CDC could have much less information after the emergency ends

People walk past a Covid-19 testing site in Times Square on May 12, 2022 in New York City.

Liao pan | China news service | Getty Images

The Centers for Disease Control and Prevention will have less data to track the spread of Covid-19 and new variants in the US after the public health emergency ends Thursday.

“The end of the public health emergency means the CDC will have less authority to collect certain types of public health data — meaning less data will be available to us,” said Dr. Nirav Shah, the CDC’s deputy chief executive officer, told reporters during a call Thursday.

Shah acknowledged that disease surveillance in the US has been inadequate during the pandemic and needs improvement.

“Our ability to detect and monitor disease threats should be better in the future than in the past,” he said. “And that ability to detect and monitor should be built into our baseline and not dependent on emergency declarations,” Shah said.

The US, unlike other affluent nations, has a fragmented health care system where decision-making authority over what disease data to report rests largely with corporations, the 50 states, tribes and territories — not the CDC.

dr James Lawler, an infectious disease expert at the University of Nebraska Medical Center, said this fragmented system is a result of a lack of will to reform — not a technical challenge.

“How ridiculous it is that I can tell you where my UPS packages are at any given time in 2023 and I don’t have access to the health records,” said Lawler, who spoke to the Bush and Obama administrations on biodefense advised and pandemic preparedness.

“Healthcare is the third rail in politics and no one wants to touch it,” he said.

A more fragmented system

Laboratories certified by the Centers for Medicare & Medicaid Services are no longer required to report Covid test results to the CDC. Congress required these labs to send results to the federal government in March 2020, but that mandate was tied to the public health emergency.

Some states will also stop reporting cases to the CDC altogether, said Dr. Brendan Jackson, who leads the agency’s Covid response team.

Covid has been classified as a national reportable disease since April 2020. That means new cases should be reported to the CDC, but states’ reporting to the federal government is a recommendation — not a mandate.

“Each individual state or other jurisdiction has its own set of rules or regulations that determine what is reportable,” Jackson said. “In some jurisdictions or some states, when the public health emergency ends, those agencies will go away,” he said.

The CDC will shift its collection of positive Covid tests to a voluntary network of more than 450 labs, Jackson said.

Covid case data in the US became unreliable many months ago because of so many people testing at home – if at all. These test results are not included in the CDC data because they are not required to be reported.

The World Health Organization has repeatedly warned that the dramatic drop in testing around the world is making tracking new Covid variants more difficult.

Although the CDC will continue to track Covid variants domestically and among international travelers entering the United States, the agency needs to reduce the frequency with which it reports this data.

“There’s certainly been a decrease in the tests being performed and the samples that can be submitted for genome sequencing, so we may need to reduce the frequency with which we report that,” Jackson said.

Variant data is reported twice a month, instead of weekly, according to the CDC.

The patchy reporting of case data also means the CDC will no longer report virus transmission at the county level after the public health emergency ends. Healthcare facilities used this data to know when to mask, and nursing homes relied on it to test uptake.

Jackson said the CDC will update its recommendations for those facilities so they know how to prevent infection.

The agency will also be phasing out its Covid community layers, which provide local recommendations to the public on when to mask and take other precautions, based on how many cases and hospitalizations the virus is causing in individual counties.

The community levels will be replaced with a new system based solely on hospitalization, Jackson said.

Other ways to monitor

Health officials are focused on tracking serious illnesses through hospitalizations and deaths rather than cases as infections have become a lesser threat due to the availability of vaccines and so many people have some level of immunity to Covid.

Shah said the CDC will still have ways to monitor Covid after the public health emergency ends. Hospitals are required to report Covid admissions by 2024. The CDC will primarily rely on this information, as well as sewage monitoring, which covers nearly 140 million Americans, Jackson said. In the future, hospital data will be reported weekly and no longer daily.

The CDC will continue to report deaths from Covid even as the system transitions to the National Vital Statistics System. Jackson said this should improve reporting of death dates.

“We’ll still be able to tell that it’s snowing even if we don’t count every snowflake,” Shah said.

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However, Lawrence Gostin, a health law expert, said that after the public health emergency passes, the CDC will lose its ability to easily collect data. Gostin said the problem is that unlike most other wealthy nations in the world, the US does not have a national health care system.

The CDC is currently negotiating data sharing agreements with states, tribes and territories to maintain access to Covid vaccine administration data. Those negotiations can take weeks to months, Jackson said.

“That’s just not a way to run a top-notch surveillance system. It’s porous, it’s unreliable, it’s just inadequate for the job,” Gostin said.

This information is critical to successful immunization campaigns as it can reveal disparities in vaccine administration based on race, age and geography. This allows health authorities to focus on making sure the unvaccinated vulnerable populations get their vaccinations.

Jackson said most of the 64 jurisdictions, including the 50 states and other local authorities, have signed data-sharing agreements for vaccine delivery. The CDC will continue to conduct its separate national immunization surveys, which provide information about race and ethnicity, he said.

Gostin said Congress is reluctant to authorize the CDC to order reporting amid suspicions about what the federal government will do with the data.

“This is public health information,” Gostin said. “The CDC is bound by confidential laws, and the public health agencies in all the peer countries have these agencies, and nothing goes wrong — the government doesn’t use them for bad things,” he said.

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