As shutdowns loom, report says poor COVID-19 data hampered US response

As COVID-19 cases, hospitalizations, and deaths rise across the country, several US cities are starting to tighten their restrictions on businesses, and some cities and counties are on the verge of returning to lockdowns.

The US COVID-19 case total rose to 3,858,686 today, including 141,426 deaths, according to the Johns Hopkins University coronavirus tracker.

Meanwhile, a report today overseen by former Centers for Disease Control and Prevention (CDC) Director Tom Frieden, MD, argues that incomplete and inconsistent COVID-19 data from states, along with the absence of national leadership, is behind the poor US response to COVID-19.

The report comes as CDC data suggest that the number of people infected with the coronavirus in different parts of the country is likely far higher than the number of reported cases (see related CIDRAP News story).

Chicago closing some bars; LA might shut down

Among the cities tightening restrictions in the face of rising cases is Chicago, where Mayor Lori Lightfoot yesterday announced that bars that serve only alcohol will be shut down, indoor fitness classes will be capped at 10 people, restaurants can only allow groups of no more than 6 people indoors, and renters will not be allowed to have more than 5 guests at a time. The restrictions go into effect Jul 24.

"The goal, of course, is to take focused actions now that are able to keep us from having to take a very large step backward," Chicago's Commissioner of Public Health, Allison Arwady, MD, MPH, said at a press conference, according to WBEZ.

In hard-hit Texas, meanwhile, Hidalgo County Judge Richard Cortez issued an emergency order Monday night mandating that county residents shelter at home, restrict travel, and limit gatherings, the Texas Tribune reports.

The order came after the county, the eight largest in the state, reported that 524 people tested positive for the virus, bringing the total number of infections to 12,787. The mandate, however, has no enforcement mechanism, Texas Gov. Greg Abbott said.

Los Angeles Mayor Eric Garcetti has also said in recent days that his city may be on the verge of shutting down again because it is currently at high risk, according to the city's Threat Level Indicator. Under the next level on the indicator (extreme), city residents would be advised to stay home and avoid contact with others unless they are performing essential services.

LA County Department of Public Health officials reported 3,160 new cases on Monday, with 2,232 COVID-19 patients currently hospitalized, the highest number of hospitalizations the county has seen in a single day since the pandemic began.

Critical gaps in state data

A report released today by Resolve to Save Lives is the first to take a comprehensive look at the COVID-19 data that all 50 states, the District of Columbia, and Puerto Rico are using to track and control the virus.

The analysis of COVID-19 dashboards found several critical gaps, with incomplete and often inconsistent data. Nearly 40% of states do not provide any information other than new or cumulative confirmed cases, and some don't specify whether a case is probable, confirmed, or recovered.

Not a single state reports turnaround time for diagnostic tests, while just two states report how quickly contact tracers were able to interview people testing positive. Only 18% and 37% of states are reporting on influenza-like illness (ILI) and COVID-like (CLI) illness, respectively, two important indicators of potential COVID-19 spread.

The analysis also found that one-third of states don't report data on outbreaks in congregate care facilities such as nursing homes and meatpacking plants, which have driven the spread of the virus in many communities. And many of the dashboards are difficult to navigate, making it hard to find key information.

"The lack of common standards, definitions, and accountability reflects the absence of national strategy, plan, leadership, communication, or organization and results in a cacophony of confusing data," Resolve to Save Lives President and CEO and former CDC director Frieden said in a statement. "By tracking essential metrics publicly in all states, we can build the transparency and accountability essential to make progress."

The report defines a set of 15 essential indicators state dashboards should track and make public, either immediately or as soon as possible, that would help people better understand how their states are doing in controlling spread of the coronavirus, what that means for their own risk, and what's being done to reduce that risk.

The indicators include new confirmed and probable cases and per capita rates by date, with a 7-day moving average; percentage of cases epidemiologically linked to at least one other case; the number of new polymerase chain reaction tests per capita; the percentage of positive tests by date and test turnaround time; ILI and CLI trends from emergency departments; per-capita COVID-19 hospitalization rates; and indicators on outbreaks in congregate care facilities and essential workplaces.

An ideal state data dashboard would include all 15 essential indicators, the report said, and the ability to drill down on the data.

Vaccine hearing

Also today, in the wake of yesterday's release of promising data on two COVID-19 vaccine candidates, members of a House subcommittee questioned executives from Moderna, AstraZeneca, Merck, Pfizer, and Johnson & Johnson about their companies' efforts to develop a safe and effective vaccine. The first question the executives faced was whether a vaccine could be ready for distribution by the end of the year.

While hesitant to commit to that timeline, two officials expressed optimism about their vaccine candidates.

Menelas Pangalos, PhD, executive vice president of biopharmaceutical research and development at AstraZeneca, which is working with Oxford University on a vaccine candidate, said his company was very encouraged by data published yesterday that showed a strong immune response and tolerability in volunteers in a phase 1/2 trial and hopes that data from an upcoming phase 3 trial could result in Food and Drug Administration (FDA) approval.

"If we have efficacy data, we hope that [FDA approval] will happen any time from September onward," Pangalos said.

Stephen Hoge, MD, president of Moderna, said he was "cautiously optimistic" about the vaccine candidate being developed with the National Institute of Allergy and Infectious Diseases.

"We would hope in the fall, or towards the end of the year, we'd have data that we could submit to the FDA for them to make a determination on whether to approve," Hogue said. "We would also hope at that point to have millions of doses of vaccine available."

Officials were also pressed on the question of safety and concerns that the accelerated timeline for developing a vaccine that will end the pandemic could mean sacrificing safety.

"We do believe it's possible to deliver a safe and effective vaccine," said Macaya Douoguih, MD, MPH, head of clinical development and medical affairs at Janssen Vaccines, a division of Johnson & Johnson. "A lot needs to be done in parallel, but it can be done safely and without compromising any of the standards that we usually undertake for any clinical trial."

But Douoguih noted that post-marketing surveillance may be needed to monitor for any safety issues after a vaccine is approved.

The five executives did not promise to make their vaccines available for free or pledge that their companies would not profit from a vaccine.

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