WASHINGTON – The Trump administration this spring tied billions of dollars in much-needed medical funding for coronavirus to hospitals working with a private provider collecting data for a new Covid-19 database that the centers for control and Disease prevention bypasses.
The highly unusual demand directed at hospitals in coronavirus hotspots using funds passed by Congress without preconditions alarmed some hospital administrators and even some federal health officials.
The Office of the Secretary of Health, Alex M. Azar II, set out the request in an April 21 email from the New York Times instructing hospitals to provide a one-time report of their Covid-19 admissions and beds on the Intensive Care Unit to be built TeleTracking Technologies, a Pittsburgh company whose five-month $ 10.2 million government contract took a close look at Capitol Hill.
"Please note that submitting this data affects decision-making about targeted payments from the relief fund and is a requirement for payment," the message reads.
The financial situation, which has not yet been reported, applied to money from a US $ 100 billion Coronavirus Provider Relief Fund established by Congress under the Coronavirus Aid, Relief and Economic Security Act [CARES Act] worth $ 2.2 trillion was established on March 27th. Two days later, the administration ordered the hospitals to report to the CDC daily, only to change course.
"Another question about data reporting," a regional health department official informed colleagues in an email exchange received from The Times, adding, "There is an incentive attached." We really need a consolidated message on the reporting / data requirements, this is more than ridiculous. "
A colleague replied: “Another wrinkle. What a mess."
The April Demand Disclosure is the most striking example of the department's efforts to expand the role of private companies in collecting health data. According to critics, this practice violates the long-standing central task of the C.D.C. Last month, the Federal Health Office went beyond financial incentives and abruptly ordered hospitals to send daily coronavirus reports to TeleTracking, not the C.D.C. to send, raising concerns about the transparency and reliability of the data.
Officials from the Department of Health and Human Services say the measures were necessary to improve and streamline data collection during a crisis and that the one-off reports TeleTracking collected in April were not available from any other source.
"The national health system has never been challenged in this way in recent history," said Caitlin Oakley, spokeswoman for the department, in a statement, adding that TeleTracking offers a "standardized national system for tracking hospital capacity" that Provides more real-time, better-informed data from which decisions can be made. "
However, critics remain alarmed.
"In the midst of a pandemic, the Trump administration is using funds to support hospitals, forcing them to deploy an unproven, untrustworthy and deeply flawed system that is getting public health experts out of the way," said Washington Senator Patty Murray , the senior Democrat on the Senate Health Committee, said in a statement.
In a statement, TeleTracking said it had three decades of experience providing healthcare systems "with actionable data and unprecedented visibility to help them make better, faster decisions."
Still, public health experts and hospital executives are puzzled as to why the health department chose such a difficult time to hire an untested private provider instead of upgrading the CDC's National Healthcare Safety Network, a decade-old disease tracking system that was deeply known to hospitals and state health departments.
The so-called N.H.S.N. had built trust over decades in working with hospitals and state health authorities. Administrators were reluctant to make the switch.
"People – especially in the public health and clinical health sectors – are very protective of their data, so the trust factor is certainly an issue," said Patina Zarcone, director of computer science for the Association of Public Health Laboratories. "The fear that their data will be leaked, or misused, or used for a purpose they don't know or agree to – I think that's the biggest downside."
Ms. Oakley said the C.D.C. is "not designed for use in disaster relief" and cannot adapt quickly to a crisis. Allies of the C.D.C. Withholding taxpayer money from the CARES Act in lieu of collaboration has been an inadequate effort to force hospitals into a system they are reluctant to use.
"It's an absolutely tremendous leverage," said William Schaffner, an infectious disease expert at Vanderbilt University. "It is a compulsion to oblige institutions to report to this TeleTracking system because they knew that it would not happen if it were not tied to money."
The Pittsburgh company has no obvious ties to the Trump administration. Rather, the move seems to be part of a wider privatization. The Department of Health and Human Services has also asked Minnesota-based manufacturer 3M to "compile and continuously update a statewide clinical dataset on Covid-19 treatment," according to documents obtained from The Times.
The efforts are independent of the TeleTracking data acquisition. Tim Post, a company spokesperson, said that because 3M already operates hospital information systems, with the permission of its customers it is "uniquely positioned" to submit information to the health department to help officials investigate disease patterns and recommend treatment options.
Some experts say this type of collaboration with the private sector is long overdue. The push also appears, at least in part, to be driven by a growing gap between Atlanta-based C.D.C. and officials from the White House and the Department of Health and Human Services, the parent agency of disease control centers.
Dr. Deborah L. Birx, the White House's coronavirus response coordinator, and Mark Meadows, the President's Chief of Staff, have awarded the C.D.C. and believe that its reporting systems were inadequate. In a recent interview, Michael Caputo, Mr. Azar's spokesman, accused the C.D.C. having a tantrum.
Accurate hospital data – including information on coronavirus case numbers, deaths, bed capacity and personal protective equipment – are used by the pandemic to track the pandemic and to help the government make decisions about the distribution of scarce resources such as ventilators and the drug Remdesivir, the only approved treatment for Covid in the hospital crucial -19 patients.
The health department has set up a new database, H.H.S. Protect, collect and analyze Covid-19 data from various sources. TeleTracking supplies hospital data to this system.
But the public rollout of H.H.S. Protect was rocky. The non-partisan Covid Tracking project identified large differences between state and federal government reported hospital data and deemed the federal data "unreliable."
The tension goes back to March when the novel coronavirus hit its first spike in the United States
On March 29, Vice President Mike Pence, appointed by Mr. Trump to oversee the federal response, informed hospital administrators that the C.D.C. set up a "Covid-19 module" and asked them to submit daily reports "necessary to monitor the spread of serious Covid-19 diseases and death and the impact on hospitals".
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frequently asked Questions
Updated August 17, 2020
Why does it help to stand three feet away from others?
- The coronavirus spreads mainly through droplets from your mouth and nose, especially when you cough or sneeze. The C.D.C., one of the organizations using this measure, bases its six-foot recommendation on the idea that most of the large droplets that people make when they cough or sneeze fall within six feet of the ground. But six feet has never been a magical number that guarantees complete protection. For example, sneezing, according to a recent study, can trigger droplets that are far farther than two meters away. It's a rule of thumb: it is safest to stand six feet apart, especially when it's windy. But always wear a mask even if you think they are far enough apart.
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- As of now, this seems likely for at least a few months. There have been appalling reports of people apparently suffering from a second attack of Covid-19. However, experts say these patients may have a protracted course of infection, with the virus taking a slow toll weeks to months after initial exposure. People infected with the coronavirus typically produce immune molecules called antibodies, which are protective proteins made in response to an infection. These antibodies may only last in the body for two to three months, which may seem worrying, but that's perfectly normal after an acute infection subsides, said Dr. Michael Mina, an immunologist at Harvard University. It may be possible to get the coronavirus again, but it is highly unlikely to be possible in a short window of time after the initial infection or make people sick the second time.
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- The stimulus packages passed in March provide help for millions of American small businesses. Eligible are companies and non-profit organizations with fewer than 500 employees, including sole proprietorships, independent contractors and freelancers. Some larger companies in some industries are also eligible. The assistance offered, administered by the Small Business Administration, includes the Paycheck Protection Program and the Economic Injury Disaster Loan Program. But a lot of people haven't seen any payouts yet. Even those who have received help are confused: the rules are draconian, and some are stuck on money they cannot use. Many small business owners get less than expected or hear nothing at all.
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What will the school look like in September?
- Many schools are unlikely to return to a normal schedule this fall, which will require online learning, makeshift childcare, and stunted work days to continue. California's two largest public school districts – Los Angeles and San Diego – announced on July 13 that classes will only be held remotely this fall, citing concerns that the rise in coronavirus infections in their areas is too great Poses risk to students and teachers. Together, the two districts enroll around 825,000 students. They are the largest to date in the country, abandoning plans for a partial physical return to classrooms when they reopen in August. For other districts, the solution is not an all-or-nothing approach. Many systems, including the largest in the country, New York City, are developing hybrid plans where some days are spent in classrooms and some days online. There is still no national guideline on this. So check regularly with your city school system to see what's happening in your community.
At that time, TeleTracking made a proposal to the Trump administration to collect data as part of an initiative, ASPR Next, launched to drive innovation. TeleTracking received its order on April 10th.
The Ministry of Health spokeswoman said the intent was to encourage the C.D.C. to complement and not to compete with it. Like the C.D.C. network, the TeleTracking system requires manual reporting on a daily basis. In June, Ms. Murray asked the administration to provide more information on what she called a "multimillion-dollar contract" "dual health records".
Some hospital officials also opposed the change.
"We have referred our hospitals to the NHSN," wrote Jackie Gatz, vice president of the Missouri Hospital Association, in an email received from The Times to a regional health and welfare officer. "And now this email with a much larger carrot." – CARES Act distributions – forward them to TeleTracking. "
When the order was delivered, defects had already occurred in the new system.
"HHS recognized long wait times for those requesting technical support and stated that TeleTracking recently hired 100 people to respond to call center inquiries," the American Hospital Association wrote in a special bulletin on April 23 "Instruct their members to leave a message when hospitals are unable to reach someone live."
At that time, hospitals had the option to submit their daily coronavirus reports to TeleTracking or the C.D.C. Only a few used the new database.
In June, the administration once again used a stick to ask hospitals to report to TeleTracking, this time to get remdesivir. Until July, when Dr. Urging Birx to improve compliance with hospital regulations, the administration directed hospitals to stop reporting daily reports to the C.D.C. and send them to TeleTracking instead.
An officer at a major academic hospital who spoke on condition of anonymity for fear of disgruntled officials in Washington said the move made her "unable to sleep at night."
“Ethically, it felt like they had a very trustworthy institution in the C.D.C. and all of that trust that has been built among many people in the public health sector has then transferred to a politically and financially motivated part of that response.
Health and social care officials say the government now has a much more complete picture of hospital bed capacity, with more than 90 percent of hospitals reporting. Dr. Janis M. Orlowski, the Chief Health Officer of the Association of American Medical Colleges, who with Dr. Birx and the administration worked together to strengthen hospital coverage but said she was "stunned" by the move and that coverage was increasing due to the efforts of her group and others, not the TeleTracking system.
Dr. Orlowski said the data and maps are now on the H.H.S. Protect Data Hub are "just not as sophisticated as the C.D.C."
The move also caused a pushback within the C.D.C., where officials have refused to analyze and publish TeleTracking data, saying they could not be sure of its quality and continue to have questions about its accuracy, according to a senior federal health official.
Administrative officials say the C.D.C. is working with a little-known executive office – the United States Digital Service – to build a "modernized automation process" that will keep data flowing directly to the Department of Health and Human Services. But the project is still in its infancy, said a senior federal health official.
Critics say that if the department believed the C.D.C. Had problems, they should have been fixed.
"We have a public health system that relies on communication between hospitals and state health departments with the C.D.C.," said Dr. Schaffner, an infectious disease expert at Vanderbilt University. "It is very well established. Can it be improved? Of course. However, it is extremely wrong to shut down public health infrastructure and report essential public health data to a private company."