California and Texas show the folly of viewing this pandemic through a political lens.
The two most populous states are seeing record numbers of Covid-19 infections amid other concerning trend lines. The Golden State was hit early on by this pandemic and had taken a cautious, calibrated approach to re-opening, while the Lone Star State was one of the first to reopen and until this past week had greeted the virus with Texas swagger. Both are now recoiling as ever-more disturbing data pour in, and the coronavirus shows how little it cares about our politics.
Yet as the nation enters the summer months amid various phases of reopening, we are continuing to witness the unhealthy collision of politics and public health. Public health leaders have been harassed and threatened, as many politicians seem to rationalize reopening decisions in alignment with the cabin fever of their constituencies. But the only effective and believable arbiter of truth — and critically, the vehicle for managing the public health emergency fairly and equitably — is data.
How data will help ease the crisis
Gathered widely and distilled down to the neighborhood level, data can provide a detailed roadmap to our economic recovery while giving public health experts the information they need to make sure that the reopening of this nation does not fall hardest on America’s most vulnerable populations. It can be useful in both supporting decisions to reopen, or in holding decision-makers accountable for hasty and ill-informed judgments. It can ensure that a new case in a neighborhood does not become an outbreak that overwhelms the local healthcare system and causes preventable harm. Amid our ongoing national conversation about systemic racism and the reckoning with our nation’s past, we must recognize that these data deficits that vary greatly state to state and locality to locality will lock in our disturbing status quo, and the reopening of America will be erratic, unsafe and profoundly unjust.
As acting director of the Centers for Disease Control and Prevention during the 2009 H1N1 pandemic, I saw the immense value of data gathering. When we first learned that an unusual respiratory illness was spreading in Mexico, we saw hospitals overrun with pneumonia patients and people dying at a very high rate. We thought we might be facing a pandemic as serious as the 1918 flu. But if hospitals are the only places data are gathered, almost every case is severe. Until the CDC and the World Health Organization, working with the Mexican government, were able to go out into neighborhoods to collect data, we didn’t know that this particular strain was not as lethal as we initially believed. Many patients were being hospitalized, but most in the community were doing well. What we didn’t know is what we couldn’t see — and this is precisely the predicament in the U.S. today.
A glance at the weekly COVIDView from the CDC shows how the initial hopes that the pandemic would wilt in the summer heat have quickly evaporated. These recent upticks, unaccompanied by the granular data we need, likely are unfolding in ways that continue to disproportionately impact communities of color and low-income workers. Unless we collect, analyze and report testing data by age, race, ethnicity, gender, disability, income, and other sociodemographic characteristics, we’re setting ourselves on a path to recovery that will exacerbate the already widespread health and economic disparities nationwide. And without significant action this summer, states will be ill-prepared for what awaits us this fall.
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The CDC understands the value in such data, and its recommendations on data collection released this month include the basics — race, ethnicity, age, sex, and ZIP code — and are a sound starting point. But the CDC does not have the power of enforcement. Troublingly, it has not been allowed to effectively use the public stage to implore, convince, and influence actions during this pandemic. So it falls to states with wide gaps in capacity and funding to implement these recommendations. Federal dollars should flow to state and local health districts to make this happen, lest the recommendations simply become unheeded advice.
Data will help the U.S. know how to reopen
We’ve already seen in just a few months how a better data infrastructure could have improved the ill-fated U.S. pandemic response. In places that were reporting data by race and ethnicity, for instance, we were able to see the disproportionate impact on Black, Latino, and Native Americans. And though some of our nation’s challenges have been exacerbated by a lack of preparedness and a shortage of resources, a dearth of data compounded these gaps. If we had had a system in place to track data from community clinics and other points of care and act on that data, there’s no telling how many lives and how much suffering could have been averted. There’s no telling where we would be on our journey toward economic recovery.
Though much is still unknown about the novel coronavirus, we have a sense of how to contain it. Test widely and aggressively, then identify the infected and their contacts. Isolate the infected until cleared, and quarantine those exposed for 14 days. But none of this works well, as New York City has learned, without social supports for the impacted, trust in our institutions, and the data to inform the response. None of this works well, we know, if the very people we need to follow CDC’s guidelines can’t do what’s asked of them to protect the greater community.
One of the best ways to know if the level of testing is adequate is to track the percentage of tests that are positive. The WHO recommends that we test 10 times the number of people who actually have the disease. Doing so will allow us to detect even mild cases, but this singularly most important data point must be interpreted carefully. A high positive rate could mean a shortage of testing of mildly ill patients — or it could mean widespread disease. Disease transmission can only be controlled equitably if this 10% positive rate benchmark is achieved for every demographic group in every community — and if the data are reported with enough granularity to inform decisions to reopen. Without this data, our political leaders across the spectrum can spin the numbers however they please — and today, they’re doing just that.
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In the months ahead, as we see images of people crowding beaches, restaurants buzzing with activity, and interstates swelling with summer traffic, it’s worth remembering what we’re not seeing. Some states or cities might look like things are under control, but what’s happening at the neighborhood level, particularly in communities of color, could be another story. Data provide us a window into the places where historic structural impediments have limited people’s opportunities to live and thrive, and it will help us to see and serve the people and places we have repeatedly, and throughout our history, neglected.
Richard E. Besser, a physician, is president and CEO of the Robert Wood Johnson Foundation and former acting-director of the Centers for Disease Control Follow him on Twitter: @DrRichBesser