The change was confirmed by Michael Caputo, a former Trump campaign strategist who is now an assistant secretary for public affairs at HHS. He said in a statement: “The CDC’s old hospital data collection operation once worked well in monitoring hospital information across the country, but today it is an inadequate system.”
But former CDC acting director Dr. Richard Besser said Wednesday that changing the hospital’s data path is a “step backward” for the country’s coronavirus response.
“It is another example of CDC being marginalized. Not only should data get to CDC, but CDC should be talking to the public through the media every day,” Besser told the chief medical correspondent for CNN Dr. Sanjay Gupta in an interview.
The conversation, done over the phone and lightly edited for flow, is below.
CNN: Hospital data on coronavirus patients will now be redirected to the Trump administration instead of being sent to CDC first. What is your reaction to that movement?
ARKANSAS: Right away, my first concern is what this means for the system that has been established in recent years, if not decades. By suddenly changing, you are really disrupting the process that took a long time to establish. And it is also setting a precedent that can be very damaging in the future.
CNN: Can you expand on that a little bit?
ARKANSAS: Basically, I think every time you make changes to these systems that are so difficult to set up, and take time to get organized, every time you make changes to this it could be really damaging the integrity of the data and the system as a whole.
I don’t think many people fully understand how complex it is to translate data from clinics or hospitals into a usable format that a large entity like the CDC can select, check for quality, and make usable for follow-up, surveillance, and understanding. what is happening in the country in terms of health.
Therefore, it could be causing substantial damage to the system that we have implemented and that has taken time to accumulate. Any high-income country or any, what we sometimes call a developed country, depends on having timely surveillance and usable data to help the country truly promote health and have the best possible health system and public health system. So when you start disassembling things or moving things like this, you’re actually creating a lot of chaos and potentially configuring your future system to fail.
ARKANSAS: Absolutely. It is a complex process. Because each hospital has a contact person or a department that processes the data and then forwards it. And then, the receiver at the CDC, they have systems to receive the data, to verify its quality, to communicate with the hospital if data is missing or if there is data that doesn’t make any sense, to get clarification and really get the data in the best quality form you may have. And that is not an easy task.
We have these systems for a variety of different health conditions and pathogens. And when you start choosing which pathogen or what health condition CDC will report to HHS, you’re really creating a bigger burden on the hospital system and on departments or people trying to figure out which reports go to whom.
CNN: Obviously there are concerns about transparency here. Can you explain why transparency is so important when it comes to hospital data, particularly right now?
ARKANSAS: If you use the established system, we know that there are controls and quality control in which we verify the data and make sure that it is clean. So we understand that when we look at our usual system for tracking hospital data. That is really important. When you start to establish a new system, a new movement of data, immediately, there will be some growing pains. You must have the databases running. People need to be trained to understand how to interpret data, how to solve quality control issues, who to contact when they have a question – all of that takes time.
Is there really a reason to do this now in the midst of the pandemic? That is not clear to me.
It appears that perhaps it would be more reasonable to let CDC use the procedures it has in place to collect the data, the hospital data, and then send it to HHS or the administration. That seems to be a more reasonable and transparent way of doing this rather than indicating that you are going to create a new process.
CNN: Michael Caputo, HHS deputy secretary of public affairs, said in a statement that the CDC’s former hospital data collection operation is an inadequate system today. Is there any truth to that?
ARKANSAS: We know in this country that we have allowed the public health system and our health system to deteriorate. We know that many of our systems are not as good as what you would see in Northern Europe or parts of Asia. We know. But this is a deeper problem that needs to be addressed, but once again, don’t take apart what has been working and try to recreate it. What we should be doing in this pandemic is to build our public health systems or rebuild them in some cases.
In 2008, when we had the Great Recession, one of the consequences was that many public health systems and local health departments really lost many of their resources. And much of her staff was fired, one day a week on leave. And what finally happened was that you lost a lot of talent and now you have to rebuild it, right? So things like that have been going on in this country for a long time. And in this country, it seems that we have this reaction that if everything is fine, which means that we are not having outbreaks and we do not have excessive infant or maternal mortality or diseases due to contaminated water, what we tend to do is take resources away of those systems that really protect our health.
And therefore the consequence is systems that are not as robust as they could be. And they certainly aren’t as good as what we see in other countries, but that’s also a problem we have in resource allocation and policy. That’s a fundamental thing they should be addressing, not shifting the way we do data collection or data collection from one agency or part of government to another. It doesn’t seem to really address the problem we have.
If you really want to make the system robust, put resources to it and continue to build the system, but don’t remove a disease from the hospital notification mechanism and move it somewhere else, because what you are doing is fundamentally really damaging the system in general.
ARKANSAS: The best place to search will be on state and local health department websites and on the CDC website. That is traditionally where we have the most current, verified and reliable information. It took years, decades, to build that system. And we have established mechanisms by which there is collaboration between the local, the state and the CDC.
Therefore, it has taken a long time to build, and CDC should be an independent agency whose purpose is to truly protect the health of the American people. It should never be politicized. Frankly, I don’t understand why we have politicians appointed inside and outside the CDC.
I think this is an agency where you should have professional people running the program. Politics should never have been introduced to start with and now it seems to be here to stay and that is really problematic.
In all the other recent pandemics or large-scale national outbreaks, CDC’s job has been to preserve the data, present the information. All other administrations have examined CDC dashboards and data sets.
I think a lot of people, or the general public who are consuming the data, don’t understand that the information that is fed into these panels and these private university websites and these other university websites, that information ultimately comes from the state, local and federal health agencies. That’s typically where that information comes from.
H1N1 and MERS, coronavirus, Ebola – all of those outbreaks, and there are so many others, we’ve always come back to CDC as the trusted source of information. And it is really problematic that in this outbreak, the CDC has become more politicized than in recent years or in the past two administrations. I think that is another one of the things that a lot of people are completely missing. It doesn’t seem to be in the speech, but it needs to be addressed.
CNN: Are you concerned in the long term about the emergence of politics that plays a role at the CDC?
ARKANSAS: The long-term damage of what’s happening right now: I think it will damage trust, I think, among those of us who consume CDC data and information. I think it is dangerous. I think we are at a point where we could be eroding confidence to the point that we are going to further deteriorate our public health system.
What we have seen in this outbreak is that we must be doing the exact opposite. We should be building our systems, and whether we like it or not, it’s pretty clear, we need some kind of national central health agency, and that’s the CDC. So by politicizing the CDC and really destroying trust by taking away their role to a large extent, you’re just going to prepare this country for failure. The next outbreak will not have the benefit of a national public health agency. And that’s what you want to avoid.
Now, no agency is perfect. The CDC is certainly not perfect. Obviously, every part of this pandemic response has been fraught with problems globally. And we’ve also had a few mistakes here at the national and local levels, at the state level, but that’s also the nature of dealing with an emergency.
This is, again, unprecedented. We haven’t seen anything that big since 1918. And I think we also have to admit that yes, there have been mistakes, but a lot has to do with the bigger system and you can’t really point to the CDC and they say, ‘Oh, you know, the errors in proving it were his fault or it was only this person’s fault. ‘ Many decisions were made in larger committees, and the CDC was just one of many involved in decision-making. So I think we should be careful not to oversimplify things and just choose an easy target which, human nature, is the easiest thing to do, just choose a scapegoat. And those are some of the most in-depth conversations and analyzes that need to happen.
CNN: Anything else you want to add?
ARKANSAS: I want to say that one of the biggest problems with the way we work in terms of response and preparedness is that we really are very reactive, not with regard to prevention, which is a key problem. I think we really need to consider how to depoliticize this and make CDC independent again so that it can do its job and do it right because we’ve seen if you start taking resources away from public health infrastructure, and if you start to politicize it, all that you’re doing is shooting you in the foot.
The data will be of poor quality, which means you won’t be able to make really good decisions based on solid data. And that is exactly what we should avoid.
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