Minor Thoughts from me to you

The United States is still struggling to control COVID-19, because we don’t have the tools that we need to see where it’s been, where it is, and where it’s going. Mr. Lipsitch and Mr. Grad—experts in epidemiology—wrote an op-ed for The Washington Post describing what we need. It’s time to start planning how we can meet those needs, so that we can save lives, and jobs, the next time that a new virus invades.

How to fix public health weaknesses before the next pandemic hits

Surveillance systems — counting and tracking infected people, monitoring the course of the epidemic and projecting resource needs as the epidemic unfolds — are inflexible and outdated. The systems have been undermined by the long neglect of local and state public health. Fundamentally, there is no common system for collecting and reporting the key numbers, confounding efforts to control disease spread.

Eight months into the pandemic, states and counties around the country are struggling to track the spread of the virus through routine, reliable testing of representative members of their communities. Efforts to help hospitals and public health systems by modeling the covid-19-related demand for intensive care have been stymied by this fact: There is insufficient information available about the duration of stays in intensive care units in the United States. And few jurisdictions provide specific data on where their epidemiologists determine transmission is occurring, making it difficult to identify areas that can reopen safely or health-care facilities that need to bolster their prevention measures.

The list could go on. The common denominator is an antiquated and unstandardized system of linking data from clinical records and public health monitoring in ways that provide evidence on how to control the virus while minimizing the disruption to the economy and society. Electronic medical records — envisioned as a boon for public-health surveillance, providing data that could be readily analyzed — turn out to be much better for billing than for the exchange of data.

The next phase of pandemic response that might be placed at risk by these spotty data systems is vaccination. Accurate records of who has been vaccinated, when and with which vaccine will be essential. They will encourage trust in the safety and effectiveness of vaccines, ensure prioritization of the groups that should first receive the vaccine, and aid in monitoring vaccine impact on the pandemic. A patchwork of local systems, already strained, is not well-suited to this task.

Solving this problem will require significant investment to link public health agencies at the local level to state and national databases, and to ensure that the information coming into these systems is of adequate quality.

Nontraditional sources of data — tracking mobility through cellphones to see how people respond to lockdowns, measuring viral RNA in sewage and predicting epidemic trends through analysis of Internet searches — potentially provide information faster and with higher resolution than traditional epidemiologic data. But efforts to make use of them remain bespoke collaborations between companies or academic groups and individual health departments. Large-scale serological surveillance, a potentially game-changing idea pioneered by several of our colleagues, remains just that, an idea. Calls for a national pandemic forecasting center have so far gone unfunded.

All this will require new investment in these good ideas, IT infrastructure, highly skilled personnel and equipment to run large numbers of diagnostic tests. The improvements would aid in fighting the current pandemic, and they will be essential weapons against future pandemics and other major health threats, such as antimicrobial resistance, that will still loom when the world emerges from covid-19.