Covid-19: US states are not reporting vital data, says former CDC chiefBMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2993 (Published 27 July 2020) Cite this as: BMJ 2020;370:m2993
Most US states are missing key indicators in the data they publish about the course of the covid-19 pandemic, says a report presented by Tom Frieden, former director of the Centers for Disease Control and Prevention (CDC).
The report by Resolve to Save Lives, a New York based non-profit group led by Frieden, examined the covid-19 “dashboards” of all 50 states and the District of Columbia.1
Indicators critical to understanding the pandemic’s course were often missing, it found. Not a single state currently reports the average turnaround time of a polymerase chain reaction (PCR) test, as press reports abound of tests in many regions taking a week or more to come back, a delay that renders testing nearly useless in controlling the disease’s spread. The test positivity rate goes unreported by 25% of states.
Resolve to Save Lives, which is part of the global health organisation Vital Strategies, listed 15 indicators that are routinely used in other countries’ reporting and examined the performance of each US state on each indicator.
These indicators include syndromic reporting of influenza-like illness, reported by 10 states, and covid-like illness, reported by 18 states. These two are considered leading indicators, allowing a faster response than the trailing indicators of hospital admissions and deaths.
Reporting and clarity
Reporting tends to be most lacking in areas where the response has also been most lacking. “State reporting on contact tracing is abysmal,” the report said. “Only eight states report data on the source of exposure for cases, which is determined during case interviews. Source data is routinely reported in countries that are responding effectively to covid-19; infections from unknown sources signal undetected community transmission.”
The District of Columbia published such contact tracing data for the first time this week, reporting that just 2.8% of new cases had been linked to cases that were already known. The district’s target was 60%.
The data that are widely reported—notably test numbers, cases, and deaths—are often rendered less useful by lack of clarity. Half of states fail to distinguish between active and recovered cases or between probable and confirmed cases.
All but three states report trends in daily test numbers, but few make the vital distinction between PCR tests for active infection and antibody tests for previous infection.
Only seven states provide information about health worker infections on their dashboards. A figure is provided by the CDC, which currently reports 106 180 infections and 552 deaths among healthcare personnel, but the agency acknowledges in an accompanying note that “healthcare personnel status was only available for 634 428 people”—about one in five of those known to the CDC.2
A lack of standard definitions makes it impossible to compile national data reliably, Frieden told a news briefing presenting the report. Despite good work by many states and a “tsunami of data points,” he said, “because of the lack of national leadership, we don’t have common standards, definitions, targets, or accountability.”
The US is “flying blind,” he said, questioning the current “obsession” with higher test numbers. If results are taking several days, if positive cases are rarely isolated, and if contacts are almost never warned, he said, then “we really have done very little good.”
The current number of cases in the United States exceeds the combined total in all of Europe, Africa, and Asia, said Frieden. He explained, “With 4% of the world’s population, we have one quarter of covid reported deaths. And during the 45 minutes of this briefing, more than 20 people will die from covid in the US and thousands more will become infected.”
This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.https://bmj.com/coronavirus/usage