As criticism of the Trump administration’s response to the coronavirus pandemic escalates, a former director of the Centers for Disease Control and Prevention Tuesday asked state health officials to begin reporting the data from Coronavirus in a detailed and uniform way, instead of the disorganized hodgepodge in most states now produces.
Other public health experts said such guidelines had been long overdue and that the agency’s current director, Dr. Robert Redfield, should have ordered them months ago.
The CDC’s lack of clear guidance, even on simple issues like data collection, was an example of the administration’s ineptitude and ineffective leadership in the face of a growing crisis, experts said.
“We have a true leadership vacuum at the national level,” said Dr. Thomas R. Frieden, former director of the CDC, who now runs Resolve to Save Lives, a nonprofit health advocacy initiative.
“In the absence of a national strategy, our best hope is to get all 50 states on the same page, so that we know where we are,” he said.
Dr. Frieden’s organization concluded that states report only 40 percent of the data needed to combat the pandemic. Some states disclose less useful information than the Ugandan government, which Resolve to Save Lives also advises on its response to the coronavirus, he said.
The report presented 15 indicators that each state must report daily on a public “dashboard” that anyone can see.
They included not only basic elements such as cases, hospitalizations and deaths, but sophisticated metrics such as what percentage of infections came from groups of people who know each other, how many health workers are infected at work, how long it takes to get a result of the diagnostic test and what percentage of residents of any city or county wear masks.
Dr. Frieden also suggested tracking how many people in any city are hospitalized with symptoms of the coronavirus or flu, regardless of the test results. Whenever legally possible, he said, states should name institutions with major outbreaks, including nursing homes, jails, schools, or meat packing plants.
Leading public health experts asked why the CDC itself had not required such data from the states. Dr. Irwin E. Redlener, founding director of Columbia University’s National Disaster Preparedness Center, said it was “pathetic” that a private organization had to propose data standards and recruit states to voluntarily accept.
“The feds should have been demanding exactly this type of standardized information from each state and territory since March,” he said. “This is another illustration of the federal government’s failures: Trump was explicit in telling the governors that they were alone.”
Michael T. Osterholm, director of the University of Minnesota Center for Infectious Disease Research and Policy, who helped design the data dashboard used by New York State and quoted by Governor Andrew M. Cuomo during his press conferences Dr. Frieden’s said the proposal was “something we need in our toolkit that has been missing.”
Dr. Osterholm was concerned that both the spread of the virus and the progress against it were not adequately measured. “Without standards, how do you know if it is failing or succeeding?” Dr. Osterholm said. “Without them, you can’t hold anyone’s feet to fire. This is something CDC should have done. “
Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases and chief scientist for the White House Coronavirus Task Force, agreed that Dr. Frieden’s initiative was a major effort.
When asked for comment, CDC spokesman Tom Skinner said the agency “was always looking for best practices” and had made plans with states to track 14 of the 15 indicators cited in Dr. Frieden’s report. .
The exception was the percentage of people who wore masks correctly in public, as it was unclear how that could be done, Skinner said. (Dr. Frieden’s report suggested doing street counts or viewing images from security cameras.)
When the data is collected, it will be posted on the CDC’s Covid Tracker website, Skinner said. The Department of Health and Human Services recently suggested that hospital coronavirus data would be sent to Washington first, not to the CDC, as has long been done.
Last week, discussing whether his proposed metrics would be adopted by states, Dr. Frieden said he had consulted with the National Association of Governors and several governors had said they would soon adopt their guidelines. “We hope that peer pressure will bring others in,” he added.
Lack of uniform metrics has contributed to the country’s failed response to the pandemic, Dr. Frieden said.
“It is impossible to overstate how outlier the US is with respect to reporting data,” he said. “Hong Kong may have 67 cases and think it is a serious situation. We may have 67,000 cases and there is a debate about whether it is serious. “
No state now reports all the data that is needed, but some is better than others. Dr. Frieden singled out Minnesota and Arizona as overall leaders, while Oregon and Virginia, he said, were doing their best by reporting a crucial metric to curb the spread: contact tracking.
Asian and European countries rely heavily on the tracking and testing of all contacts for each known case. In most states in this country, cases are increasing so fast that it is impossible to trace dozens of contacts from each patient.
Information about contact tracing is generally “abysmal,” said Dr. Frieden. “Uganda is doing better to locate and contact quarantined people and report them.”
Dr. William Schaffner, a preventive medicine specialist at Vanderbilt University School of Medicine, welcomed the standards proposed by Dr. Frieden, but said that few states had the experience and money needed to generate and analyze the data.
“This is the Platonic ideal of how state health departments should they work but it is some distance from the way that can function, “he said. After two decades of budget cuts,” they are limited in personnel and technology. “
Hospitals also find it difficult to report data during crises, he added.
