An unusually active hurricane season has brought devastation and fear all too familiar to America’s coasts.
But with early warning systems in place, we are able to shore up our defenses. The National Weather Service forecasts storms from their nascent stages far away in the ocean, allowing us to benefit from increasingly serious real time warnings and deploy the National Guard to assist with evacuation and recovery. From hurricanes to tsunamis, early warning systems are critical infrastructure that saves lives.
But when it comes to the Category 5-like disaster that is COVID-19, our forecasts fall short. In contrast to hurricane preparedness, our disease response strategy has been akin to waiting for the winds before boarding up the house. We need a robust national early warning system capable of identifying disease hotspots so we can contain them before they spin out of control.
Currently, our national response relies on a patchwork of incomplete information. On the cusp of a new school year, attempts at data-driven reopenings are resulting in chaos: Colleges and universities have seen nearly 30,000 cases and many reopened public schools were forced to close just as quickly. Nearly six months into this crisis, the path forward remains hazy — but the staggering death count is crystal clear.
On the bright side, there is some progress. Despite delays, testing is more widespread. Some cities and states are ramping up treatment, isolation and contact tracing protocols. The federal government has put its full weight behind the most ambitious vaccine development effort in history.
These steps are critical, but ultimately, they are reactive to conditions on the ground. To get back to normal life and to keep economies open, we need to be proactive and be a step ahead of the virus. We have the necessary tools to build an early warning system. Such a system would allow leaders to target interventions exactly when and where they are needed, while sparing unaffected areas from economic hardship. But we have yet to deploy these tools.
To date, most COVID-19 forecasting is based on what the health care system knows: test results, hospitalizations and deaths. But by the time we see the numbers, the picture has changed. If someone has tested positive, gone to the doctor or died, that means they have had the virus long enough to spread it. Imagine a household where multiple people fall ill, but only the last person becomes sick enough to seek care after an incubation period which can extend to 14 days. That person gets a test and potentially waits another two weeks for a result. All the while, the first mildly symptomatic family member has been spreading the virus. Now, imagine a family without insurance, as is true for so many of those affected. Do they ever get tested? Shouldn’t we know about these cases before they show up at the hospital, or worse?
I don’t envy public officials facing critical decisions about whether to delay the school year or shut down the economy based on data that is weeks behind the virus. The reality is, you just can’t stop an outbreak before it becomes an epidemic — or a pandemic — if you don’t know where it’s starting or how fast it’s spreading.
However, early warning technology exists. Innovators like Flu Near You, Healthmap.org and Kinsa, where I am an advisor, are helping public health officials identify outbreaks of influenza-like illness weeks before traditional systems, while there is still time to do something about it. Aggregated data from tools that people use before they enter the health care system can paint a clear picture of where COVID-19 hotspots are developing, weeks before official case counts tick up.
Knowledge is power. Early warning means governments can know exactly when to tighten restrictions and advise people to take precautions — and when it may be okay to relax, allowing us to recharge and more effectively prepare for a future wave. Early warning will also help us know precisely where to focus the distribution of tests, treatments, vaccines and other critical resources for greatest impact.
This pandemic revealed a gaping hole in our public health infrastructure. While there’s no such thing as “outsmarting” a virus, we can make smarter decisions that give us the best chance to keep it at bay until we have a vaccine. We need to embrace early warning systems that will give us an upper hand and allow us to observe illness transmission in real time. If we can do it for hurricanes, we can do it for COVID-19. Lives and livelihoods depend on it.
Dr. Nirav R. Shah, MD, MPH, is a senior scholar at Stanford University. He is a former health commissioner for New York.