We're still in the early phase of the outbreak, when decision-makers need to make snap judgments that could have large implications - closing schools, canceling public events, mandating telework. Leaders in cities, at schools, in corporate offices - and even individuals - should have the numbers they need to understand what's happening around them.
Health officials should commit to publishing daily updates of five key data points:
* How many people are known to be infected? All states currently publish this information, but some are slow to update. The Centers for Disease Control and Prevention updates its coronavirus tracking data Monday-Friday only.
* How many people have been tested?
* Health conditions of the ill: how many recovered, remain hospitalized or in critical care, or have died?
* Where the outbreaks occurred. That is, which towns and counties?
* How did people acquire COVID-19? For example, international travel and contact; specific events or facilities; "community spread"
Many countries suffering from the disease, including Italy, South Korea, France and Singapore, provide such crucial details about the progression of the epidemic. By comparison, the public website of the CDC is scandalously incomplete. It reports the number of people confirmed to have the disease, how many have died from it and the number of known cases in the states. But the CDC site doesn't report the number of people who have been tested. It doesn't tell us how many people have been hospitalized or how many have recovered.
Enterprising journalists have attempted to piece together some of this information from disparate sources, but only government agencies whose health workers are on the front lines can collect and provide definitive information.
America's public health system is highly decentralized. State and local health agencies are on the front lines. They report to the CDC and the CDC should do a much better job of informing Americans about the details of the new coronavirus. But we cannot wait for the CDC and its political masters to make transparency a priority. State and local health agencies can act now to provide more information to Americans, and they should do so.
According to state health department sites, about 5,800 people in America have been tested for COVID-19 as of March 12, 2020. But that estimate is not accurate because about one-third of states do not report the total number of people who have been tested. Knowing the total number tested would enable us to compare our government's performance to other countries. The daily update of the South Korean health authorities reported that they had tested 209,402 people as of March 12.
Knowing the total number tested in particular places would also help us interpret the number found to be COVID-19 positive. If 20 people have tested positive but only 30 tests have been administered because few test kits are available, then we might suspect that there are many more untested sick people out there. Several health departments of states hit hard by coronavirus fail to disclose regularly the number of people who have taken COVID-19 tests. Perhaps authorities fear that people may panic or misinterpret the low testing rates.
On Monday, North Carolina State Senator Jeff Jackson took the opposite approach. He decided to be very direct about the testing constraints: "laboratory supplies we have on-hand from the CDC are only adequate to test approximately 150 individuals. Additional supplies en route to NC, however those incoming shipments will only allow us to test an additional 500 people - far below CDC guidance," he announced on Twitter.
The Oregon Health Authority provides many useful data points for Oregonians to understand the impact of coronavirus and the state's management of it. Its dashboard includes the number of positive and negative tests, the number of pending tests, the number of people under public health surveillance, the counties where infected people live, and the ages of those who are ill (58 percent of Oregonians found to have the disease are older than 55 but only one person is under 18).
Very few health departments systematically report how the infected are faring. The Snohomish Health District in Washington state offers an example that others should follow. They report the number of people who are hospitalized, in home isolation, and have recovered. They also tell residents how those who are ill likely acquired the disease: some through travel, but many through contact with specific elder care facilities.
State health departments should also systematically report the places where sick people are and, when possible, how they got sick. On Tuesday, New York state reported a total of 173 positive cases. It helps to know that 108 of them are concentrated in Westchester County. We know these details only because the New York Public Health department has chosen to provide regional information. Ninety two people have tested positive in Massachusetts. That health department is reporting that 70 of those people can be traced to a single Biogen corporate gathering. Unfortunately, only about half of state health department sites currently provide this kind of localized data or information about paths of transmission.
Suffering from decades of budget cuts, state and local health departments are under-resourced and overwhelmed by the greatest health crisis in our lifetime. Nevertheless, they should provide the public with timely, detailed information about the effects of coronavirus and our response to it. Some - such as the Oregon Health Authority and Snohomish Health District - provide models that others should follow. Such information would enable those in positions of responsibility - school superintendents, university administrators, restaurant managers, large employers or store owners and many others - to make more informed decisions about closures, event cancellations and other social distancing measures. In places with ample testing but few positive cases - if any places are so fortunate - people might not need to take measures as severe as those in states stricken with outbreaks.
Better information would help employees, parents and other citizens to understand why such decisions are being made and why their lives are being disrupted. That information would help mobilize an informed civic response to the new coronavirus. We know that slowing the spread requires hundreds of millions of people to change their behavior: to wash hands, to avoid certain places and large events, to stop visiting loved ones in care facilities, and to refrain from hoarding scarce medical supplies.
In the social media era, providing more facts about the reality of COVID-19 will help increase accountability and trust while reducing misinformation and confusion. Though most citizens do not browse public health department websites, journalists and activists would be able to ground the stories they write about the crisis in more accurate data and so increase public understanding. Is the testing drought easing? Which states have better and worse health outcomes? What can we all learn from more successful states? Full information should be the foundation of public accountability.
Transparency is key to sustaining trust between citizens and government. And we will need that trust to get us to the other side of this crisis.
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