WASHINGTON -- Nearly three dozen current and former members of a federal health advisory committee, including nine appointed or reappointed by Health Secretary Alex Azar, are warning that the Trump administration's new coronavirus database is placing an undue burden on hospitals and will have "serious consequences on data integrity."
The advisers, all current or former members of the Healthcare Infection Control Practices Advisory Committee, issued their warning in a previously unpublished letter provided to The New York Times.
The letter was made public as hospital officials and independent data experts around the country were reporting kinks in the new system, which critics say is undermining the government's ability to understand the course of the pandemic.
The concern grows out of an order, issued by Azar last month, for hospitals to send daily reports about virus cases to a private vendor that transmits them to a central database in Washington instead of to the Centers for Disease Control and Prevention, which had previously housed the data.
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The information, including patient and hospital bed counts, helps guide the government's response to the pandemic, informing critical health care decisions like how to allocate scarce supplies -- including ventilators or the drug Remdesivir, which is approved as a treatment for covid-19 patients.
The order raised alarm that the data could be politicized or withheld from the public. But the authors of the letter expressed additional concerns. They said the transition from the CDC to the private vendor, TeleTracking Technologies, has left hospitals "scrambling to determine how to meet daily reporting requirements" and that CDC data experts had been sidelined.
"The U.S. cannot lose their decades of expertise in interpreting and analyzing crucial data," the authors wrote, adding that the CDC's experts, from its Division of Healthcare Quality Promotion, must "be allowed to continue their important and trusted work."
The letter's 34 signatories are doctors, nurses and public health experts, and include the current co-chairwomen of the panel, Dr. Lisa Maragakis of the Johns Hopkins Hospital and Dr. Hilary Babcock, a professor in the Infectious Disease Division at the Washington University School of Medicine in St. Louis. Both were reappointed by Azar.
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"These are the elite of the infection control personnel from hospitals all over the country," said Dr. William Schaffner, an infectious disease expert at Vanderbilt University, who is not affiliated with the group. Another expert, Michael Osterholm of the University of Minnesota, said the letter should be taken "very seriously."
CDC NETWORK
At the outset of the pandemic, the CDC expanded its National Healthcare Safety Network, which for several decades has collected information on hospital infections, to begin collecting hospital data related to the virus.
Hospitals around the country are familiar with the network, which the authors of the letter described as a "robust" surveillance system. The CDC published estimates of hospital bed capacity, based on the information it collected.
But officials at the Health and Human Services agency felt that the CDC was not moving quickly enough. Earlier this year, they set up their own data tracking system -- HHS Protect -- and hired TeleTracking Technologies, a Pittsburgh firm, to take over the CDC's duties. Azar made the switch official in a notice to hospitals issued on July 10, and on July 14 the CDC stopped publishing its estimates.
The CDC referred questions about the letter to the Department of Health and Human Services, where officials say the new system was necessary to streamline and improve data collection. A spokesman for Azar, Michael Caputo, said the CDC's health care network "was unable to keep up with the fast-paced data collection demands of the covid-19 pandemic" and that the CDC still had access to the data.
"If the writers of that letter want the CDC to be more involved in the hospital data, they should tell the CDC, because the CDC has refused to be involved in something that they don't control," Caputo said. When the shift occurred, he added, "they had a tantrum."
While Health and Human Services officials say the underlying data is updated daily, The Wall Street Journal reported Wednesday that outside experts who are tracking the pandemic say there has been a lag of a week or more in reporting key indicators that flow from the analyses, such as estimates of the share of inpatient beds occupied by covid-19 patients.
ANTIBODIES PROMISE
Separately, with a coronavirus vaccine still months off, companies are rushing to test what may be the next best thing: drugs that deliver antibodies to fight the virus right away, without having to train the immune system to make them.
Antibodies are proteins the body makes when an infection occurs. They attach to a virus and help it be eliminated. Vaccines work by tricking the body into thinking there's an infection so it makes antibodies and remembers how to do that if the real bug turns up.
But it can take a month or two after vaccination or infection for the most effective antibodies to form. The experimental drugs shortcut that process by giving concentrated versions of specific ones that worked best against the coronavirus in lab and animal tests.
"A vaccine takes time to work, to force the development of antibodies. But when you give an antibody, you get immediate protection," said University of North Carolina virologist Dr. Myron Cohen. "If we can generate them in large concentrations, in big vats in an antibody factory ... we can kind of bypass the immune system."
These drugs, given through an IV, are believed to last for a month or more. They could give quick, temporary immunity to people at high risk of infection, such as health workers and housemates of someone with covid-19. If they proved effective and if a vaccine doesn't materialize or protect as hoped, the drugs might eventually be considered for wider use, perhaps for teachers or other groups.
They're also being tested as treatments to help the immune system and prevent severe symptoms or death.
"I'm cautiously optimistic" about the drugs, said the nation's top infectious diseases expert, Dr. Anthony Fauci. "I'm heartened by the experience that we had with Ebola," where the drugs proved effective.
RUSSIA UNDETERRED
Meanwhile, Russia has brushed aside international concerns about the safety of the world's first covid-19 vaccine and announced that it will start mass inoculation this month before clinical testing is completed.
"Western colleagues, who can sense the competitive advantage of the Russian drug, are trying to express some opinions that are completely unjustified in our view," Health Minister Mikhail Murashko said at a briefing Wednesday. "This vaccine is a platform that is already well-known and studied," he said, adding that other countries have developed antidotes under accelerated testing programs.
Authorities plan to start inoculating medical workers and other risk groups within two weeks on a voluntary basis, Murashko said. The vaccine will be available to the wider population beginning in October.
Elsewhere, Azar on Wednesday touted Taiwan's success in battling the coronavirus and criticized China for a lack of transparency in addressing the outbreak, arguing that the country, where the virus emerged, helped seed it across the globe.
Azar, the highest-level U.S. official to visit Taiwan in four decades, said the island exemplified that "open, democratic societies" were best equipped to respond to outbreaks such as covid-19, the disease caused by the coronavirus.
His remarks Wednesday morning in Taiwan came as he wrapped up a three-day trip to the island and as U.S.-China relations have soured in recent months as Trump and his administration have sought to blame Beijing for the global outbreak.
Azar also met with several top Taiwanese officials, including the island's president and health minister, and visited a mask machine factory Wednesday.
BRITISH CHANGES
Also on Wednesday, the British government changed the way it compiles coronavirus deaths, a move that reduced the country's official death toll by more than 5,000.
The Department of Health said the new total is 41,329, down from 46,791. That is still Europe's highest death toll.
The government announced last month that it was reviewing the way death statistics were compiled, after academics pointed out that in England the tally included anyone who has tested positive for covid-19 and later died, with no cut-off point between positive test and death. That means some people recorded as coronavirus deaths may have died of other causes.
That could explain why England has been showing far higher daily death tolls than Scotland, which counts only deaths that occur within 28 days of a positive test.
Public Health England said Wednesday that it will also adopt a 28-day cut-off date, bringing it into line with the rest of the U.K. People who die more than 28 days after testing positive, but fewer than 60 days, will be added to the total only if covid-19 appears on their death certificates.
Public Health England said it made the change after discovering that "in recent weeks the numbers of deaths in people who have tested positive have become substantially greater than the numbers of deaths subsequently registered as covid-19 deaths" by the Office for National Statistics, which uses death certificates to keep its tally.
The change highlights the difficulty in comparing death tolls among countries, which use different counting methods.
U.S. FIGURES
In the U.S., Florida's Department of Health warned that a dump of months-old covid-19 data had severely skewed the latest daily report, making it appear worse than it was.
The disclosure sheds new light on a report that, on its surface, seemed to suggest a stalling of the recent downward trend in coronavirus cases and positivity rates in hard-hit Florida. It had an especially outsize impact on statistics for Miami-Dade, Florida's largest county.
The state reported a 1.5% increase in cases Wednesday, sending the total to 550,901. The rise was greater than the past week's 1.3% average, and the rate of people testing positive for the first time hit 11.9%, the highest since July 29.
The state said Niznik Lab Corp. just disclosed thousands of cases dating back seven weeks. Indeed, the state's archive of reports showed Niznik results never appeared in Florida's data until Wednesday, when it debuted with 4,422 positive tests at a 31% positivity rate.
Gov. Ron DeSantis has often blamed spikes in cases on so-called data dumps. Last week, he said some "smaller, private labs" don't report negative results and that had caused him to lose faith in the positivity-rate metric.
In California, at least 15,800 essential workers would not have contracted covid-19 if California had stockpiled enough masks and other protective equipment, and the state would have saved $93 million weekly on unemployment claims for out-of-work health care workers and avoided overpaying for supplies, according to a study released Wednesday.
The University of California, Berkeley Labor Center study urges California officials to stockpile masks, gowns, gloves and other equipment in the coming years to avoid shortages seen during the covid-19 pandemic.
Lawmakers currently pushing a bill that would create a state stockpile said the UC Berkeley report demonstrates that California needs a plan to ensure personal protective equipment shortages aren't as sharply felt during a future health care crisis.
Information for this article was contributed by Sheryl Gay Stolberg of The New York Times; by Marilynn Marchione and Jill Lawless of The Associated Press; by Henry Meyer, Ilya Arkhipov and Jonathan Levin of Bloomberg News; by Yasmeen Abutaleb of The Washington Post; and by Melody Gutierrez of The Los Angeles Times.
