What has to happen next? And who should help us to get there? Implementing a new, real-time, nationwide surveillance program is a huge effort and requires a coordinated schedule from different agencies, governments and leaders – and even the private sector.
Here’s what it might look like and who needs to figure it out next.
Better dates – now.
What we need: Improved, centralized tracking and analysis of identified cases.
Why? If we want to be able to reduce social distance, we have to trust that the number of new infections will not exceed our health capacity. Individual states publish case numbers, but often without the additional 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 use to test people, what percentage of a state’s population has been tested, and what percentage of tests are positive. As soon as we find that the number of cases decreases despite the increasing number of people tested, we can be reassured that social distancing measures have an impact and we can begin a gradual return to normal life. We only know that when we have more data.
Who has to do that? State and federal agencies coordinated by the Centers for Disease Control and Prevention. States probably have some or all of this data, but it is not shared publicly. The CDC should immediately work with states to collect this data and publish it on a national COVID-19 dashboard.
Faster and more comprehensive tests.
What we need: Much more comprehensive tests and real-time results.
Why? We have to start by identifying not only those who already have the disease, but also those who may have been exposed and may become cases themselves. First and foremost, this means much more comprehensive tests, including asymptomatic people, and it means getting test results in real time – in minutes, not hours or days. Although the availability of test kits has improved somewhat, we are still testing far too few people to generate the data we need. In order to achieve this level of testing, we also need to significantly expand the capacities of the laboratories, which are currently limited by supply bottlenecks such as swabs, protective equipment and reagents. Places like South Korea and Germany have shown that extensive testing can help isolate infected patients at an early stage and help prevent the number of cases from accelerating.
Who has to do that? The Food and Drug Administration, the Ministry of Health and Human Services, and private sector companies must identify and address the bottlenecks that are slowing the delivery of material to public and private laboratories. The CDC should also issue guidelines on how easily sick people can safely isolate themselves without infecting others, and how local health authorities can provide alternative housing for people who cannot isolate themselves safely at home
Find medical care – and bring it to the right place.
What we need: Better systems for monitoring the availability of medical accessories such as ventilators, personal protective equipment, including resources for health masks for face masks, and test accessories.
Why? Our current inability to track health resource availability at both national and local levels paralyzes our response to COVID-19. Widespread bottlenecks in primary care have been reported: in a survey conducted by the U.S. Mayors’ Conference, more than 91 percent of cities said they had insufficient face mask supplies for healthcare workers and first responders, and 85 percent said none sufficient supply of fans. We urgently need to gain insight into complex medical supply chains so that we can better identify where resources are still available and anticipate bottlenecks. Existing supply chain management approaches are unsuitable for the current, unprecedented situation, in which several countries are trying to buy exactly the same products at exactly the same time.
Who has to do that? The Ministry of Defense. While U.S. agencies such as the FDA and the Federal Emergency Management Agency are working to address the shortage of personal protective equipment and other medical supplies, the complexity and scale of the problem require greater efforts – with greater private sector involvement – than currently. A federal agency with logistics experience such as the Department of Defense should instead direct these efforts.
Monitor our healthcare workers.
What we need: Front-line monitoring systems to track infections among healthcare workers.
Why? Healthcare workers are our primary medical resource. Although reports have warned of bottlenecks in the number of ventilators needed to cope with an increase in COVID-19 patients, less attention has been paid to the availability of medical personnel for patient care. As the number of cases in China accelerated rapidly, they were criticized for initially not disclosing how many healthcare workers had COVID-19. But we’re effectively doing the same thing now: So far, there has been no official list of healthcare worker infections in the U.S., although news articles report that healthcare workers get sick or have been quarantined after exposure to COVID-19 patients. In view of the ongoing pandemic, a shortage of health care workers can be expected in some areas. Once we know where more medical personnel are needed, it may be possible to increase their numbers through qualified federal or state employees or through trained volunteer programs such as the Medical Reserve Corps.
Who has to do that? HHS already has an office with the right resources to perform this type of surveillance:: the deputy secretary’s office for readiness and response. ASPR will interact with hospitals and government agencies as part of the federal hospital aid program and will be able to collate this information as part of this program. States should work to remove legal barriers that prevent healthcare workers from crossing national borders to work in healthcare facilities that require additional staff.
Start new health information systems.
What we need: New digital tools and more staff to collect and analyze the data you need.
Why? Few U.S. health departments are currently able to locate individual COVID-19 cases and ensure that they remain isolated. In particular, they lack the tools with which South Korea, Singapore and China are fighting the disease, especially mobile phone-based applications and a large number of employees. Even if there are states If you are already collecting some of the above data, you are unlikely to have the scope, expertise, and software to process and use it in real time. Health departments also need support to painstakingly ensure that COVID cases isolate themselves and to identify and monitor their contacts.
Who has to do that? The CDC must immediately provide the criteria necessary for the development of digital tracking systems, particularly for contact tracking and monitoring of known COVID-19 cases. HHS should consider training and deploying Peace Corps returning volunteers, medical or nursing students, and other volunteers to help states monitor patients. And private sector technology companies should work with the CDC to develop the necessary apps and tools.
We are now in a crisis where the lack of information is actively hampering our responsiveness. Even if it were possible to maintain measures at home indefinitely without causing other social harm, they alone will not 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.
As soon as we have better understood where the cases are, we can determine who still has to stay at home and answer the question that so many are currently asking: “How long?”