Recently, the Government Accountability Organization (GAO) released a report detailing the federal government’s response to the COVID-19 pandemic. This recent report follows a June 2020 Report and details federal spending in response to the pandemic, metrics to monitor public health and the economy, and the status of recommendations from the June 2020 report.
The report notes that of the $2.6 trillion in appropriated relief funds, $1.5 trillion had been obligated and $1.3 trillion expended. Payments for providers related to COVID-19 through the Public Health and Social Services Emergency Fund (also known as Provider Relief Fund) reached $92.4 billion by July 31, 2020. GAO continues to monitor the quality of spending data available and has previously made recommendations to improve the quality of publicly available data.
Monitoring Systems
In the June 2020 Report, GAO identified four indicators to monitor the health care system and public health including: the positivity rate for COVID-19 testing, contract tracing performance, the proportion of intensive care unit beds available, and the number of higher than expected deaths from all causes. In this August report, GAO further evaluates how each of these metrics can be used to determine the effectiveness of COVID-19 emergency responses.
Positivity Rate
In the June report, GAO determined that the testing data reported by the CDC did not provide “sufficiently reliable information” on the COVID-19 testing occurring over time because the data was incomplete and inconsistent. Going forward, GAO noted that it plans to work with the National Academies to establish an approach for monitoring the positivity rate, such as an appropriate way to geographically define the positivity rate (i.e., by nation, state, county, etc.).
Contact Tracing Performance
In June and July 2020, several organizations recommended that governments track performance indicators for contact tracing to help them assess the effectiveness of their contact tracing programs and overall progress in reducing the transmission of COVID-19. CDC has provided funds to help state and local health departments expand their contact tracing capacity, which may include hiring additional contact tracers. CDC also awarded funds to the CDC Foundation to hire and place public health professionals (including contact tracers) in state, local, territorial, and tribal health departments. According to GAO, as of July 30, 2020, the CDC Foundation had hired and placed about 300 such professionals, of which more than half were contact tracers.
ICU Beds Available
Because several states reported record increases in the number of new COVID-19 cases in July 2020, and flu cases are likely to increase in the next few months, the proportion of staffed ICU beds remains an important indicator to monitor. While CDC and other organizations have given guidance to help inform response decisions at different levels of government they differed in whether to recommend a threshold. For example, CDC recommends state and local jurisdictions monitor the indicator based on a threshold of 70% ICU bed occupancy while Johns Hopkins Bloomberg School of Public Health recommended that cities monitor the indicator by ZIP code but did not specify a threshold.
On July 15, 2020, HHS revised its guidance for hospitals to report COVID-19 data—including ICU bed availability—in an effort to help coordinate federal reporting and ensure flexibility in data collection. Now, hospitals are to report these data directly to HHS through TeleTracking, or states may submit these data on behalf of hospitals to HHS Protect. HHS expects this change to help them more quickly update the data it collects.
Higher Than Expected Deaths
As noted in the June GAO report, the number of deaths from all causes during the pandemic compared to historical counts provides a potential indicator of the impact of deaths from COVID-19, as well as the pandemic’s broad effect on deaths from other causes, as the full effect of COVID-19 goes beyond just those infected with the disease. Between January 1, 2020, and June 13, 2020, about 125,000 more deaths occurred from all causes than would normally be expected, according to data from CDC’s National Center for Health Statistics.
Economic Recovery
The GAO report also details the status of US economic recovery. While there have been economic gains in June and July, up from record lows in May, the United States economy remains far weaker than it was prior to the pandemic. Unemployment levels have declined in recent months, but the GAO states that new COVID-19 outbreaks in certain states may threaten economic progress.