Local, state, and federal governments rapidly built a public health data infrastructure throughout the COVID-19 pandemic. The data from all jurisdictions is critical to continuing effective pandemic responses.
Around the globe, there is still a deadly pandemic. Many countries are confronting a new wave of cases driven by the Delta variant. Russia has been breaking daily death records1 and the daily case rate in the United Kingdom is surpassing 2020 levels while continuing to accelerate2. The Gamma variant continues to ravage South America, but now Lambda may take over as vaccination rates remain low across the continent3.
I have said this before and am reiterating here, to avoid a similar devastating resurgence in the United States, governments of all sizes -- local, state, and federal -- need to continue their data collection efforts. Unfortunately the trends of data shops closing up and slowing reporting persist. Many states are limiting or stopping public reporting of vital data, a move that will limit the nation’s ability to anticipate disease spread.
It has been over six months since the rollout of COVID-19 vaccines in the United States, which was an incredible feat of science, logistics, and leadership. However, vaccination coverage across the U.S. is stagnating just below 50%, much less coverage than the ~70% vaccination rate in the U.K., which is experiencing some of the worst effects of COVID-19 in months2. The data collection and surveillance efforts established across all levels of government in the United States are now even more valuable as we watch for breakthrough cases and the emergence of the Delta variant.
At the beginning of this pandemic we learned that the United States lacked data infrastructure to adequately respond to a new public health crisis. I commend the efforts of governments on all levels to fund, develop, and grow their public health data collection systems in response to COVID-19, and now is not the time to slow down. Data is critical at all geographic levels: county, state, and federal. While the PDI has addressed the importance of maintaining temporal data resolution through reporting cadences, we now need to discuss the importance of geographic resolution.
The above image is a screenshot of the CRC’s U.S. Map for new cases from July 8, 2021. The blank spaces would appear to indicate that some states had zero new cases of COVID-19. However, here “zero” doesn’t mean zero cases; it means zero data as some states, such as Alabama4,5, Alaska6, Florida5,7, Oklahoma8, and South Dakota9 have stopped reporting county-level case data daily.
County-level data enables local public health officials to catch breakthrough cases of COVID-19 in areas with high vaccination rates and notice hotspots in low vaccination areas that would otherwise be impossible to pinpoint from averaged state-wide data. It also gives individuals and families the information they need to make important decisions on traveling, school, or just going to the grocery store. County-level data can also highlight the positive impacts of mitigation techniques, such as masking, and empower local officials to reintroduce additional measures if COVID-19 is resurging.
We are already seeing instances of individual counties having a dramatic rise in per capita cases and deaths from COVID-19 unmatched by the rest of the state. As of July 3, 2021: Colorado has high vaccination coverage, beating the U.S. average at 53%; however, Moffat County, Colorado is experiencing 54 new cases a day per 100,000 people10 - almost 20 times the state average. The issue of “hotspot” counties is further amplified in states like Arkansas with low vaccination rates, where 13% of counties are displaying 20 or more new cases daily per capita, much higher than other counties in the state, with Dallas County alone experiencing 94 new cases a day per 100,000 people10. Without county-level data, COVID-19 variants can fester unnoticed until they spread across the rest of the state and country. We would have no way of flagging those surges if it wasn’t for county-level data collection efforts.
State dashboards have been one of the most incredible products of the COVID-19 pandemic response, and I have made it clear that I believe they should be a tool that we continue to fund and utilize in perpetuity. Not everyone agrees. Many states have reduced their reporting cadences, and some, like Nebraska, are completely shutting down their dashboards and directing their citizens to CDC for data11. This is not acceptable.
As discussed by Dr. Tinglong Dai, having state-level data equips us to better learn from each other and improve our responses to this pandemic and future crises. Without state-level data there is no way to assess policies, gauge success, and make informed changes to state response. In the case of a new variant outbreak, state-level data will be critical to understand the efficacy of vaccines, policies, and mitigation strategies, so it is short-sighted to shut down state reporting efforts now.
The CDC has done what once felt impossible during this pandemic, wrangling data from thousands of disparate sources and trying to shape blanket policies and guidelines that equally cover and assist a diverse nation of people. One of the difficulties CDC faces as the federal government’s official public health record keeper is that it is limited to sharing data received from written, standardized reports from the states. Throughout the pandemic this has resulted in major lags and significant discrepancies between CDC’s data website and state data dashboards.
Last week I shared my experience testifying before Congress regarding upcoming bills to establish rules for state data reporting for both COVID-19 and social determinants of health. It is important to have a robust data stream at the federal level, as it will have the most impact on shaping policy and allocating future resources. Additionally, the federal government is tasked with preparing our country for the next public health crisis, and that effort is unlikely to be fruitful without robust, detailed data. As part of its federal mandate, the CDC will continue to keep records on COVID-19, but whether the states are required to share data with any level of detail with the CDC is yet to be determined.
We set up this public health data infrastructure over the past year not because it was easy, but because it was essential. We have learned that a decades-long divestment in public health has led to a catastrophic inability to navigate fast moving and deadly pandemic. If anything, we need to reimagine public investment in health and double down on better reporting and public health infrastructure, not return to business as usual. Nothing has changed the importance of public health data, and the investments we have made both financially and with human effort deserve to be honored and continued. We have collected an unprecedented amount of public health data because of this pandemic and we can leverage it to significantly improve the country’s health and safety. The data can also begin to help us address social determinants of health, systemic racism, and healthcare inequality. None of that will be possible without robust, updated data streams on the local, state, and federal levels.
1. AFP, Russia sets another Covid record as world battles Delta variant, 03 July 2021. https://www.france24.com/en/live-news/20210703-russia-sets-another-covid-record-as-world-battles-delta-variant. (Accessed 04 July 2021).
2. H. Ellyatt, The Covid delta variant has ‘exploded’ in the UK — and it could be a blueprint for the U.S., 28 June 2021. https://www.cnbc.com/2021/06/28/how-the-uk-with-the-delta-variant-is-a-blueprint-for-the-us.html. (Accessed 06 July 2021).
3. J. Solis-Moreira, SARS-CoV-2 Lambda variant spreading rapidly in South America, report reveals, 7 July 2021. https://www.news-medical.net/news/20210707/SARS-CoV-2-Lambda-variant-spreading-rapidly-in-South-America-report-reveals.aspx. (Accessed 08 July 2021).
4. K. Landers, ADPH COVID-19 dashboard changes will take effect June 7, 4 June 2021. https://www.alabamapublichealth.gov/news/2021/06/04.html. (Accessed 08 July 2021).
5. A. Lardieri, Florida, Alabama No Longer Reporting Daily Coronavirus Data, U.S. News & World Report, 8 June 2021.
6. COVID-19 Updates, Alaska Department of Health and Social Services. http://dhss.alaska.gov/dph/epi/id/pages/covid-19/Communications.aspx. (Accessed 08 July 2021).
7. Florida Department of Health, Florida Department of Health Provides Week 24 Updates on Florida’s Vaccination Efforts Under Governor DeSantis’ Leadership, 29 May 2021. https://www.floridadisaster.org/news-media/news/20210528-florida-department-of-health-provides-week-24-updates-on-floridas-vaccination-efforts-under-governor-desantis-leadership/. (Accessed 08 July 2021).
8. H. Raache, Oklahoma Dept. of Health switching how and when reporting COVID-19 data, 17 March 2021. https://kfor.com/news/coronavirus/oklahoma-dept-of-health-switching-from-reporting-covid-19-daily-to-weekly/. (Accessed 08 July 2021).
9. J. Fugleberg, South Dakota scales back COVID-19 reportin, 2 July 2021. https://www.dglobe.com/newsmd/coronavirus/7098548-South-Dakota-scales-back-COVID-19-reporting. (Accessed 08 July 2021).
10. J. Allen, S. Almukhtar, e. al., Coronavirus in the U.S.: Latest Map and Case Count, 06 July 2021. https://www.nytimes.com/interactive/2021/us/covid-cases.html. (Accessed 06 July 2021).
11. P. Ricketts, Gov. Ricketts Ends Coronavirus State Of Emergency, Nebraska Department of Health and Human Services, 28 June 2021.
Title image via Wikimedia Commons, GNU Free Documentation License Version 1.2.