This is a time when the American public hangs on every official word about Ebola. And it’s a time when American’s are extremely sensitive and anxious about full transparency. Given this, it’s hard to understand why the CDC’s latest weekly infectious report may be missing vital Ebola data that the public already knows about.
The Morbidity and Mortality Weekly Report, or MMWR, is the Centers for Disease Control’s premiere journal for reporting and tracking infectious diseases in the United States.
The MMWR was the first journal that alerted physicians nationwide to HIV. According to the career healthcare professional who brought the MMWR to our attention here, doctors, nurses and hospitals use the report to pick out trends in infectious diseases and take appropriate measures against them. The MMWR is also used to justify expenses for specific areas in healthcare funding.
“Mistakes in reporting rob healthcare professionals of information that may be vital for making good decisions,” the health care profession said.
The criteria the CDC has published for authors of the MMWR establishes that this is the case. Authors are reminded that the “MMWR Weekly publishes information useful to readers in the public health community, private clinicians, researchers, teachers and students, and the news media. Reports are based in science (especially epidemiology) or on public health policy or practice.”
We will not identify the healthcare professional or where the person works, but I have verified their identity and place of employment, as a manager on the funding side of healthcare, and positioned to have extensive knowledge of the CDC MMWR and how it is used.
The MMWR for the week ending October 4, 2014, is out, and may be found here. The important sections for this story are Table I and Table III.
Table Table I makes no mention of the Ebola case in Dallas, despite the fact that it was confirmed on September 30, 2014 — well within the week that this MMWR covers.
Yet the column covering such diseases for the week ending October 4, 2014, is empty of any diagnoses. Here is a screenshot of the relevant section of that chart. Click to enlarge.
As is readily apparent, the chart gives granular data for cases of reportable diseases, and breaks those numbers out by state in the column on the right-hand side. According to the healthcare professional who alerted us, Ebola should be listed in the “Viral hemorrhagic fever” column. If it was listed, then the chart would also show one case in Texas, over on the right. That would have been Thomas Eric Duncan, the Liberian man who died this week of Ebola.
His case is not listed, and the table’s footnote explicitly states:
There were no cases of viral hemorrhagic fever reported during the current week. See Table II for dengue hemorrhagic fever.
The other four recent cases of Ebola, which involve Americans who were diagnosed outside the United States but were brought into the U.S. for treatment, would not appear in the MMWR chart because they were diagnosed overseas. And they do not. The Duncan case is our focus.
Duncan’s case also should not appear in Table III, which lists deaths from reportable diseases. Duncan died on October 8, four days past October 4, which is the last day in the reporting period covered by this MMWR. Duncan’s case does not appear on Table III, as we should expect. His death ought to appear in next week’s MMWR, on Table III.
So back to Table I.
The CDC compiles the MMWR from local reports of diseases. Typically, the county where a disease case occurs will report to the CDC, and the CDC will add up the counties’ reports to compile its national report.
After Thomas Eric Duncan tested positive for Ebola on September 30, Dallas County issued a Health Advisory. Therefore the county in all likelihood did report Duncan’s case. The advisory notes that the county is working with the CDC. But Duncan’s case is nowhere to be found on Table I of the MMWR.
That’s the question that I posed to our healthcare professional. Are we looking at error, or malice? After all, the whole world knows about the Duncan case, as it is the first case of an Ebola diagnosis in the United States.
The heathcare professional ruled out malice, characterizing it as a “strong word that I do not think currently fits this specific incident.” Error appears to be the cause. And that’s worrying.
“While I think there is a possibility that this incident was due to possible political factors, that is not what is important,” the professional said in email. “What is important is that a significant oversight has occurred at the CDC. If the ‘premiere journal’ has made such an oversight, what does it say about the agency’s practices? What does it say about its staff?”
Indeed. The healthcare professional highlighted previous cases in which the CDC has exhibited disturbing sloppiness.
“With the anthrax exposure accident, the inability to keep track of the smallpox samples it loans to other government organizations, and this incident, Americans have a right to question the competency of the CDC’s leadership along with the ability of the CDC to handle the Ebola crises in the most effective manner. This incident, among the aforementioned, may cause more Americans to question the CDC, the Obama appointed director, and in turn the administration itself.”
The Centers for Disease Control is America’s front-line defense against infectious disease such as Ebola. Its omission of the Duncan case in the MMWR is not likely to have any long-term effect, according to the healthcare professional.
“It’s not a catastrophic mistake, but for what the CDC bills as the ‘CDC’s premiere journal’ it is a concerning one that raises questions about the competency of those in charge of publishing it.”
The professional added that once this error is brought to light, finger-pointing and the blame game are likely to commence.