Tom Frieden and Cyrus Shahpar write in the New York Times about a plan to collect crucial data, even if the federal government won’t help.
Doctors caring for patients track vital signs of temperature, blood pressure, breathing and pulse. Public health doctors fighting epidemics do something similar — they track the most important indicators of the spread of a disease and attempts to control it.
During the Ebola epidemic in West Africa, for example, with coordination from the National Security Council at the White House, the Centers for Disease Control and Prevention produced a weekly dashboard that graded how well each country was doing on the steps to stop the disease. This focused attention on where Ebola was spreading and what needed to be done to stop it. But today, the White House is not guiding our response to Covid-19, and neither the C.D.C. nor any other part of the government has been empowered to play this role.
We aren’t tracking the public health equivalent of vital signs. That’s one big reason the United States is losing the battle against Covid-19.
We have a per capita death rate five times the global average, cases are increasing, and our economy and educational systems will not recover until we get the virus under control. Last week’s abrupt decision by the Trump administration to stop sending information on Covid-19 patients to the C.D.C. and instead to send it to the Department of Health and Human Services reflects this lack of national coordination.
Over the past three weeks, researchers in our initiative, Resolve to Save Lives, searched all the data they could find on publicly available websites from all 50 states. They found it to be shockingly inconsistent, incomplete and inaccessible.
Not a single state published turnaround time for testing, nor how promptly patients are isolated, nor the proportion of cases diagnosed among people who had contact with a Covid-19 patient. In most states, there is no way to track the trend of Black and Hispanic people suffering hospitalizations and deaths at greater rates than white people.
Only two states — Oregon and Virginia — even reported information on whether patients were interviewed promptly for contact tracing. Indicators such as these are essential to know how well we are fighting the virus so that we can do better.
The fault does not lie with the states — it’s a federal failing. Although getting the data quickly and accurately is hard, the underlying problem is the lack of common standards, definitions and accountability. This reflects the absence of national strategy and leadership. Unless we get onto the same page, we will face continued and preventable disorganization, economic decay and death.
There is a better way. Our group — along with a coalition of national, state and academic partners including the American Public Health Association and the Johns Hopkins Center for Health Security — has developed a list of 15 indicators. Every state and county should be able to collect and publish nine of these immediately and the other six within a few weeks.
The basics are early signals from emergency departments that could warn us if cases are spiking; information about cases, tests and deaths over time by age, sex, and race and ethnicity; and information about outbreaks in nursing homes and elsewhere, as well as epidemiological links among cases.
Indicators that could be published in a few weeks include performance measures for testing, case interviews and contact tracing; health care worker infections; and objective assessment of the proportion of people wearing masks correctly in indoor public spaces such as stores and public transit. (This could be monitored by human surveyors or security cameras for aggregate analysis, while protecting individuals’ privacy.)
The full list is available here.
The greatest benefit of good information isn’t knowledge, it’s action. Among other things, these indicators would give us:
- An early-warning system to prevent explosions of cases by scaling back physical connections as soon as cases begin to rise.
- More incentive to improve the turnaround time of tests, which is crucial to stop spread (there is little value to tests that come back more than two or three days later).
- Information on the size, lethality and status of control of every outbreak, including those in every nursing home, homeless shelter, correctional facility and meatpacking factory.
- The opportunity to better understand and reverse the unequal burden the pandemic is placing on Black, Hispanic, Native American and other communities.
- Accountability for how many health care workers have been infected each week; if we published this, we would drive that number down toward zero.
Joshua Lederberg, the great microbiologist and Nobel laureate, used to say that microbes outnumber us: It’s our intelligence against their numbers. But today, despite a glut of data, we are starved of intelligence. These indicators would start to fix that by enabling people to know what their risk is and how well their community is dealing with the virus, and to let every government know what needs to be done. What gets measured — publicly — can get managed.
The federal government has some of this information, at least in some form. This should immediately be made public, as hospitalization data has been. Every state and every county should provide this information, and we are encouraged that several states have already told us they will begin doing so. Journalists should ask for it. And the public — including educators trying to reopen schools, business owners planning their financial future and parents trying to safeguard their children — should demand it.
Tom Frieden (@DrTomFrieden), the director of the C.D.C. from 2009 to 2017, is the president and chief executive of Resolve to Save Lives, part of the global public health organization Vital Strategies. Cyrus Shahpar, a former director of the Global Rapid Response Team at the C.D.C., is the director of the Prevent Epidemics team at Resolve to Save Lives.