The Centers for Disease Control and Prevention is using outdated and unreliable data on coronavirus breakthrough infections to help make major decisions, such as who gets booster shots, according to three officials with direct knowledge of the situation.
The agency originally tried to track all infections in vaccinated people, from mild to severe. But in May it decided to focus on the most severe cases, saying that would allow it to better monitor overall conditions and make more informed, targeted policy decisions.
Forty-nine states are now regularly sending CDC information on hospitalized breakthrough patients. But more than a dozen told POLITICO that they do not have the capacity to match patients’ hospital admission data with their immunization records. Instead, those states rely on hospital administrators to report breakthrough infections. The resulting data is often aggregated, inaccurate and omits critical details for teasing out trends, such as which vaccine a person received and whether they have been fully vaccinated, a dozen state officials said.
The gaps in this crucial data stream raise questions about the Biden administration’s ability to spot and respond to changes in the virus’s behavior — such as the rapid spread of the Delta variant, which crowded out other strains — or vaccines’ performance. It also underscores the extent to which the CDC and public health departments across the country are still struggling to collect and study critical Covid-19 information 18 months after the pandemic began.
“I think it would be really challenging [for the CDC] to interpret the results or to interpret the data when you have only some jurisdictions reporting [breakthrough infections],” said Theresa Sokol, lead epidemiologist for Louisiana’s state public health department, which is working closely with the CDC on studies of breakthrough infections. “I know that there are some jurisdictions that don’t even have access to their vaccination data. They don’t have the authority or their permission.”
Many of the hurdles facing CDC and state officials trying to gather data during the age of the Delta variant are the result of the patchwork of public-health agency data systems, many of which cannot communicate with each other. For more than a decade, states have pleaded with the federal government for money to make it easier to gather and study disease trends electronically. The pandemic has overloaded those arcane systems, revealing the disorganized nature of public health reporting and case investigation.
The CDC has allocated tens of millions of dollars this year to help states address their data woes, but federal and state officials said it will take years for the U.S. to rebuild its public-health infrastructure.
In the meantime, the years-long neglect is hampering state and federal officials yet again as they attempt to contain the Delta variant. Already this summer it has caused new infections and hospitalizations to spike in the South and Midwest. It is now starting to batter the Northwest, including in Oregon and Washington where case rates are rising.
“Nothing has changed since the pandemic began,” one senior Biden health official said. “We’re still dealing with this patchwork system — and it continues to fail us.”
Of particular concern for health officials now is how rapidly the Delta variant spreads, whether it is reducing the effectiveness of vaccines and whether it causes more severe disease.
A senior CDC official told POLITICO the state health department reporting system is one of several tools the agency uses to analyze breakthrough infections. The CDC receives hospitalization data in several other ways, including from established networks that draw from specific health care facilities. It is conducting targeted studies on vaccine efficacy among frontline health care workers as well as residents of New York and Los Angeles, releasing its second slate of findings on Tuesday.
But the majority of the data on breakthrough infections is coming through state health departments via hospitals. Every week or two, the CDC updates its statistics on breakthrough infections and deaths among those who have been hospitalized.
State health officials said when they are able to study the data hospitals report to them, they often find errors such as individuals with the wrong gender or age as well as missing information about vaccination status, including what type of shot the individual received and whether they have been fully vaccinated. There is also a significant lag — sometimes more than two weeks — in reporting from states to the CDC because the hospital electronic systems do not automatically track breakthrough infections. Physicians must 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 examine all of their breakthrough infections, including mild cases that don’t send people to the hospital. The states participating in this smaller study have the ability to match lab reports with immunization records, but they don’t maintain their own databases of hospitalization data. They collect that information from hospitals and pass it on to the CDC.
“We report what we have, but we know that it’s limited because it’s based on a direct report from a provider — as opposed to taking a data set of all hospitalizations and matching that against our vaccine registry,” said Sokol, the Louisiana epidemiologist. “We’re not able to do that for hospitalization. We rely on individual reports from hospitals. And some report well, others do not. So we know that it’s not complete.”
State health officials say their comprehensive data on breakthrough infections suggests the rate of these cases in their jurisdictions is greater than the hospitalization counts show. And the number of new infections continue to rise.
As of last week, the CDC said it had received reports of 9,716 patients with breakthrough infections who were hospitalized or had died. In Louisiana, where cases are still surging, health officials had counted 14,650 breakthrough infections as of last week. That’s up 4,700 from the week before — the biggest one week jump since Louisiana began tracking breakthrough infections, Sokol said.
Louisiana is participating in the CDC’s smaller state study on all types of breakthrough infections. But Sokol said her department does not have reliable data that would allow her to estimate what percentage of all of the breakthrough infections have led to hospitalization.
The state is able, however, to dedicate staff members to matching immunization records with Covid-19 lab reports at a time when dozens of health departments across the country are struggling to keep up with case investigations.
Karen Landers, an adviser to Alabama’s health department, said the state is attempting to track all breakthrough infections regardless of hospitalization status. But the task is too overwhelming some weeks. Health officials have also been bogged down trying to convince people to get vaccinated, processing lab reports or ensuring there is enough ICU space for children in the state’s hospitals.
And in Wyoming, local health officials said it is unclear whether the state health department has enough staff to track breakthrough infections beyond the updates sent in by hospitals.
The CDC’s fight to improve data on breakthrough infections comes as the agency is under fire from senior Biden officials and outside health experts for endorsing boosters shots for all adults. Critics argue that the data CDC has released to date on breakthrough infections, including a cohort study that revealed New York residents’ waning immunity to the vaccine, is not definitive enough to justify boosters. Many say that the U.S. government should instead donate more doses overseas, to help bring the pandemic to and end, before it doles out boosters to Americans.
The CDC has said for weeks that it had undisclosed data on breakthrough infections that supports the booster decision. It released one study focusing on frontline health care workers Tuesday showing that Covid-19 vaccines provide strong protection against hospitalization and death, but their effectiveness in preventing infection at all is waning. One analysis examined vaccine efficacy among frontline health care workers; the other tracked efficacy among residents of Los Angeles.
White House officials have increasingly grown frustrated with the CDC over its tendency to not share data at a time when the administration is making major pandemic policy decisions on everything from masks to school reopening, two other senior Biden officials working on the federal government’s Covid-19 response told POLITICO.
“We don’t have a clear understanding of what the data actually says about the Delta variant, transmission and boosters,” one of those officials said.
CDC officials argue they are collecting the best data they can on a range of topics involving the current state of Covid-19, and that the current data gaps at the state level and within hospitals are limiting their ability to assess the national picture clearly.
“These issues are not going to get magically fixed overnight,” one CDC official said.