August 13, 2020

America has a coronavirus data integrity problem, public health experts argue

Daily Briefing

    Dozens of public health experts are warning that issues with coronavirus testing and a recent change that left hospitals "scrambling" to report Covid-19 data are skewing—and hampering—the United States' response to the coronavirus epidemic.

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    US new coronavirus cases surpass 5.2M, deaths top 165K

    The warnings come as U.S. officials on Wednesday reported about 54,132 new cases of the novel coronavirus, bringing the total number of coronavirus cases reported in the country since the epidemic began to 5,208,700 as of Thursday morning—up from 5,154,700 cases reported as of Wednesday morning.

    Data from the New York Times shows that Guam, Puerto Rico, the U.S. Virgin Islands, and two states— Hawaii and Illinois—saw their average daily numbers of newly reported coronavirus cases rise over the past 14 days.

    The Times' data also shows that the average daily numbers of newly reported coronavirus cases over the past two weeks remained mostly stable in Washington, D.C., and 25 states: California, Connecticut, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, Montana, Nebraska, New Jersey, New York, North Dakota, Ohio, Oregon, Rhode Island, South Dakota, Texas, Vermont, Virginia, West Virginia, and Wisconsin.

    Meanwhile, the Times' data shows that 23 states saw their average daily numbers of newly confirmed coronavirus cases decrease over the past 14 days: Alabama, Alaska, Arizona, Arkansas, Colorado, Delaware, Florida, Louisiana, Maine, Maryland, Mississippi, Missouri, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Utah, Washington, and Wyoming.

    U.S. officials also reported about 1,468 new deaths tied to the coronavirus on Wednesday, representing the highest single-day increase in coronavirus-linked deaths that the country's reported since May 15 (with the exception of three days during the summer when three states—New Jersey, New York, and Texas—each reported large backlogs of coronavirus-linked deaths from unspecified days). As of Thursday morning, U.S. officials had reported a total of 165,936 coronavirus-linked deaths since the epidemic began—up from 164,468 deaths reported as of Wednesday morning.

    According to the Times' data, Puerto Rico and 14 states saw their average daily numbers of newly reported deaths linked to the coronavirus rise over the past 14 days: Arkansas, Florida, Georgia, Hawaii, Iowa, Louisiana, Minnesota, Mississippi, Montana, Nevada, North Carolina, North Dakota, Pennsylvania, and West Virginia.

    Coronavirus testing is declining—and experts say US could be undercounting cases

    While the average daily number of newly reported coronavirus cases in the United States declined over the past week, some public health experts warn that those numbers might be deceiving, because the decline in newly reported cases has been accompanied by declining rates of coronavirus testing nationwide.

    A CNBC analysis of data compiled by Johns Hopkins University found that the average daily number of newly reported coronavirus cases over a seven-day period is down 19%, dropping from an average of 65,285 newly reported cases per day during the week ending on July 28 to an average of 52,875 newly reported cases per day during the week ending on Aug. 12.

    At the same time, data from The Atlantic's Covid Tracking Project show that the average daily number of coronavirus tests performed nationwide over a seven-day period is down by 12%, declining from an average of about 814,000 tests  performed daily during the last week of July to an average of about 716,000 tests performed daily during the week ending on Aug. 12.

    Decreases in testing are occurring even in some states experiencing severe coronavirus outbreaks, such as Texas, where the average daily number of newly reported cases over the past two weeks decreased by 10% as testing declined by 53%—and the state's coronavirus test positivity rates stood at nearly 20%.

    Ashish Jha, director of the Harvard Global Health Institute, during an interview with CNBC said, "I really have come to believe we have entered a real, new, emerging crisis with testing and it is making it hard to know where the [epidemic] is slowing down and where it's not."

    For instance, Jha said he is "not at all convinced it's getting better" in Texas. "It may in fact be getting worse."

    Catherine Troisi, an epidemiologist with The University of Texas Health Science Center at Houston, told CNBC, "We know we're missing a lot of people. Basically, we don't know what's happening. We're not casting a wide enough net, which we know because testing is going down."

    According Axios' "Vitals," the drop in testing could hamper the country's response to the coronavirus epidemic, but there also appears to be a slight upside: The reduction has helped to clear coronavirus testing backlogs, which means people are getting their test results sooner and public health officials can step in faster to mitigate outbreaks through contact tracing. HHS this week estimated that nearly 90% of coronavirus tests are being completed within three days, marking a significant improvement from previous weeks, when some people could wait up to 10 days or more for their results.

    Dozens of infection control experts say hospital reporting change has jeopardized 'data integrity'

    Separately, dozens of public health experts are raising concerns about HHS' new system for compiling hospital-reported data on Covid-19, saying a recent change to the system left hospitals "scrambling" to comply and has "serious consequences on data integrity."

    HHS on July 10 issued guidance directing hospitals to send data regarding their patients with Covid-19, the disease caused by the new coronavirus, to a central HHS database instead of to CDC, as hospitals had been doing for several months. HHS issued the new guidance after Deborah Birx, the White House's coronavirus response coordinator, and others raised concerns that hospitals were not adequately reporting their data to CDC, and that CDC was lagging in making the data available to the public. On July 20, HHS launched its new online portal to collect and share coronavirus-related data reported by U.S. hospitals.

    However, nearly three dozen experts who are current or former members of the federal Healthcare Infection Control Practices Advisory Committee in a letter obtained by the Times and published Wednesday wrote that the switch will have "serious consequences on data integrity," as it left hospitals "scrambling to determine how to meet daily reporting requirements."

    To address the issue, the experts called on HHS to allow CDC to "continue [the agency's] important and trusted work" of collecting, analyzing, and distributing daily reports on coronavirus-related data.

    Separately, other experts have said data integrity already has become an issue under the new reporting system, according to the Wall Street Journal. For instance, experts have said the portal's estimates on some key indicators, including tallies of the number of inpatient beds occupied by Covid-19 patients, are lagging by at least a week, the Journal reports.

    "The transition has been a disaster," as hospitals had very little time to adjust to the new reporting system, Jeffrey Engel, a senior adviser to the Council of State and Territorial Epidemiologists, told the Journal. "What HHS said was that the CDC was not nimble enough and couldn't handle new data elements, and that's simply not true," he added.

    In addition to placing a burden on hospitals to rapidly adjust to the change, any issues with data accuracy in the new portal could affect hospitals' ability to respond to the epidemic, because the federal government uses the hospital-reported data to determine allocations of equipment and medications needed to treat Covid-19 patients, the Journal reports.

    According to the Times, a spokesperson for HHS Secretary Alex Azar and HHS Assistant Secretary for Public Affairs Michael Caputo said the switch was necessary because CDC was "unable to keep up with the fast-paced data collection demands of the Covid-19 [epidemic]."

    Further, an HHS official told the Journal, "We've been at it for a month now, so we're starting to see the data stabilize and shake out. It's why the data has only been updated on a weekly basis." The official added, "In being more transparent, it creates some level of confusion (in the short term)" (Owens, "Vitals," Axios, 8/13; Feuer/Rattner, CNBC, 8/12; Whelan, Wall Street Journal, 8/11; Weixel, The Hill, 8/12; New York Times, 8/12; New York Times, 8/13).

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