“Armchair epidemiology” endangering efforts to get epidemic under control
11 June 2020 – With the exponential rise in collection of COVID-19 data, experts warn of its misuse. Today, Dr. Tom Frieden, former CDC Director and President and CEO of Resolve to Save Lives, an initiative of the global health organization Vital Strategies, held a press briefing along with other epidemiology experts, outlining COVID-19 data misconceptions and metrics that matter to guide public health officials.
“What gets measured, matters. Lots of COVID-19 data that get attention are either inaccurate, partial, or misleading,” said Dr. Tom Frieden, President and CEO of Resolve to Save Lives, an initiative of Vital Strategies. “Collected, analyzed, and disseminated correctly, data can save lives and help restore livelihoods.”
The number of data sources for COVID-19 has surged with the virus. These data are informing public health decisions as communities work to get the epidemic under control and reopen. Resolve scanned best practices from around the world and identified what metrics governments, and reporters, can prioritize and pay close attention to as we fight the virus.
At a press briefing today, Dr. Frieden outlined 11 misconceptions about COVID-19 data and ways public health officials can better interpret the data for critical decision-making.
Among the myths outlined and debunked by Dr. Frieden and colleagues are:
- Myth: Case counts and trends are enough to monitor COVID-19 spread.
Reality: Trends in the counts of cases, even those adjusted for population, are insufficient to fully understand the disease situation. It is critical to understand the actual intensity and distribution of viral infection, the level of testing, and the number of susceptible people over time.
- Myth: Case incidence is always a good indicator of community risk.
Reality: The number of new (incident) cases in a population does not always reflect the risk of transmission in a community. The main reason is that the composition or distribution of these cases may be very different, even if the overall total is the same.
- Myth: COVID-19 deaths are an indicator of the current situation.
Reality: Because the average lag between symptom onset and death and reporting is about a month, deaths are not a useful early indicator for monitoring whether the disease situation is worsening or improving today.
- Myth: COVID-19 deaths are the only indicator of COVID-19-related mortality.
Reality: COVID-19 deaths are underestimated for several reasons, including limited testing leading to underdetection of those infected and deaths occurring in the community which may not be attributed to COVID-19.
- Myth: Mobility indicators—data from mobile phones—are a direct indicator of risk.
Reality: Mobility data reflect trends in frequency and distance of travel but not much about high-risk behaviors, such as being in close contact with someone for an extended period of time indoors.
- Myth: Reproductive number (R) – how many people each case infects – is all you need to know about disease transmission.
Reality: There is no one standard way to estimate R, estimates typically have a large amount of uncertainty and wide range, and lag by 1-2 weeks or more.
- Myth: Symptom-based screening is adequate to protect every population.
Reality: The lack of symptoms does not imply a lack of infectiousness.
- Myth: Hospital and ICU bed capacity are the most useful metrics for capturing health care system readiness.
Reality: Hospital occupancy changes with seasonality, rising during influenza season and falling in other months, and changing with bed availability
- Myth: Test positivity is all you need to know about the state of COVID-19 testing.
Reality: This metric is useful in understanding whether or not a location is testing enough people to detect cases, regardless of the size of the outbreak. However, the positivity rate is not sufficient to understand testing for many reasons, including because it does not tell you whether high-risk people are getting tested.
- Myth: The most significant health impacts of the pandemic are directly related to COVID-19.
Reality: As in prior disease outbreaks, in many communities, the largest health impacts of COVID-19 may not be among those directly affected with the disease, but in the secondary disruptions of essential health services and public health programs, especially in lower-income countries. In the COVID-19 pandemic, disruptions have undermined communicable disease control programs, immunization activities, reproductive and maternal and child health activities, and non-communicable disease management.
- Myth: Everyone is an epidemiologist.
Reality: Anyone should be able to understand well-conducted epidemiological investigations and analyses. But doing epidemiology safely and well – like doing open heart surgery or architecture well – requires specialized skills and years of experience.
“It’s important to know the limitations and implications of data and how to use well-analyzed data to produce a more accurate picture of what’s happening,” said Cyrus Shahpar, a medical epidemiologist and Director of the Resolve to Save Lives Prevent Epidemics initiative, who joined Dr. Frieden at the press briefing.
“COVID-19 deaths are underestimated. Understanding how current death totals—from all causes—compare to historical averages can provide critical insight into the true scope of the pandemic and inform lifesaving policies,” said Dr. Philip Setel, the Vice President of Civil Registration and Vital Statistics at Vital Strategies.
In addition to outlining these common data misinterpretations, Dr. Frieden and his team listed some important metrics that matter that governments and communities should using to guide their COVID-19 response including:
- The number of unlinked infections
- Isolation of patients within 3 days of symptom onset
- The proportion of cases arising among quarantined contacts
- The number of health care worker infections
- Trends in excess mortality
- Where and how the virus is spreading in each community
Drs. Frieden and Shahpar also noted important findings in the Weekly Science Review by Resolve to Save Lives:
- A simple method of calculating the likely number of deaths in the coming month. Within a month, this number will pass 500,000 globally and 128,000 in the US.
- According to the latest information available, COVID-19 is as deadly as the 1918 pandemic for people over age 60 and those with underlying health conditions, but similar in severity to seasonal influenza for children.
- A comprehensive approach to safety will enable workplaces to open sooner.
- The COVID-19 pandemic, more than other events that disrupt society, may pose significant dangers to mental health through the combined direct effects of COVID-19, the effects of measures to control the epidemic such as societal or school closures, and because of the length of the disruption.
- The COVID-19 pandemic has the potential to aggravate drug and alcohol use while undermining some of the more effective service and treatment strategies. Fortunately, regulators have made it possible for providers to innovate and improve medication treatment access in the face of the twin crises of overdose and COVID-19. Some of these measures may be worth continuing indefinitely.
“Collected, analyzed and used to improve programs well, epidemiology can guide us through this public health crisis. The best public health programs use real-time data to continuously improve measures to stop the spread of infection,” added Dr. Frieden.
To watch the full video from today’s media briefing, click here.
Join Dr. Tom Frieden on Friday, June 12 at 11:15 AM EST for a LinkedIn Live conversation on what employers can do to ensure a safe and healthy work environment during the COVID-19 pandemic. Visit: www.linkedin.com/in/tom-frieden/
About Dr. Tom Frieden
Dr. Tom Frieden is former director of the US Centers for Disease Control and Prevention and former commissioner of the New York City Health Department. He is currently president and CEO of Resolve to Save Lives, a global non-profit initiative funded by Bloomberg Philanthropies, the Chan Zuckerberg Initiative, and the Bill and Melinda Gates Foundation and part of the global non-profit Vital Strategies. Resolve to Save Lives works with countries to prevent 100 million deaths and to make the world safer from epidemics. @DrTomFrieden
About Resolve to Save Lives
Resolve to Save Lives is a five-year, $225 million initiative funded by Bloomberg Philanthropies, the Bill & Melinda Gates Foundation, and Gates Philanthropy Partners, which is funded with support from the Chan Zuckerberg Foundation. Resolve received additional funding from Bloomberg Philanthropies, the CDC Foundation and the Stavros Niarchos Foundation for the COVID-19 response. It is led by Dr. Tom Frieden, former director of the US Centers for Disease Control and Prevention, and is part of the global organization Vital Strategies. To find out more visit: https://www.resolvetosavelives.org or Twitter @ResolveTSL
Resolve to Save Lives created a website called PreventEpidemics.org that shows how prepared each country is for an epidemic. This site is also a resource for current coronavirus statistics and resources.
About Vital Strategies
Vital Strategies is a global health organization that believes every person should be protected by a strong public health system. We work with governments and civil society in 73 countries to design and implement evidence-based strategies that tackle their most pressing public health problems. Our goal is to see governments adopt promising interventions at scale as rapidly as possible. To find out more, please visit vstrategystage.wpengine.com or Twitter @VitalStrat.