Expert witnesses spoke about the importance of accurate data to the COVID-19 pandemic response, with some raising serious concerns about possible political manipulation of that data, during a hearing of a House Committee on Science, Space, and Technology subcommittee on Wednesday.
Subcommittee Chairman Bill Foster (D-Ill.) said he is also concerned about ensuring the integrity of the data, particularly after the Trump administration redirected all COVID-19 related hospital data from the CDC’s National Healthcare Safety Network to the Department of Health and Human Services (HHS) TeleTracking system or to individual state health departments, which would then funnel the information to HHS.
“The American public should never have to doubt that federal data collection and management efforts serve one purpose alone: informing public health decisions with the best available science,” Foster said.
Ensuring that data is accurate, transparent, and free of political influence is key to decision-making and helping Americans stay safe, he said.
“Moving the federal government’s primary database from the CDC, with its expert career epidemiologists, to an HHS now dominated by short-term political appointees places this all-important data at risk of political manipulation,” Foster said.
For context, the CDC launched a COVID-19 module, building on an already existing database, the National Health Safety Network, in March. The module creates region-specific reports that help to assess the severity of the pandemic, and help make decisions about disease control measures and resource allocation, he explained.
Then in April, HHS contracted with TeleTracking Technologies to implement a completely new system, and in July, HHS made that new system mandatory, he said.
The change came as a surprise to hospitals and created a new burden for them, said Lisa Maragakis MD, MPH, senior director of Infection Prevention for Johns Hopkins Health System in Baltimore and a witness at the hearing.
Forty-eight hours after the change was mandated, hospitals scrambled to begin manually reporting data to the new system, including information that hadn’t been requested before, under “a cloud of fear” that the federal government would claw back resources if hospitals didn’t properly meet its requirements.
Maragakis said she was most concerned about “irregularities” and “inconsistencies” in the data, particularly because CDC officials are no longer validating the information in the new system before it’s seen elsewhere, including by White House policymakers.
“My colleagues and I have concerns over the accuracy of the data that is being used for decision-making at the federal and state levels,” Maragakis stated bluntly.
Another witness, Lisa Lee, PhD, associate vice president for research and innovation at Virginia Tech in Blacksburg, who spoke on her own behalf and not that of her employer, was similarly worried about the fallout from sidelining CDC scientists, which she likened to “removing trusted NASA engineers from sending a rocket to Mars.”
At the core of these issues is trust, Lee said. “The public has to trust that their government leaders are acting in the public’s best interest.”
Currently, that trust is lacking, she noted, pointing to polls that have found that 68% of Americans do not trust what the president says about the coronavirus.
And when a for-profit private company takes on “an inherently governmental activity,” Lee argued, there’s a clear mismatch in objective, which creates even more mistrust.
A guiding principle for strengthening the public health infrastructure is to ensure that data flow from healthcare to the state and local public health departments and from there to the federal government.
“So [data] should be flowing through the public health system, not around the public health system,” said Jane Hamilton, MPH, executive director of the Council of State and Territorial Epidemiologists.
The subcommittee’s ranking member, Ralph Norman (R-S.C.), also expressed worries about the state of the pandemic response. But he was less worried about political influence than about long-standing data-collection challenges, including the “incomplete and sometimes inaccurate” data reported to state and local health departments.
Norman argued that if better data had been available, policymakers would have realized how vulnerable older Americans are to the virus, and “countless deaths and hospitalizations could have been prevented.”
The biggest challenge, according to Norman, is that Americans don’t know “how much COVID is out there,” and that uncertainty makes it harder for researchers to make predictions about cases, hospitalizations, and deaths.
“We cannot afford to make bad policy decisions due to poor data during the pandemic and future public health emergencies,” he said.
Avik Roy, president of the Foundation for Research on Equal Opportunity, which promotes free-enterprise policies, echoed Norman’s concerns that poor data had led to unnecessary deaths.
Roy said that if more accurate data about seniors’ vulnerability to COVID-19 had been available, then state governors — whose priority at the time was ensuring that hospitals were not overwhelmed — would not have forced nursing homes to accept COVID-19 patients.
Even today, some states “systematically undercount” COVID-19 deaths. “If you die in a hospital but you got infected in a nursing home, they’re counting it as a hospital death, not a nursing home death,” he said.
The Centers for Medicare & Medicaid Services is beginning to require that nursing homes send this data directly to the agency, Roy said, also suggesting that COVID-19 cases may be overcounted.
“It turns out that in many parts of the country, roughly half of the positive PCR tests appear to be false positives,” Roy asserted, noting that the difference depends on the level of amplification of the PCR samples.
This could mean that states are making decisions to “lockdown” or close schools based on community positivity rates that aren’t accurate, Roy surmised, also suggesting that this could be why the U.S. isn’t seeing the same magnitude of deaths per positive case as the country saw early in the pandemic.
It’s important that the scientists begin to have “a better understanding” of the actual level of positivity in PCR tests, said Roy, a former healthcare investment analyst.
Finally, the witnesses also commented on the importance of funding for public health surveillance and responses.
Hamilton noted that the public health system has “never had dedicated funding” for modernizing and improving surveillance systems.
One improvement she sees as transformational is the shift to electronic case reporting.
In places such as Florida that have electronic case reporting, the amount of missing information — whether it is race and ethnicity or an individual’s address or phone number — has dramatically fallen, she noted.
“We need that foundational core funding and it needs to happen on an annual basis,” she stressed.
Source: MedicalNewsToday.com
