Ali Mokdad, an epidemiologist at the University of Washington, tried to make sense of this summer’s increase in COVID-19. He says he can broadly theorize about why the virus has spread and what to do.
“Yes, the new instances seem to be more commonly young,” he said. “Yes, they would possibly be reducing their guard. Yes, it would possibly be wise to close the bars.”
But as an expert in global fitness at the university’s Institute of Health Measurement and Assessment, he says he can provide much more nuanced responses.
“Why can’t we sense what contributed to the recent spread? It’s very simple,” Mokdad said. “No to the data”.
In a noted move that potentially hinders access to even more information about COVID-19, the Trump administration last month ordered hospitals to avoid sending knowledge to the Centers for Disease Control and Prevention and send it to a personal knowledge company contracted with the Department of Health and Human Services, whose secretary reports directly to the White House.
Cases of ups and downs, clashes between federal leaders, and a mix of state knowledge have led many Americans to wonder how America will return to something resembling a general life.
The answer is simple, Mokdad and other epidemiologists say: dressed in masks, social estrangement, more tests and greater data.
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Epidemiologists insist that the standardization of COVID-19 knowledge published across states and localities is imperative to help others navigate their lives and allow political leaders to make science-based decisions that the public can support.
It’s particularly critical now, they say, as parents, teachers and elected officials are deciding when to open schools and how to keep them open.
“This virus is not going to go away,” said Dr. William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University School of Medicine. “COVID will be there in 3 years one way or another. We hope to get a vaccine soon. But even when we do, other people will want to know to see the effect of vaccines.”
State and local fitness officials say that offering greater knowledge is that simple. The meager budgets, large generation, and disjointed state and local reporting systems make standardization of knowledge an arduous task.
“It’s a smart idea,” said Oscar Alleyne, head of systems and the National Association of County and City Health Officials. “But this is not the highest sensible precedence in the maximum jurisdictions at this time.
“Local fitness facilities are focusing on what’s in front of them, and that’s the knowledge they want about opening schools without getting caught up in a whirlwind of developing diseases.”
Still, epidemiologists point out that every other developed country battling the virus has been able to publish the kind of data average people and scientists need to track the course of the disease each day and pivot their individual behavior and public response accordingly.
The nation’s lack of federal leadership has put him in other countries in the fight opposite the virus, former CDC leader Dr. Tom Frieden said at a press conference last month.
He and other public health experts urged state and local health agencies to adopt a uniform system of reporting on testing, positive cases, hospitalizations and deaths, as well as on the effectiveness of contact tracing efforts and the percentage of people wearing masks.
Separately, researchers at Stanford University and the University of California who are trying to determine what caused California’s COVID-19 surge reported last month that the state had refused to release crucial data, citing privacy concerns and workload constraints.
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Detailed case and contact-tracing data from state and county health authorities, they said, could point to more effective, targeted approaches to slowing the pandemic. Without the data, the scientists said, little more can be done.
For the state side, Janet Hamilton, executive director of the Council of Territorial and State Epidemiologists, said that privacy and considerations about publishing incomplete knowledge are primary considerations.
“It’s about seeking to provide knowledge in a way that causes others to replace their behavior, which happens regularly when other people are personally affected or when they have local information,” he says. “We need to provide knowledge as locally as possible without violating privacy rights or confusing others. But we know we’re short of information.”
For example, she said, in some communities where very little testing is available and, therefore, very few cases are reported, people could decide that they are not at risk, when they actually are.
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Public health officials and advocates argued in a new report that without uniform data, the United States will continue to lag behind the rest of the world in fighting the pandemic.
The groups included Frieden’s organization, Resolve to Save Lives, along with the Johns Hopkins Center for Health Security, the American Public Health Association, Trust for America’s Health and the Association of Schools and Programs of Public Health.
People need to know what their local health departments are doing to contain the virus and hold them accountable, said Dr. Cyrus Shahpar, who directs the epidemics prevention team at Resolve to Save Lives, an initiative of Vital Strategies, in an interview with Stateline.
Shahpar, who lives in California, said, “If there’s a bunch of fires outside, I want to know how many are contained. Right now, we know there are big fires everywhere. But we have no idea which ones are contained.
“We also want to compare cities and states. If I’m in New York State, I want to know which states will limit travel. I also want to know which states and cities they will visit.”
An important piece of missing information, he said, is the lag time between collecting a test sample and getting the results. Is the delay the same in every ZIP code? Are poor neighborhoods and predominantly Black and brown neighborhoods experiencing greater testing delays? No states are providing that type of data, Shahpur said.
Public health agencies need to tell the public what the local data means, Shahpur said. Five cases could be a crisis in a tiny rural town, while 50 could be manageable in a medium-sized city. The average person doesn’t know that on their own, he said.
Some states and cities have developed red, orange, yellow and green alert point systems that come with a list of tips for age and demographic organization at the point of threat, Shahpur said. This type of graphic presentation can help businesses and citizens plan their days, he said.
“To let others know the extent to which their local fitness branch controls the virus, cities and states report the percentage of new instances resulting from the so-called network spread, the known outdoor transmission chains,” said Dr. Amesh Adalja, a senior researcher at the Johns Hopkins Center for Health Safety.
“How many new instances were already on your radar and how many were not? This is important, because if too many instances have unknown sources, the virus could become uncontrollable,” Adalja said. “People want to know that.”
Only a handful of states do that.
The Oregon Health Service measures the good fortune of the tactile search in the percentage of new instances similar to a known source. Every day, the state publishes those percentages on its COVID-19 dashboard.
By a peak of July, the number of new instances increased in Oregon, as did the percentage of instances without a known source. As of July 28, more than 73% of new instances had no known sources. The goal, depending on the state, is that no more than 30% of new instances lack a known source.
Virginia also tracks contact tracing by publishing the percentage of new cases and contacts the health department is able to reach within 24 hours of receiving test results. As of last week, the state reported reaching 75% of all new cases and 85% of their contacts the same day.
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“Too often, states provide numbers to show their good fortune, when it’s not a good fortune,” Dr. Georges Benjamin, executive director of the American Public Health Association, said at the Resolve to Save Lives press conference.
Epidemiologists say that many national and local supply figures that can be misunderstood or require others to make their own calculations to put them into context.
For example, daily test totals mean nothing, Adalja said, unless the percentage of positive tests is provided along with the date the samples were taken. Those numbers should be parsed at the county or ZIP code level and presented as a number per capita so they can be compared among states, counties and cities. And while daily case counts may be useful, the trend is more revealing, he said.
The number of hospital admissions is vital for epidemiologists, but it is not useful for other average people, Adalja said. They want to know how many COVID-19 patients are at their local hospital on a given day and whether the hospital is nearly full. They also want to know how many physical care staff members have tested positive for the virus and how many others come to the emergency room with flu-like symptoms.
According to Frieden’s organization, states provide 40% of the knowledge needed to combat the pandemic, and some states report less applicable knowledge than others.
No state reports knowledge about check delays, and few report tactile search. Frieden said the nonprofit running with the states to help them provide more knowledge, much of which he said he already has it.
“It’s no surprise we haven’t been able to get this virus under control,” said Dr. Ali Khan, dean of the University of Nebraska Medical Center’s public health school and a former CDC official. “States don’t have timely, complete, relevant or transparent data. And they lack the political will to develop it. That needs to change.”
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