Sept. 22, 2020 -- Unlike countries like Germany, Senegal, South Korea, and Uganda, the United States lacks a national strategy for reporting COVID-19 data.
While all 50 states and the District of Columbia have COVID-19 data dashboards, the data reported is inconsistent, incomplete, and inaccessible in most locations, a report from Resolve to Save Lives concludes.
“It’s quite clear that dashboards vary across the states and municipalities, which makes them hard to compare and get a comprehensive understanding of what’s happening across the U.S.,” says Yonatan Grad, PhD, an assistant professor of immunology and infectious diseases the Harvard T.H. Chan School of Public Health in Boston.
n addition, states are not reporting key information needed to track and control COVID-19, especially testing and contact tracing.
Across the country, only 40% of essential data points are being monitored and reported publicly, leaving major gaps in “strategic intelligence that leaders need to turn the tide against COVID-19,” according to the report “Tracking COVID-19 in the United States: From Information Catastrophe to Empowered Communities.”
“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,” Tom Frieden, MD, former CDC director and president and CEO of Resolve to Save Lives, says in a news release. Several public health leaders, including the president of the American Public Health Association, support the recommendations.
The report recommends that all state dashboards use 15 essential metrics and prioritize the first nine, including new cases by date, new tests done, percent of positive tests, PCR diagnostic test turnaround time, daily hospitalizations, health care worker infections, and syndromic data, which represents people who seek health care due to symptoms before they are diagnosed with a disease.
This fall, influenza and COVID-19 will spread at the same time. Respiratory symptoms in both diseases, like cough and high fever, overlap, so “it’s hard to discriminate between the two viruses without tracking symptoms and testing for both,” says Grad.
A distinction is that COVID-19 symptoms include shortness of breath, a hard time breathing, and unusual symptoms like loss of smell or taste.
Currently, only 18% of states report data on influenza-like illness as part of their COVID-19 dashboard, and only 37% report data on COVID-like illness, according to the report.
Resolve to Save Lives recommends that all states report both illnesses as trends on their dashboards.
“Having this data may also help health care providers and institutions develop and tailor responses such as directing influenza vaccine, treatments, and supplies to where they are needed,” says Grad.
Group Settings Overlooked
One-third of states do not report any dashboard data on outbreaks in group settings such as nursing homes, homeless shelters, and correctional facilities. In addition, high-risk essential workplaces remain overlooked in many areas, such as meatpacking plants, which are known to be hot spots for spreading COVID-19, according to the report.
“A large number of cases have come from nursing homes, and superspreader events have occurred in meatpacking plants. It’s important to collect data on these vulnerable populations if the goal is to prevent outbreaks,” says Grad.
Poor Reporting on Contact Tracing
Only two states reported data on how quickly contact tracers interview people testing positive to learn about their potential contacts. Just eight states report data on the source of exposure for people who test positive. This is important because cases coming from an unknown exposure signal a much higher risk from undetected community transmission, according to the report.
States should use metrics that address cases with and without known exposure, how fast contacts are obtained, and the percentage of new cases arising from among quarantined contacts.
“Case identification, contact tracing, and quarantine/isolation are key components of a pandemic response. You want to measure how well you’re doing to know if there are deficiencies and how you can improve them,” says Grad.
Age, Race, Ethnicity, Location
The recommended essential indicators would significantly increase the information available on disparities in COVID-19 cases, deaths, and the quality of the government response for different ages, races, ethnicities, and locations, according to the report.
“This virus is affecting different racial groups in different ways. Having more data enables you to know which groups are at greatest risk and tailor messages and design targeted programs or treatments,” says Amesh Adalja, MD, a senior scholar at the Johns Hopkins University Center for Health Security in Baltimore.
Resolve to Save Lives recognizes that putting these metrics into practice will be a challenge for health departments, requiring technical changes in the current data systems, more money, and more staff.
“This is where we need to invest to achieve an informed comprehensive and effective response strategy. Our public health institutions are chronically underfunded -- we need to reverse course quickly and understand that our investment now in measuring and understanding the effectiveness of our responses is critical to our emerging from the pandemic,” says Grad.