Holes in reports of groundbreaking Covid cases hamper CDC response

Gaps in this crucial data flow raise questions about the ability of the Biden administration to detect and respond to behavioral changes in the virus – such as the rapid spread of the Delta variant, which has crowded out other strains – or vaccine performance. It also highlights how the CDC and the country’s public health departments are still struggling to collect and study critical information on Covid-19 18 months after the start of the pandemic.

“I think it would be really difficult [for the CDC] interpret results or interpret data when you only have certain reporting jurisdictions [breakthrough infections]”said Theresa Sokol, chief epidemiologist for the Louisiana State Department of Public Health, who works closely with the CDC on studies of groundbreaking infections.” I know there are jurisdictions that do not ‘do not even have access to their immunization data, they do not have the authority or their permission.

Many of the obstacles faced by CDCs and state officials attempting to collect data during the Delta Variant era are the result of the patchwork of data systems of public health agencies, many of which cannot communicate between them. For more than a decade, states have been asking the federal government for money to facilitate the collection and electronic study of disease trends. The the pandemic overloaded these dark systems, revealing the disorganized nature of public health reports and case investigations.

The CDC has allocated tens of millions of dollars this year to help states solve their data problems, but federal and state officials said it would take years for the United States to rebuild its public health infrastructure.

Meanwhile, years of neglect once again hamper state and federal authorities as they attempt to contain the Delta variant. Already this summer, it has caused an increase in new infections and hospitalizations in the South and Midwest. It is now starting to hit the Northwest, including Oregon and Washington where case rates are increasing.

“Nothing has changed since the start of the pandemic,” said a senior health official from Biden. “We’re still struggling with this patchwork system – and it continues to fail us. “

Of particular concern to health officials is how quickly the Delta variant spreads, whether it reduces the effectiveness of vaccines and causes more serious illness.

A senior CDC official told POLITICO that the state health department’s reporting system is one of many tools the agency uses to analyze breakthrough infections. The CDC receives hospitalization data in several other ways, including from established networks that rely on specific health facilities. He conducts targeted studies on the effectiveness of vaccines in frontline health workers as well as residents of New York and Los Angeles, publish its second list of conclusions Tuesday.

But the majority of data on breakthrough infections travels through state health departments through hospitals. Every week or two, the CDC updates its statistics on infections and deaths among those hospitalized.

State health officials have said that when they are able to study the data hospitals give them, they often find errors such as people of the wrong gender or age as well as missing information. on immunization status, including the type of vaccine the person has received and whether they have been fully immunized. There is also a significant lag – sometimes more than two weeks – in state reports to the CDC, as hospital electronic systems do not automatically track breakthrough infections. Doctors have to do it manually.

To complement data on hospitalized cases from the 50-state reporting network, the CDC is conducting a smaller study with a subset of states to look at all of their breakthrough infections, including mild cases that don’t send people. to the hospital. States participating in this small study have the option of matching lab reports with immunization records, but they do not maintain their own databases of hospitalization databases. They collect this information from hospitals and pass it on to the CDC.

“We report what we have, but we know it’s limited because it’s based on a direct report from a supplier – instead of taking a dataset of all hospitalizations and comparing it to our vaccine registry. Louisiana epidemiologist Sokol said. “We are not able to do this for hospitalization. We rely on individual hospital reports. And some pay well, some don’t. So we know it’s not over.

State health officials say their comprehensive data on breakthrough infections suggests the rate of such cases in their jurisdictions is higher than what the number of hospitalizations shows. And the number of new infections continues to rise.

As of last week, the CDC said he had received reports of 9,716 patients with breakthrough infections who were hospitalized or had died. In Louisiana, where cases continue to rise, health officials counted 14,650 breakthrough infections last week. That’s 4,700 more than the week before – the biggest one-week jump since Louisiana began tracking revolutionary infections, Sokol said.

Louisiana is participating in the CDC’s smallest state study of all types of breakthrough infections. But Sokol said his department did not have reliable data that would allow it to estimate what percentage of all breakthrough infections led to hospitalization.

The state is, however, able to dedicate staff to matching vaccination records with Covid-19 lab reports at a time when dozens of health services across the country are struggling to keep up with investigations. on the cases.

Karen Landers, counsel for the Alabama Department of Health, said the state tries to track all breakthrough infections, regardless of hospital status. But the task is too overwhelming some weeks. Health officials have also gotten bogged down in trying to convince people to get vaccinated, process lab reports, or make sure there is enough intensive care space for children in hospitals across the country. the state.

And in Wyoming, local health officials said it was unclear whether the state’s health department had enough staff to track groundbreaking infections beyond updates sent by. hospitals.

The CDC’s fight to improve data on breakthrough infections comes as the agency comes under fire from senior Biden officials and outside health experts for approving booster shots for all adults. Critics argue that the data the CDC has released to date on breakthrough infections, including a cohort study that found New York residents’ decreased immunity to the vaccine, is not definitive enough to warrant claims. reminders. Many say the U.S. government should instead give more doses overseas, to help end the pandemic, before handing out boosters to Americans.

The CDC has said for weeks that it has undisclosed data on breakthrough infections that supports the recall decision. He released a study focusing on frontline healthcare workers on Tuesday showing that Covid-19 vaccines offer strong protection against hospitalization and death, but their effectiveness in preventing infection is declining. One review looked at the effectiveness of the vaccine in frontline health workers; the other monitored efficacy among Los Angeles residents.

White House officials are growing frustrated with the CDC for its tendency not to share data at a time when the administration is making major pandemic policy decisions on everything from masks to reopening schools , two other senior Biden officials working on the federal Covid-19 response told POLITICO.

“We don’t have a clear understanding of what the data is actually saying about the Delta variant, the drivetrain and the boosters,” one of those officials said.

CDC officials say they are collecting the best possible data on a range of topics involving the current state of Covid-19, and current data gaps at state level and within hospitals are limiting their ability to clearly assess the national situation.

“These problems will not be solved by magic overnight,” said a CDC official.