Internal Documents Reveal COVID-19 Hospitalization Data The Government Keeps Hidden

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The ICU at Tampa General Hospital in Tampa, Fla., was 99% full this week, according to an internal report produced by the federal government. It’s among numerous hospitals the report highlighted with ICUs filled to over 90% capacity.

Michael S. Williamson/The Washington Post via Getty

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Michael S. Williamson/The Washington Post via Getty

A page from a report shared internally to HHS staffers presents hospital data from Oct. 27, including a list of cities where hospital and ICU beds are filling up.

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For instance, the most recent report obtained by NPR, dated Oct 27, lists cities where hospitals are filling up, including the metro areas of Atlanta, Minneapolis and Baltimore, where in-patient hospital beds are over 80% full. It also lists specific hospitals reaching max capacity, including facilities in Tampa, Birmingham and New York that are at over 95% ICU capacity and at risk of running out of intensive care beds.

In reviewing the analysis obtained by NPR, Panchadsaram says the local and hospital-level data HHS is collecting would be very useful to researchers and health leaders. «That stuff isn’t easy to find at a national level,» he says, «There’s no one place [publicly] you can go to get all that data.»

Hospitalization data is invaluable in looking ahead to see where and when outbreaks are getting worse, says Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington: «Right now, as we head into the fall and winter surge, we’re trying to put more emphasis on predicting where systems will be overwhelmed.»

But what’s missing for this kind of planning, he says, is «exactly the information» that appears in the internal report.

NPR has reviewed several of these reports generated in the past month. They present trends in hospital utilization, including increases in ventilator usage, along with a growing number of inpatient and ICU beds being occupied by COVID-19 patients. The October 27th report showed that all three measures have increased by 14%-16% in the past month.

Around 24% of U.S. hospitals are using more than 80% of their ICU capacity, based on reporting from nearly 5,000 «priority facilities,» and more hospitals have joined their ranks in recent weeks.

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A page from a report shared internally to HHS staffers shows the rising percentage of hospital ICUs that are at or above 80% capacity. It reflects data as of Oct. 27.

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A page from a report shared internally to HHS staffers shows a list of health care facilities where beds are filling up, reflecting data as of Oct. 27.

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A page from a report shared internally to HHS staffers shows a list of health care facilities where beds are filling up, reflecting data as of Oct. 27.

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A controversial data switch

Experts who reviewed the internal documents for NPR say that even for the limited group of federal employees who get them, the daily reports are not as useful as they could be.

«We’re so focused on counting things but not contextualizing them,» explains McPheeters. A community hospital might become overwhelmed at a different point than a big academic hospital, and without that context, she says, it’s impossible to tell: «Is 75% [full] a good thing or is 75% a bad thing?»

Health data experts NPR consulted had ideas on how to improve the analysis. For instance, Panchadsaram suggested that some of the county-level charts, currently presented as raw numbers, would be more useful if analyzed per capita. «You really need to adjust it to the number of people [in an area] to get a sense of where things are being overwhelmed,» he says.

And the quality of the underlying data is a concern. Health experts say the data quality was compromised by a controversial shift in data collection from CDC to HHS in July, and that the issues with data quality have not been fully resolved.

Hospitals have had to adjust to onerous new reporting requirements, and the hospital data is no longer checked and analyzed by seasoned epidemiologists and other experts at CDC.

The daily trend documents circulated at HHS include this disclaimer: «This analysis depends on the data reported by hospitals. To the extent that the data is missing or inaccurate, this analysis will also reflect those issues.»

According to HHS data posted on Monday, just 62% of the nation’s hospitals reported all the required information last week.

But greater transparency, even of incomplete data, can be invaluable in a crisis, experts say.

HHS told NPR that since it took over collecting hospital capacity data, it has «consistently displayed state-level hospitalization data to help inform the public about COVID-19 prevalence in their communities.»

But public health experts say the state level data isn’t detailed enough — and since the government is putting the effort into generating more granular daily analyses, it should share them.

«Even though they’re collecting all these things and putting so much effort behind it, it gets blocked when it tries to get out of the door,» Panchadsaram says.

• COVID-19 hospitalizations
• COVID-19 data
• coronavirus in the U.S.