Why the CDC's coronavirus data is so bad

• The Centers for Disease Control and Prevention has struggled to provide accurate data on the novel coronavirus.
• The CDC must wait for states to report infections and deaths, creating a built-in lag time.
• There is also a lack of standardization and political pressure to keep numbers low.
• "The CDC missed its window to be able to have that position of authority on the data and people are looking for other sources," Thomas Tsai, a health policy researcher at the Harvard School of Public Health, told Business Insider.

Since the start of the pandemic, The Centers for Disease Control and Prevention, the country's preeminent public health institution, has struggled to gather accurate data on the coronavirus.

Reporting challenges, along with delays in providing guidance to policymakers and the public, has damaged the country's ability to slow, stop, and prevent outbreaks, public health experts say.

"A coordinated response from the CDC, the FDA, and the White House would have been important in containing the virus in the early stages," Thomas Tsai, a health policy researcher at the Harvard School of Public Health, told Business Insider. "And we missed that opportunity."

How the CDC tracks data

CDC officials monitor viral outbreaks by relying on reporting from a network of hospitals, public health agencies, and clinical and commercial laboratories.

For the coronavirus, the agency publishes a weekly summary of positive test results and hospitalizations nationwide. And its website updates infections and deaths by state daily.

But the CDC depends on state health departments to collect and submit their findings. It also has to check that laboratory-confirmed cases and probable positives are properly listed, a lengthy process that can delay the release of vital information.

In the UK, the National Health Service centralizes testing information. But in the US, every laboratory and hospital sends its own reports to state and federal officials on its own timetable.

That adds more lag time for the testing data the agency receives.

"The CDC can't just go and get the data, they have to wait for it to be submitted," Danielle Ompad, an epidemiologist at NYU's School of Public Health, told Business Insider. "A lot of hospital systems are overwhelmed because there's so much going on right now and it takes time for that data to make its way up and get processed."

In a Senate hearing Tuesday, CDC Director Robert Redfield described the country's coronavirus tracking system as "archaic."

"This nation needs a modern, highly capable data system that can do predictive analysis," Redfield said, according to The New York Times. "It's one of the many shortcomings that has been identified as we went through this outbreak."

When states do file their reports to the CDC, the data is rarely standardized: At one point, less than 20 states were reporting negative test results, according to the COVID Tracking Project, and just 13 noted if a patient had a pre-existing condition.

Ten states, including Nebraska and North Dakota, don't break cases down by race.

"The different rates of reporting different social, racial, and demographic groups in different states is a political decision that has profound and large-scale effects on public health in the short, medium and long-term," Joseph Vinetz, an infectious disease expert at the Yale School of Medicine, told Business Insider.

The CDC's data is also weakened by the limited availability of diagnostic testing, with guidelines varying greatly: Coming into contact with an infected person is grounds for a coronavirus diagnostic test in Utah, for example, but not Massachusetts, according to the Markup.

And a changing list of symptoms has forced the agency to reevaluate results from earlier in the year.

"Our understanding of the disease is evolving and new symptoms start to emerge as we follow up with people," said Ompad. "When we first started talking about coronavirus, the symptoms were fever, shortness of breath, and a dry cough. Now it's more than what we initially understood."

Mistakes were made

When the coronavirus first hit the US, the CDC chose to develop its own testing kit instead of adopting a World Health Organization version that was already available. That slowed down testing distribution, implementation, and results.

Then, in early February, the agency sent faulty test kits to 100 state and local labs. After the possible contamination was uncovered, the CDC continued to develop its own test, delaying widespread availability even further.

White House adviser Peter Navarro says the tainted tests and insistence on keeping testing within the bureaucracy "really did set us back" in the early weeks of the outbreak.

"The CDC, which really had the most trusted brand around the world in this space, really let the country down," Navarro, coordinator for the Defense Production Act, told NBC's Meet the Press.

Experts have also complained about inadequate communication: The CDC didn't begin updating coronavirus data over the weekends until late March, and press briefings have gone from regular to sporadic.

"Daily updates from the CDC would allow all of us to better understand how we are doing, whether we are likely to run out of hospital capacity and when, what the bottlenecks are on testing, and how we get ahead of this outbreak," Harvard Global Health Institute director Ashish Jha wrote in an opinion piece in STAT. "It would be easy for the CDC to do this, but it hasn't."

The agency has been "inexplicably absent" since the pandemic began, he added, "and Americans are suffering and dying for it."

Research institutions have stepped into the gap. Updated nightly, Johns Hopkins University's widely used Coronavirus Resource Center site tracks confirmed cases and deaths in each county. On Monday afternoon at 5 pm, Johns Hopkins listed 90, 312 COVID-19 deaths in the US, while the CDC tracker listed 89, 407.

Housed at the Atlantic, the COVID Tracking Project posts positive, negative, and pending test results, as well as hospitalizations and deaths for each state in real time.

"The public deserves the most complete data available about COVID-19 in the US," reads the CTP website. "No official source is providing it, so we are."

The CTP also includes racial and demographic data broken down by state, and includes rates of hospitalization and intubation, which the CDC's tracker does not.

"It would have been incredibly important for CDC to have been front and center early on to have accurate reporting in cases from all the labs," Tsai said. "The CDC missed its window to be able to have that position of authority on the data and people are looking for other sources."

Politics at play

The CDC continues to provide guidance to the public about reducing coronavirus transmissions. But the White House and the Department of Health and Human Services, the CDC's parent agency, have different considerations for what data is disseminated and how best to inform Americans about the virus.

"It's really important to keep in mind that data are political," Ompad said. "We measure what we care about and what gets released is not always under the control of the CDC."

"Sometimes reports are changed or delayed and that's because the CDC is not autonomous," she added.

President Donald Trump and the White House Coronavirus Task Force have urged the CDC to revise how it counts COVID-19 fatalities, for example. They've suggested the agency remove individuals presumed to be positive without a lab test and those who had the virus but may have died of another cause, the Daily Beast reported.

"Trump thinks he benefits from underreporting," Vinetz said. "He wants everything to be hunky-dory so everyone can go back to work."

The consequences of bad data

According to a report Thursday in the Journal of the American Medical Association, incomplete data means COVID fatalities are likely underrepresented. People who died at home are not being reliably counted, the report indicated, nor are those who had symptoms but not a positive test result.

That lack of accurate data means both crucial resources may not be allocated and local authorities may reopen an area too soon. Health experts also worry it undermine Americans' faith in the government during the pandemic.

"There's been an erosion of the public trust in these policies and the only way forward to regain that trust is to rely on the data," Tsai said. "We know the patchwork response hasn't worked for the last several months and we can't keep just playing whack-a-mole with this going forward."