Prevent Epidemics • July 21, 2020
Dr. Tom Frieden joins APHA President Dr. Georges Benjamin and other public health leaders in recommending essential information to track in order to control COVID-19
July 21, 2020 (New York) – After five months of attempting to control COVID-19, the United States has emerged as one the worst-performing countries in the world, with one in four of all global COVID deaths occurring in the US and a death rate that is among the world’s worst. Today, Dr. Tom Frieden, former CDC Director and President and CEO of Resolve to Save Lives, an initiative of the global health organization Vital Strategies, joined public health leaders to release the first-ever comprehensive review of the status of COVID-19 information in the United States and outlined how states and communities can increase transparency about risk of COVID-19 and accountability for progress.
The report found critical gaps in the availability of information necessary to track and control COVID-19: across the 50 states, only 40% of essential data points are being monitored and reported publicly. More than half the essential information—strategic intelligence that leaders need to turn the tide against COVID-19—is not reported at all.
“Despite good work done in many states on the challenging task of collecting, analyzing, and presenting crucial information, the United States is flying blind in our effort to curb the spread of COVID-19. By revamping our approach and using data to empower people to know their own risk and ensure accountability for decreasing that risk by improving our response, we can get our kids back to school, ourselves back to work, accelerate economic recovery, and save tens of thousands of lives,” Dr. Frieden said at a press briefing today. “The lack of common standards, definitions, and accountability reflects the absence of national strategy, plan, leadership, communication, or organization and results in a cacophony of confusing data. By tracking essential metrics publicly in all states, we can build the transparency and accountability essential to make progress.”
“Tracking COVID-19 in the United States: From Information Catastrophe to Empowered Communities,” reviews state-level COVID-19 data dashboards for all 50 U.S. States, the District of Columbia and Puerto Rico, and draws on best practices to define a set of 15 essential indicators that would dramatically improve the ability of people in the United States to understand both their own risk and how well each state and county is doing to reduce that risk.
These essential indicators include: confirmed and probable cases; percentage of new cases linked to known cases; new PCR tests per capita; percentage of positive tests; influenza-like illness and COVID-like illness presenting to emergency departments; per capita COVID-19 hospitalization rates; percentage of hospital beds occupied by COVID-19 patients; indicators on outbreaks in congregate facilities and essential workplaces; health care worker infections; testing and contact tracing performance indicators (including test turnaround time, cases with and without a known source of exposure, timeliness of contact elicitation, and percentage of new cases which arise from among quarantined contacts); and percentage of people wearing masks correctly in public indoor settings. Of these, nine indicators should be able to be reported now by all states, and the other six should be able to be reported within several weeks.
The essential indicators would significantly increase the information available on disparities in COVID-19 cases, deaths, and the quality of the governmental response for different ages, races, ethnicities, and locations.
“Public health officials in states and communities across the country are working hard, but in a vacuum with little guidance,” said Dr. Cyrus Shahpar, the Director of Prevent Epidemics at Resolve to Save Lives. “What gets measured gets managed, and we found that media and others are paying entirely too much attention to less important data. Our recommended indicators for states and counties will help ensure that more attention is paid to the most important data and that our knowledge is turned into action. It is about knowing our risk and improving our response.”
“Controlling the COVID-19 pandemic requires a uniform science-based and data-driven approach to disease tracking and reporting that is lacking to date. These indicators provide public health and medical practitioners, policy makers and community leaders evidenced-based targets to aid decision making,” said Georges C. Benjamin, MD, Executive Director of the American Public Health Association. “Now is the time for all of us to come together in a data-driven way to collectively and uniformly control the outbreak so we can realize a shared goal to reopen our nation as safely as possible.”
“Credible, real-time data are essential to any public health response,” said Dr. Caitlin Rivers, Senior Scholar at the Johns Hopkins Center for Health Security. “Implementing these indicators will not only give individuals the information they need to make decisions, but will improve the state and national response to COVID-19.”
Overall, data are inconsistent, incomplete, and inaccessible, making it impossible to understand risk and focus on important core components of the response. For 11 of the 15 essential indicators, not a single state was reporting according to best-practice criteria, and for 9 of 15 essential indicators, more than half of states were not reporting at all. No state reached even half an optimal score, and half of states scored 20% or below compared with optimal reporting.
The U.S. is missing crucial opportunities to find and stop COVID-19. Currently, only 18% of states are reporting on flu-like illnesses on their COVID-19 dashboard (despite widespread collection of this information) and only 37% of states are reporting COVID-like illnesses—both important early signals of potential COVID-19 spread.
Nursing homes and high-risk essential workplaces remain overlooked in many areas. One third of states do not report any data on outbreaks in congregate facilities (e.g., nursing homes, homeless shelters, correctional facilities) or workplaces such as meatpacking plants, known to be hotspots for spread. This leaves communities without the information necessary to protect these vulnerable populations and can skew understanding of risk in the broader community.
Incomplete demographic information obscures the extent of unequal COVID-19 burden. Most states report proportions of total cases and deaths among different racial and ethnic groups, but disparate access to testing, hospitalization rates, and other factors remain unreported, making the development of effective measures to protect those most at risk more difficult. Few states provide demographic information on recent cases and deaths, with the result that trends in race/ethnicity and other factors are not readily apparent (cumulative reporting, which many states provide, does not enable reporting of this crucial trend).
Information shared on contact tracing is abysmal. Not a single state reported on turnaround time of tests, a crucial indicator of program effectiveness. Only two states reported data on how quickly contact tracers were able to interview people testing positive to learn about their potential contacts. Just eight states reported data on source of exposure for people who test positive; cases coming from unknown exposure signal much higher risk from undetected community transmission. And not a single state reports on the percentage of cases arising among people that are under quarantine after being notified of their potential exposure by a contact tracer—the single most important indicator of the effectiveness of contact tracing.
The report from Resolve to Save Lives recommends that all states update their COVID-19 data portals to meet basic minimum standards and includes a sample best-practice dashboard.
States should also follow basic best practices for data sharing including:
- Reporting data the same day it is collected to inform timely risk assessment and action
- Linking to county data dashboards so the public can easily see what is happening in their county and neighboring counties, ideally with zip-code look-up
- Enabling download of data.
The list of essential indicators were reviewed and endorsed by leading public health organizations, including The Johns Hopkins Center for Health Security, the American Public Health Association, Trust for America’s Health, The Association of Schools and Programs of Public Health, and the Big Cities Health Coalition.
Christina Honeysett, Vital Strategies: email@example.com; +1.914.424.3356
Erin Sykes, Resolve to Save Lives: firstname.lastname@example.org; +1.646.612.0001
About Dr. Tom Frieden
Dr. Tom Frieden is former director of the US Centers for Disease Control and Prevention and former commissioner of the New York City Health Department. He is currently president and CEO of Resolve to Save Lives, a global health initiative. Resolve is part of Vital Strategies, and works with countries to prevent 100 million deaths and to make the world safer from epidemics. Follow Dr. Frieden on Twitter @DrTomFrieden.
About Resolve to Save Lives
Resolve to Save Lives, an initiative of Vital Strategies, aims to prevent at least 100 million deaths from cardiovascular disease and epidemics. Through its Prevent Epidemics program, Resolve to Save Lives has rapidly leveraged existing networks to partner with countries throughout Africa and beyond to combat COVID-19. Resolve is led by Dr. Tom Frieden, former director of the U.S. Centers for Disease Control and Prevention, and is part of the global health organization Vital Strategies. To find out more visit: https://www.resolvetosavelives.org or Twitter @ResolveTSL.
Resolve to Save Lives created a website called PreventEpidemics.org that shows how prepared each country is for an epidemic, including COVID-19, and how many flights are coming and going from infected countries. This site is also a resource for current coronavirus statistics and resources.
About Vital Strategies
Vital Strategies is a global health organization that believes every person should be protected by a strong public health system. We work with governments and civil society in 73 countries to design and implement evidence-based strategies that tackle their most pressing public health problems. Our goal is to see governments adopt promising interventions at scale as rapidly as possible. To find out more, please visit www.vitalstrategies.org or Twitter @VitalStrat.
About The American Public Health Association
APHA champions the health of all people and all communities. We strengthen the public health profession. We speak out for public health issues and policies backed by science. We are the only organization that combines a nearly 150-year perspective, a broad-based member community and the ability to influence federal policy to improve the public’s health. Visit us at www.apha.org.