As criticism of the Trump administration’s response to the coronavirus pandemic intensifies, a former director of the Centers for Disease Control and Prevention on Tuesday called on state health officials to start reporting coronavirus data in a detailed and uniform fashion, rather than the disorganized hodgepodge most states now produce.
Other public health experts said that such guidelines were long overdue and that the agency’s current director, Dr. Robert Redfield, should have mandated them months ago.
The lack of clear C.D.C. guidance — even on simple issues like data collection — was an example of the administration’s ineptitude and ineffective leadership in the face of a growing crisis, experts said.
“We have a real vacuum of leadership at the national level,” said Dr. Thomas R. Frieden, the former C.D.C. director, who now runs Resolve to Save Lives, a nonprofit health advocacy initiative.
“Absent a national strategy, our best hope is to get all 50 states on the same page, so we know where we are,” he said.
Dr. Frieden’s organization concluded that states are reporting only 40 percent of the data needed to fight the pandemic. Some states disclose less useful information than the government of Uganda, which Resolve to Save Lives also advises on its coronavirus response, he said.
The report laid out 15 indicators that every state should report daily on a public “dashboard” that anyone can view.
They included not just basic elements like cases, hospitalizations and deaths, but sophisticated metrics such as what percentage of infections came from clusters of people who know one another, how many health care workers get infected on the job, how long it takes to get a diagnostic test result, and what percentage of any city’s or county’s residents are wearing masks.
Dr. Frieden also suggested tracking how many people in any city are hospitalized with coronavirus or flu symptoms, regardless of test results. Where legally possible, he said, states should name institutions with major outbreaks, including nursing homes, prisons, schools or meatpacking plants.
Leading public health experts asked why the C.D.C. itself had not been requiring such data from states. Dr. Irwin E. Redlener, founding director of Columbia University’s National Center for Disaster Preparedness, said it was “pathetic” that a private organization had to propose data standards and recruit states to voluntarily agree.
“The feds should have been demanding exactly this kind of standardized information from every state and territory since March,” he said. “This is another illustration of the failures of the federal government — Trump was explicit in telling governors that they were on their own.”
Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, who helped design the data dashboard used by New York State and cited by Gov. Andrew M. Cuomo during his news conferences, said Dr. Frieden’s proposal was “something we need in our tool kit that’s been absent.”
Dr. Osterholm worried that both spread of the virus and progress against it were not being adequately measured. “Without standards, how do you know whether you’re failing or succeeding?” Dr. Osterholm said. “Without them, you can’t hold anyone’s feet to the fire. This is something the C.D.C. should have done.”
Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases and the senior scientist on the White House Coronavirus Task Force, agreed that Dr. Frieden’s initiative was an important effort.
Asked for comment, a spokesman for the C.D.C., Tom Skinner, said the agency “was always looking at best practices” and had made plans with the states to track 14 of the 15 indicators cited in Dr. Frieden’s report.
The exception was the percentage of people correctly wearing masks in public, since it was unclear how that could be done, Mr. Skinner said. (Dr. Frieden’s report suggested doing street counts or viewing security camera footage.)
When the data are gathered, they will be posted on the C.D.C.’s Covid Tracker website, Mr. Skinner said. The Health and Human Services Department recently suggested that coronavirus data from hospitals would be sent to Washington first, not the C.D.C., as has long been done.
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- The coronavirus clings to wetness and enters and exits the body through any wet tissue (your mouth, your eyes, the inside of your nose). That’s why people are wearing masks and eyeshields: they’re like an umbrella for your body: They keep your droplets in and other people’s droplets out. But masks only work if you are wearing them properly. The mask should cover your face from the bridge of your nose to under your chin, and should stretch almost to your ears. Be sure there are no gaps — that sort of defeats the purpose, no?
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Last week, discussing whether his proposed metrics would be adopted by the states, Dr. Frieden said he had consulted with the National Governors Association and several governors had said they would soon adopt his guidelines. “We’re hoping peer pressure will bring along the others,” he added.
The lack of uniform metrics has contributed to the country’s failing response to the pandemic, Dr. Frieden said.
“It’s impossible to exaggerate how much of an outlier the U.S. is on reporting data,” he said. “Hong Kong can have 67 cases and think it’s a serious situation. We can have 67,000 cases and there’s a debate about whether it’s serious.”
No state now reports all the data that are needed, but some are better than others. Dr. Frieden singled out Minnesota and Arizona as the overall leaders, while Oregon and Virginia, he said, were doing best at reporting one metric crucial to slowing the spread: contact tracing.
Asian and European countries rely heavily on tracing and testing all contacts of each known case. In most states in this country, caseloads are increasing so fast that tracing dozens of contacts of each patient has become impossible.
Information about contact tracing is generally “abysmal,” Dr. Frieden said. “Uganda does better at tracing and contacting people in quarantine and reporting it.”
Dr. William Schaffner, a preventive medicine specialist at Vanderbilt University’s medical school, welcomed Dr. Frieden’s proposed standards but said few states had the expertise and money needed to generate and analyze the data.
“This is the Platonic ideal for how state health departments should function, but it’s some distance from the way they can function,” he said. After two decades of budget cuts, “they are strapped in personnel and technology.”
Hospitals also find it hard to report data during crises, he added.