Ali Mokdad, an epidemiologist at the University of Washington, has been trying to make sense of this summer’s COVID-19 surge. He says he can theorize only in a general way about why the virus spread and what to do about it.
“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 a global health expert at the university’s Institute for Health Metrics and Evaluation, he says he should be able provide much more nuanced answers.
“Why can’t we figure out what’s contributing to the recent spread? It is very simple,” Mokdad said. “No access to data.”
In a move seen as potentially obstructing access to COVID-19 information even more, the Trump administration last month ordered hospitals to stop sending data to the Centers for Disease Control and Prevention and instead send it to a private data firm under contract with the Department of Health and Human Services, whose secretary reports directly to the White House.
Skyrocketing cases, clashes among federal leaders and a hodgepodge of state data have left many Americans asking how the United States will get back to anything resembling normal 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.”
However, epidemiologists point out that all other evolved countries fighting the virus have published the kind of knowledge that the average of other people and scientists want to track the progression of the disease every day and rotate their individual habit and public reaction 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 fitness experts suggested to national and local fitness agencies to adopt a uniform formula for reporting tests, positive cases, hospitalizations and deaths, as well as the effectiveness of tactile search efforts and the percentage of other people dressed in masks.
Separately, researchers at Stanford University and the University of California who are investigating what caused the increase in COVID-19 in California reported last month that the state had refused to disclose very important data, raising confidentiality issues and workload limitations.
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In his view, detailed knowledge of the instances and contact findings through the state and county government may involve more effective and specific approaches to curbing the pandemic. Without the knowledge, the scientists said, there is nothing else that 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 a matter of trying to present data in ways that get people to make behavior changes, which usually happens when people are impacted personally or when they have local information,” she said. “We want to provide data as locally as possible without violating privacy rights or confusing people. But we know we have information gaps.”
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, as the Johns Hopkins Center for Health Safety, the American Public Health Association, the Trust for America’s Health, and the Association of Schools and Public Health Programs.
People want to know what their local fitness is doing to involve the virus and hold them accountable, said Dr. Cyrus Shahpar, who leads the epidemic prevention team at Resolve to Save Lives, a Vital Strategies initiative, 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.”
A lack of vital information, he said, is the time between collecting a verification pattern and obtaining the results. Is the time the same in the zip code? Are poor, predominantly black and brown neighborhoods experiencing further delays in controls? No state provides this kind of data, Shahpur said.
Public fitness agencies want to tell the public what local knowledge means, Shahpur said. Five cases can be a crisis in a small rural village, while 50 can be manageable in a medium-sized city. The average user doesn’t know for himself, 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.
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 touch studies by publishing the percentage of new instances and touches in which the fitness service will succeed within 24 hours of receiving the check results. Since last week, the state has reported that it has achieved 75% of all new instances and 85% of its contacts on 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 check totals mean nothing, Adalja said, unless the consistent percentage of positive checks is provided with the date the samples were taken. These figures should be analyzed at the point in the zip code or county and presented in a manner consistent with the number of capital in order to compare states, counties, and cities. And while the daily case count can be helpful, 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 not unexpected that we haven’t been able to detect this virus,” said Dr. Ali Khan, dean of the University of Nebraska Medical Center School of Public Health and former head of the CDC. “States do not have timely, complete, applicable or transparent data. And they don’t have the political will to expand them. That has to change.”
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