#18,062
In a case of exceptionally bad timing, 2 weeks after the first cattle-related H5N1 human infection was reported (April 1st) in Texas, the following notice appeared in the CDC's weekly Fluview Report announcing the latest in a series of rollbacks of reporting requirements on COVID, Flu, and other respiratory illnesses.
This decision was made long before the discovery of H5N1 in cattle, and is part of an ongoing, albeit short-sighted global move to dismantle COVID surveillance and reporting, something we've discussed ad nauseam for more than 2 years (see here, here, here, here, and here).
While proponents may argue this is good for the world's economies who need to `move on' from the pandemic, and others may find it politically expedient, it has left the world at a distinct disadvantage when it comes to collecting and analyzing data on new and emerging COVID variants and other emerging disease threats.
Late yesterday the CDC published an update (see below - emphasis mine) which acknowledges the impact of recent changes to reporting - and encourages hospitals to continue to report as they did before this change took effect - while they work to rectify the situation.
CDC Updates Respiratory Virus Dashboards
May 14, 2024, 6:00 PM EDT
Updates on respiratory illness and vaccine-preventable diseases.
CDC Updates Hospitalization Data on Respiratory Virus Dashboards
CDC keeps a close eye on respiratory viruses and the diseases they cause through a range of systems that collect data on hospitalizations, deaths, emergency department visits, wastewater findings, and testing results. But as of April 30, 2024, some federal reporting requirements for acute care hospitals and critical access hospitals expired. While CDC has access to other robust and reliable surveillance systems to track hospitalization trends for COVID-19, flu, and RSV, CDC is updating its respiratory virus dashboards to reflect this change.
What’s changing with hospital reporting requirements?
On April 30, 2024, some Centers for Medicare & Medicaid Services (CMS) federal reporting requirements for acute care hospitals and critical access hospitals expired. For now, hospitals are no longer required to report certain COVID-19, flu, and other acute respiratory illness-related hospitalization and bed capacity data to CDC’s National Healthcare Safety Network (NHSN).
Despite this change in mandatory reporting, CDC and CMS are encouraging hospitals to continue submitting data voluntarily to NHSN. CDC has begun sharing the voluntarily reported data on its website with weekly updates. Full details on NHSN hospital data reporting guidance are available on the NHSN website.
These data have proved invaluable for informing public health decisions, including during the COVID-19 Public Health Emergency and throughout the 2023/24 respiratory virus season. CDC, CMS, and the Administration for Strategic Preparedness and Response worked together on new proposed requirements for hospitals to electronically report information about COVID-19, flu, RSV, and hospital bed capacity in a standardized format and frequency specified by the HHS Secretary. This proposed requirement aims to strike a balance between the need for critical data to inform hospital decision-making while not making these data overly burdensome to report. If finalized, this proposed new standard would take effect October 1, 2024.
This proposed rule is open for public comment until June 10, 2024, and CDC encourages interested public health and healthcare partners to respond.
CDC continues to monitor and share hospitalization data
Key COVID-19, flu, and RSV information currently available on CDC’s COVID Data Tracker and Respiratory Virus Data Channel will remain available, thanks to data collected through other CDC surveillance systems, including COVID-NET, FluSurv-NET, and RSV-NET that constitute RESP-NET.
COVID-NET, FluSurv-NET, and RSV-NET provide data that help CDC continue to track and monitor COVID-19-, flu-, and RSV-associated hospitalization trends, respectively, and determine who is most at risk. COVID-NET collects data on laboratory-confirmed COVID-19-associated hospitalizations among children and adults from over 300 acute care hospitals in 13 states, representing about 10% of the US population. FluSurv-NET and RSV-NET have comparable structures and characteristics. The population covered in the communities within these systems have similar demographics as the overall U.S. population, making them good tools for understanding national COVID-19 and flu hospitalization trends, even without nationwide data. All three systems provide detailed, patient-level information about respiratory virus-associated hospitalizations (for example, demographics, underlying conditions, clinical outcomes).
CDC also operates the National Syndromic Surveillance Program (NSSP), a collaboration among CDC, local and state health departments that collects, shares, and analyzes these automated electronic healthcare data, including patients presenting to the Nation’s emergency departments who are diagnosed with COVID-19 and other conditions. These data provide public health officials with a timely system for detecting, understanding, and monitoring health events. By tracking symptoms and diagnoses of patients in emergency departments in near real-time, public health can detect unusual levels of illness or injury to determine whether a response is warranted.
What changes are occurring to CDC dashboards?
- COVID Data Tracker is CDC’s flagship website for comprehensive data on COVID-19. Current hospital data visualizations using NHSN data, including those used to calculate COVID-19 County Hospital Admission Levels, have been archived. These have been replaced with visualizations that display data that hospitals voluntarily submit to CDC’s NHSN. This includes inpatient and intensive care unit bed occupancy and reporting completeness summaries. While we continue to assess the quality and completeness of NHSN hospitalization data on respiratory viruses during the voluntary reporting period, we are changing the main COVID-19 hospitalization dashboard from using NHSN data to COVID-NET findings.
- The Respiratory Virus Data Channel is CDC’s one-stop shop for main data findings concerning the “big 3” viral respiratory illnesses—COVID-19, flu, and RSV. Current hospital data visualizations for COVID-19 and flu hospitalizations using NHSN data have been archived from this site and replaced with the respective findings from COVID-NET and FluSurv-NET; RSV-NET findings will continue to be displayed on the site.
- Data.cdc.gov is CDC’s central web-based platform that provides access to data published by CDC for partners and the public. Datasets that include the historical NHSN data have been archived and remain available on data.cdc.gov for public use. In addition, voluntarily reported NHSN hospital data products that include information on COVID-19 and flu will be made available to provide transparency in continued data collection efforts; these datasets can also be found on healthdata.gov.
While NHSN continues to be available for reporting among all U.S. hospitals, the change in reporting requirements may impact completeness of the data submitted and information may fluctuate from week to week. CDC will continue to assess the quality and completeness of voluntarily reported NHSN hospital data to understand which are most informative for patient safety and public health actions.
Looking ahead: Leaning on multiple systems and new reporting requirements
CDC will continue to collect and disseminate data from other sources—such as wastewater, laboratories, and emergency departments—to detect and monitor threats and keep its partners and the public informed about threats in their communities.
CDC will also continue to work with hospitals, health systems, and state, tribal, local, and territorial agencies to streamline reporting requirements and further minimize burden on healthcare systems. CDC has already invested more than $1 billion to increase the automation capabilities of surveillance systems such as NHSN and NSSP and its ability to connect with other data submission techniques, vendors, and systems.
Over time, reporting capabilities will become increasingly automated, standards-based, simplified, and real-time as data systems mature and become more interoperable. Thanks to hard work in collaboration with partners across the country, we will still be able to collect data that are valuable to situational awareness and public health decision-making. As the disease dynamics and impacts of respiratory viruses including COVID-19 continue to change, it is critical that we continue investing in systems that will allow us to track critical changes and take action that can save lives.
As we've discussed previously, each year we see an average of 2 or 3 new zoonotic diseases emerge around the world (see chart below), and several recent journal articles (see here and here) suggesting that rate will continue to escalate in the coming years.
It shouldn't take a Nostradamus to know that this is precisely the wrong time to be reducing our global surveillance and reporting systems. But that is exactly what has happened over the past few years, and it extends far beyond just COVID.
A little over a year ago, in Lancet Preprint: National Surveillance for Novel Diseases - A Systematic Analysis of 195 Countries, we saw a report indicating the self-reported compliance to the IHR (adopted in 2007) has been routinely overstated by many countries for more than a decade.
And 18 months ago, in Flying Blind In The Viral Storm, we looked at the increasing willingness of many countries to delay, downplay, or hide completely reports of emerging infectious disease events.
A classic example being China's under-reporting (by millions) of the number of COVID deaths in early 2023.
As a result, our `global awareness' of emerging disease threats is probably lower today than it was before the start of the COVID pandemic. While we may not always like what we find, one of the lessons from COVID should have been:
More knowledge, sooner, can save lives.
Unfortunately, that's a lesson we apparently have yet to fully embrace.