever known cases of acquired immunodeficiency syndrome (AIDS).
The CDC is a trusted broker
If the CDC had not had necessary data, these diseases may have claimed more lives. Our ability to contain outbreaks and control contagious diseases was the result of physicians, scientists and epidemiologists closely monitoring infections as they arose, as well as analyzing and sharing data in real time to find important patterns in transmission and community spread.
This sudden and radical decision to change hospital reporting from the CDC to a private third party (TeleTracking) within the Department of Health and Human Services will disrupt established lines of communication and has grave potential to hobble our ability to respond to the pandemic by allocating resources like tests, personal protective equipment and hospital beds, and crafting policies that prevent new infections. Data requirements in an emerging pandemic may not be static; as knowledge and evidence evolve, data systems may need to capture new elements. The CDC is a “trusted broker” of data. This is critical in a pandemic where the financial stakes have never been higher.
Migrating the responsibility of any data collection to HHS presents a serious conflict of interest. The department is led by former drug industry executive Alex Azar and the flow of information from the department is controlled by former Trump campaign adviser Michael Caputo, who now acts as an Assistant Secretary for Public Affairs. In stark contrast to the CDC, which has long been an independent, apolitical agency with trusted protocols for emergent infections, HHS has a recent track record of promoting conservative political causes.
The White House has not only shown its disregard for science in its pandemic response, it has freely admitted to it. President Donald Trump has already called for decreased testing, despite public health experts unanimously calling for broad testing as foundational to our pandemic response, and opposes more money for testing in the relief bill now being negotiated.
In addition, White House Press Secretary Kayleigh McEnany defended the president’s push to open schools by warning that, “The science should not stand in the way of this” and insisting that “the science is on our side.” We must consider the possibility that under HHS, data may be suppressed or manipulated as a political strategy to reflect what everyone knows the president wants to hear: that the pandemic will go away.
Report data to both HHS and CDC
Changing the reporting structure from the trusted CDC to this unknown entity has limited advantages and none of them outweigh our interest in accurate data collection and reporting, as slowed analysis may significantly impede real time practice and policy development. The erosion of public trust in the administration’s response to the pandemic can lead to mistrust when a future COVID-19 vaccine becomes available. The consequences could be disastrous.
So far, Dr. Robert Redfield, the director of the CDC, claims he has access to needed data. However, Dr. Daniel Pollock, surveillance branch chief for the CDC’s Division of Healthcare Quality Promotion, said in a recent interview that the data move concerns him. Reliable data and public trust in them are crucial in a global health crisis.
To safeguard the sanctity of the data and our public health response, we call on hospitals and data reporters to continue to simultaneously transfer data to the CDC while complying with the new rule.
Hospital administrators may worry about going against federal directives, especially if there is any potential for blowback. The Trump administration has shown a propensity to condition access to federal resources on compliance with its policies.
For example, the federal government may make access to remdesivir dependent on complying with this rule. Its distribution of its stockpile of remdesivir has already been problematic, especially to Florida hospitals, but the very possibility that hospitals might not be able to get a critical drug they need shows exactly why we cannot concentrate data — or any medical commodity — in the hands of people with a political agenda. In fact, this is exactly what President Trump claims led him to withdraw the United States from the World Health Organization: the fact that the WHO allegedly allowed China to suppress dissemination of data when the virus first appeared.
Simultaneous reporting will likely increase the reporting burden on hospitals and public health agencies at a time when they are already taxed by the enormity of the pandemic before us, but preserving the accuracy and accessibility of data is worth the cost. Until Congress enshrines protections for data distribution in legislation, we stand as the last line of defense. The oath we took to do no harm requires us to resist this harmful rule.
The authors, 19 doctors and a nurse practitioner at Massachusetts General Hospital, are fellows with the Op-Ed project. The views expressed here are solely their own and not those of the hospital.
Dr. Sarah Matathia, M.P.H.
Dr. Hemal N. Sampat
Dr. Monique Tello, M.P.H.
Dr. Amy Wheeler,
Dr. Melinda Mesmer
Dr. Jeff Liao
Dr. Lucas Marinacci
Dr. Michael F. Bierer
Dr. Marya J. Cohen, M.P.H.
Dr. Jing Ren
Dr. Audrey M. Provenzano, M.P.H.
Dr. Sejal Hathi, M.B.A.
Dr. Stephanie Eisenstat
Dr. Daniel M Horn
Dr. Jennifer S. Haas
Dr. Carolina Abuelo
Dallas M. Ducar, Nurse Practitioner
Dr. Nancy A. Rigotti
Dr. Andrea Reilly
