The Trump administration is asking governors to consider sending the National Guard to hospitals to help improve data collection about COVID-19 patients, supplies, and capacity, according to a letter, internal email, and officials familiar with the plans.
The move is part of a new data reporting protocol for hospitals. The protocol bypasses the U.S. Centers for Disease Control and Prevention, which is part of the Department of Health and Human Services, and stores data in a new HHS database run by a federal contractor — a change that is sparking controversy about whether the data will be reliable and accessible to the public.
In a letter to the nation’s governors that says the National Guard could be called upon, HHS Secretary Alex Azar and Deborah Birx, the White House’s Coronavirus Task Force response coordinator, say they ordered the changes because some hospitals have failed to report the information daily or completely. That portrayal, and the suggestion that military reservists could help with medical information flow, have infuriated hospital industry leaders, who say any data collection problems lie primarily with HHS and shifting federal instructions.
The new protocol, which began Wednesday, directs hospitals to report information daily about COVID-19, the disease caused by the virus, to the federal contractor or to their state, which would coordinate the federal reporting.
Public health experts say bypassing the CDC could undercut the quality of data and the federal response to the pandemic.
“The decision to have hospitals directly report to Washington instead of CDC makes no sense,” said former acting CDC Director Richard Besser, now president and CEO of the Robert Wood Johnson Foundation. “CDC needs to be able to look at that data and see how it correlates with actions that states have taken. You don’t want that information going to Washington, where it can be influenced even more by politics.”
Echoed Philadelphia Health Commissioner Thomas Farley: “I feel strongly that CDC, a non-political agency of public health experts, should be the central hub for data about the coronavirus epidemic. Any decision to bypass the CDC in reporting of public health data risks undermining the credibility of that information.”
Arthur Caplan, a bioethicist at New York University Langone Medical Center, was more blunt: “This represents the continued effort by the White House to defeat a plague by not collecting data, distorting data, and hiding data.“
Under the reporting system that is ending, about 3,000 hospitals — or the health systems that own them — send detailed information about COVID-19 patients and other metrics to the CDC’s long-standing collection system, the National Healthcare Safety Network, or NHSN. CDC staff analyze the data and provide tailored reports to every state twice a week and to multiple federal agencies every day. These data are used by local health officials and policymakers to identify coronavirus trends in hospitals in their communities, a federal health official said.
Some experts said the move could further marginalize the CDC, the government’s premier public health agency, at a time when the pandemic is worsening in most of the country.
“I worry greatly about cutting CDC out of these reporting efforts,” said Jennifer Nuzzo, an epidemiologist with the Johns Hopkins Bloomberg School of Public Health’s Center for Health Security. “I see little benefit from separating reporting of hospitalizations from reporting of cases, which CDC currently coordinates.”
The letter from Azar and Birx to the governors, which was sent out late Monday night or early Tuesday, backs away from earlier drafts that directed state leaders to deploy the National Guard to help hospitals with daily data submissions. It now includes the National Guard among states’ options for improving the data flow, according to copies of the letter obtained by the Washington Post .
The idea of bringing in the Guard was first broached at a late June meeting with hospital industry leaders by Birx, according to two industry officials who attended and spoke on the condition of anonymity to describe private discussions.
“Given our track record of being cooperative to evolving data requests, it’s perplexing that the possibility of using the National Guard has been suggested,” said Rick Pollack, president of the American Hospital Association. “It makes no sense. Certainly the expertise of the National Guard can be used in a more productive way.”
At meetings Monday and Tuesday of HHS officials, hospital representatives, and state health officers to discuss the new protocol, there was no mention of the National Guard, according to a senior hospital industry official and other individuals present.
According to one senior administration official, speaking on the condition of anonymity about private conversations, the draft of the letter that had directed governors to deploy the National Guard was revised over the weekend.
The final version tells governors, “If need be, you could consider prioritizing National Guard duties, in coordination with state health officers and emergency managers, to serve reporting needs for hospitals in the red zones.”
The letter also says, “[I]t is critical that we receive complete, accurate, daily hospital-level date in order to ensure that critical items such as therapeutics, testing supplies, and PPE are distributed efficiently and effectively across the country.”
Tuesday evening, Rep. Rosa L. DeLauro (D., Conn.), chairwoman of the House Budget Committee’s subcommittee that funds HHS, issued a statement accusing the department of acting “in direct violation with the law” by ordering hospitals to bypass the CDC in reporting coronavirus data. “HHS has been operating as a dangerous, political apparatus and cannot be trusted to share accurate hospital information with Congress and the American public,” DeLauro said.