By: Jennifer Nuzzo Published online: iNFOVi News
Date: March 30th 2020
As states and cities implement social distancing measures to slow the number of COVID-19 cases, the next big question is, “When will the emergency be over?” When can we begin to leave our homes, to reopen schools and restaurants, to socialize with our friends?
To begin to let down our guard, we will need to be able to determine whether the occurrence of new cases is slowing to the point where demand for healthcare resources won’t outpace their availability.
How will we know when we’ve reached that point? Answering the critical “when” question requires something called disease surveillance, and unfortunately, America simply doesn’t have adequate surveillance systems in place to provide the information we need to answer these and other crucial response questions. In fact, our current health and logistics systems aren’t built to do anything like this.
So what needs to happen next? And who is supposed to help us get there? To spin up a new nationwide surveillance program in real time is a huge lift and will require a coordinated game plan from different agencies, governments and leaders—and even the private sector.
Here’s what it could look like, and who needs to get behind it next.
Better data — now.
What we need: Improved, centralized tracking and analysis of the cases that have been detected.
Why? If we want to be able to ease social distancing, we to have confidence that the number of new infections won’t outpace our health care capacity. Individual states are publishing case counts, but often without the ancillary data that would help interpret increases or decreases. We need a way to track—ideally in one place, not on 50 different websites–what criteria states are using to test people, what percentage of a state’s population has been tested, and what proportion of tests are positive. Once we see that case numbers are falling despite increasing numbers of people being tested, we can begin to be reassured that social distancing measures are having an impact and we can begin a phased return to normal life. But we won’t know that until we have more data.
Who needs to do it? State and federal authorities, coordinated by the Centers for Disease Control and Prevention. States likely have some or all of these data, but they are not shared publicly. The CDC should immediately, in partnership with states, lead an effort to collect these data and publish them on a national COVID-19 dashboard.
Faster and more widespread testing.
What we need: Much broader testing, and real-time results.
Why? We need to start identifying not just those who already have the disease, but also those who may have been exposed and who may become cases themselves. First and foremost, that means much broader testing, including of asymptomatic people, and it means getting real-time test results – in a matter of minutes, not hours or days. While there has been some improvement in the availability of test kits, we are still testing far too few people to generate the data we need. In order to reach that level of testing, we also need to significantly expand laboratories’ capacities, which are currently limited by shortages of supplies including swabs, protective equipment, and reagents. Places like South Korea and Germany have shown that expansive testing can enable early isolation of infected patients and help keep case numbers from accelerating.
Who needs to do it? The Food and Drug Administration, Department of Health and Human Services and private sector companies need to identify and remove the bottlenecks slowing the delivery of supplies to public and private labs. The CDC should also issue guidance on how mildly ill individuals can safely self-isolate without infecting others, and how local health departments can provide alternate housing arrangements for individuals who cannot safely isolate themselves at home
Find health care supplies — and get them to the right place.
What we need: Better systems to monitor the availability of medical supplies like ventilators, personal protective equipment, including face masks healthcare resources, and testing supplies.
Why? Our current inability to track at both a national and local level the availability of healthcare resources is crippling our response to COVID-19. Widespread shortages of essential medical supplies have been reported: In a survey conducted by the U.S. Conference of Mayors more than 91 percent of cities reported not having an adequate supply of face masks for healthcare workers and first responders and 85 percent said they do not have adequate numbers of ventilators. We urgently need to gain insights into complex medical supply chains so that we can better identify where resources still exist and anticipate shortages. Existing supply chain management approaches are not well-suited to the current, unprecedented situation, in which multiple countries are trying to acquire the exact same products at the exact same time.
Who needs to do it? The Department of Defense. Although U.S. agencies like the FDA and the Federal Emergency Management Agency are working to address shortages of personal protective equipment and other medical supplies, the complexity and scale of the problem requires a larger effort — with greater participation of private sector — than what is currently happening. A federal entity with logistics experience, such as the Department of Defense, should lead this effort instead.
Monitor our health care workers.
What we need: Surveillance systems to track infections among frontline healthcare workers.
Why? Healthcare workers are our most essential medical resource. Though reports have warned of shortages in the number of ventilators needed to manage a surge of COVID-19 patients, there has been less attention to the availability of healthcare workers to care for patients. When case numbers were rapidly accelerating in China, they were criticized for not initially disclosing how many healthcare workers fell ill with COVID-19. But we’re effectively doing the same now: to date there has been no official tally of healthcare worker infections in the U.S., though news articles report that healthcare workers are becoming ill or have been quarantined after exposure to COVID-19 patients. As the pandemic continues, we should expect to see shortages of healthcare workers in some areas. Once we know where more medical personnel are needed, it may be possible to boost their numbers with credentialed workers from the federal government or other states, or through trained volunteer programs like the Medical Reserve Corps.
Who needs to do it? HHS already has an office with the right resources for conducting this kind of surveillance: the Office of the Assistant Secretary for Preparedness and Response. ASPR, as it’s known, will be interacting with hospitals and state agencies as part of the federal aid program for hospitals and will be in a position to compile this information as part of that program. States should work to reduce legal barriers that prevent healthcare workers from crossing state lines to work in health facilities that need additional personnel.
Spin up new health info-tech systems.
What we need: New digital tools and more personnel to collect and analyze the data we need.
Why? Few health departments in the U.S. currently have the capacity to locate individual COVID-19 cases and ensure that they remain in isolation. Specifically, they lack the kind of tools South Korea, Singapore and China used to control the disease, primarily cell phone-based applications and large numbers of personnel. Even if states are already collecting some of the data mentioned above, they aren’t likely to have the scale, expertise and software to crunch and use it in real time. And health departments will also need assistance to undertake the laborious work of ensuring that COVID cases self-isolate and to identify and monitor their contacts.
Who needs to do it? The CDC needs to immediately provide the criteria needed to develop digital tracking systems, particularly for contact tracing and monitoring known COVID-19 cases. HHS should consider training and deploying returning Peace Corps volunteers, medical or nursing students, and other volunteers, to assist states in monitoring patients. And private sector technology companies should work with the CDC to develop the needed apps and tools.
We are now in a crisis where the absence of information is actively hindering our ability to respond. Even if it were possible to maintain stay-at-home measures indefinitely without causing other societal harms, they alone won’t get us out of this pandemic. We urgently need to improve our situational awareness so that we can make better decisions about how to control this pandemic.
Once we have a better understanding of where cases are, we can determine who still needs to stay home and answer the question so many are asking right now, “For how long?”