COVID-19 Data Dispatch

Tag: CDC

  • The federal public health emergency ends next week: What you should know

    The federal public health emergency ends next week: What you should know

    A chart from the CDC’s recent report on surveillance changes tied to the end of the federal public health emergency.

    We’re now less than one week out from May 11, when the federal public health emergency (or PHE) for COVID-19 will end. While this change doesn’t actually signify that COVID-19 is no longer worth worrying about, it marks a major shift in how U.S. governments will respond to the ongoing pandemic, including how the disease is tracked and what public services are available.

    I’ve been writing about this a lot in the last couple of months, cataloging different aspects of the federal emergency’s end. But I thought it might be helpful for readers if I compiled all the key information in one place. This post also includes a few new insights about how COVID-19 surveillance will change after May 11, citing the latest CDC reports.

    What will change overall when the PHE ends?

    The ending of the PHE will lead to COVID-19 tests, treatments, vaccines, and data becoming less widely available across the U.S. It may also have broader implications for healthcare, with telehealth policies shifting, people getting kicked off of Medicaid, and other changes.

    Last week, I attended a webinar about these changes hosted by the New York City Pandemic Response Institute. The webinar’s moderator, City University of New York professor Bruce Y. Lee, kicked it off with a succinct list of direct and indirect impacts of the PHE’s end. These were his main points:

    • Free COVID-19 vaccines, tests, and treatments will run out after the federal government’s supplies are exhausted. (Health experts project that this will likely happen sometime in fall 2023.) At that point, these services will get more expensive and harder to access as they transition to private healthcare markets.
    • We will have fewer COVID-19 metrics (and less complete data) to rely on as the CDC and other public health agencies change their surveillance practices. More on this below.
    • Many vaccination requirements are being lifted. This applies to federal government mandates as well as many from state/local governments and individual businesses.
    • The FDA will phase out its Emergency Use Authorizations (EUAs) for COVID-19 products, encouraging manufacturers to apply for full approval. (This doesn’t mean we’ll suddenly stop being able to buy at-home tests—there’s going to be a long transition process.)
    • Healthcare worker shortages may get worse. During the pandemic emergency, some shifts to work requirements allowed facilities to hire more people, more easily; as these policies are phased out, some places may lose those workers.
    • Millions of people will lose access to Medicaid. A federal rule tied to the PHE forbade states from kicking people off this public insurance program during the pandemic, leading to record coverage. Now, states are reevaluating who is eligible. (This process actually started in April, before the official PHE end.)
    • Telehealth options may become less available. As with healthcare hiring, policies during the PHE made it easier for doctors to provide virtual care options, like video-call appointments and remote prescriptions. Some of these COVID-era rules will be rolled back, while others may become permanent.
    • People with Long COVID will be further left behind, as the PHE’s end leads many people to distance themselves even more from the pandemic—even though long-haulers desperately need support. This will also affect people who are at high risk for COVID-19 and continue to take safety precautions.
    • Pandemic research and response efforts may be neglected. Lee referenced the “panic and neglect” cycle for public health funding: a pattern in which governments provide resources when a crisis happens, but then fail to follow through during less dire periods. The PHE’s end will likely lead us (further) into the “neglect” part of this cycle.

    How will COVID-19 data reporting change?

    The CDC published two reports this week that summarize how national COVID-19 data reporting will change after May 11. One goes over the surveillance systems that the CDC will use after the PHE ends, while the other discusses how different COVID-19 metrics correlate with each other.

    A lot of the information isn’t new, such as the phasing out of Community Level metrics for counties (which I covered last week). But it’s helpful to have all the details in one place. Here are a few things that stuck out to me:

    • Hospital admissions will be the CDC’s primary metric for tracking trends in COVID-19 spread rather than cases. While more reliable than case counts, hospitalizations are a lagging metric—it takes typically days (or weeks) after infections go up for the increase to show up at hospitals, since people don’t seek medical care immediately. The CDC will recieve reports from hospitals at a weekly cadence, rather than daily, after May 11, likely increasing this lag and making it harder for health officials to spot new surges.
    • National case counts will no longer be available as PCR labs will no longer be required to report their data to the CDC. PCR test totals and test positivity rates will also disappear for the same reason, as will the Community Levels that were determined partially by cases. The CDC will also stop reporting real(ish)-time counts of COVID-associated deaths, relying instead on death certificates.
    • Deaths will be the primary metric for tracking how hard COVID-19 is hitting the U.S. The CDC will get this information from death certificates via the National Vital Statistics System. While deaths are reported with a significant lag (at least two weeks), the agency has made a lot of progress on modernizing this reporting system during the pandemic. (See this December 2021 post for more details.)
    • The CDC will utilize sentinel networks and electronic health records to gain more information about COVID-19 spread. This includes the National Respiratory and Enteric Virus Surveillance System, a network of about 450 laboratories that submit testing data to the CDC (previously established for other endemic diseases like RSV and norovirus). It also includes the National Syndromic Surveillance Program, a network of 6,300 hospitals that submit patient data to the agency.
    • Variant surveillance will continue, using a combination of PCR samples and wastewater data. The CDC’s access to PCR swab samples will be seriously diminished after May 11, so it will have to work with public health labs to develop national estimates from the available samples. Wastewater will help fill in these gaps; a few wastewater testing sites already send the CDC variant data. And the CDC will continue offering tests to international travelers entering the country, for a window into global variant patterns.
    • The CDC will continue tracking vaccinations, vaccine effectiveness, and vaccine safety. Vaccinations are generally tracked at the state level (every state health agency, and several large cities, have their own immunization data systems), but state agencies have established data sharing agreements with the CDC that are set to continue past May 11. The CDC will keep using its established systems for evaluating how well the vaccines work and tracking potential safety issues as well.
    • Long COVID notably is not mentioned in the CDC’s reports. The agency hasn’t put much focus on tracking long-term symptoms during the first three years of the pandemic, and it appears this will continue—even though Long COVID is a severe outcome of COVID-19, just like hospitalization or death. A lack of focus on tracking Long COVID will make it easier for the CDC and other institutions to keep minimizing this condition.

    On May 11, the CDC plans to relaunch its COVID-19 tracker to incorporate all of these changes. The MMWR on surveillance changes includes a list of major pages that will shift or be discontinued at this time.

    Overall, the CDC will start tracking COVID-19 similar to the way it tracks other endemic diseases. Rather than attempting to count every case, it will focus on certain severe outcomes (i.e., hospitalizations and deaths) and extrapolate national patterns from a subset of healthcare facilities with easier-to-manage data practices. The main exception, I think, will be a focus on tracking potential new variants, since the coronavirus is mutating faster and more aggressively than other viruses like the flu.

    What should I do to prepare for May 11?

    If you’ve read this far, you’re probably concerned about how all these shifts will impact your ability to stay safe from COVID-19. Unfortunately, the CDC, like many other public agencies, is basically leaving Americans to fend for themselves with relatively little information or guidance.

    But a lot of information sources (like this publication) are going to continue. Here are a few things I recommend doing this week as the PHE ends:

    • Look at your state and local public health agencies to see how they’re responding to the federal shift. Some COVID-19 dashboards are getting discontinued, but many are sticking around; your local agency will likely have information that’s more tailored to you than what the CDC can offer.
    • Find your nearest wastewater data source. With case counts basically going away, wastewater surveillance will be our best source for early warnings about surges. You can check the COVID-19 Data Dispatch list of wastewater dashboards and/or the COVIDPoops dashboard for sources near you.
    • Stock up on at-home tests and masks. This is your last week to order free at-home/rapid tests from your insurance company if you have private insurance. It’s also a good time to buy tests and masks; many distributors are having sales right now.
    • Figure out where you might get a PCR test and/or Paxlovid if needed. These services will be harder to access after May 11; if you do some logistical legwork now, you may be more prepared for when you or someone close to you gets sick. The People’s CDC has some information and links about this.
    • Contact your insurance company to find out how their COVID-19 coverage policies are changing, if you have private insurance. Folks on Medicare and Medicaid: this Kaiser Family Foundation article has more details about changes for you.
    • Ask people in your community how you can help. This is a confusing and isolating time for many Americans, especially people at higher risk for COVID-19. Reaching out to others and offering some info or resources (maybe even sharing this post!) could potentially go a long way.

    That was a lot of information packed into one post. If you have questions about the ending PHE (or if I missed any important details), please email me or leave a comment below—and I’ll try to answer in next week’s issue.

    More about federal data

  • COVID source callout: Spread at a CDC conference

    This past week, the CDC hosted a conference of about 2,000 people in the agency’s epidemic intelligence service. It was the first time this conference was held in-person since the pandemic started, and it appeared to take place with fairly limited (if any) COVID-19 precautions.

    And at least a few of the conference’s attendees tested positive for COVID-19 afterward, according to reporting by Dan Diamond at the Washington Post. While a CDC spokesperson told Diamond that the cases are “reflective of general spread in the community” and “should not be referred to as an outbreak,” it’s obviously not a great look for the agency to have virus spread at a conference intended to celebrate progress over COVID-19.

    These cases—and the CDC’s communication around them—add to a growing pattern of downplaying continued coronavirus transmission. The CDC is essentially saying it’s normal to risk COVID-19 at any large event going forward, even if that event is run by people who should, theoretically, have a good understanding of how to keep its attendees safe.

    Epidemiologist Ellie Murray elaborates on this idea in a Twitter thread about the situation:

    more source spotlights
  • CDC shifts away from COVID-19 Community Levels with the federal emergency’s end

    CDC shifts away from COVID-19 Community Levels with the federal emergency’s end

    The CDC’s Community Levels suggest (perhaps inaccurately!) that the U.S. has little to worry about from COVID-19 right now. The agency is set to stop calculating these metrics next month.

    As we’ve gotten closer to May 11, the official ending of the federal public health emergency for COVID-19, I’ve tried to collect news on how this change will impact COVID-19 data availability. We know, for example, that the CDC will lose some of its authority to collect data from state and local health agencies, and that PCR testing numbers will become even less accurate.

    This week, another key change became public: the CDC will stop reporting COVID-19 Community Levels, according to reporting by Brenda Goodman at CNN. The agency is overall planning to shift from using case data to hospitalizations and wastewater surveillance.

    The CDC’s Community Levels are county-level metrics based on cases and hospitalizations. In February 2022, the agency switched to these metrics from its prior Transmission Levels (which were based on cases and test positivity), and essentially changed its national COVID-19 map from bright red to pastel green-yellow-orange overnight.

    Community Levels have generally made the U.S.’s COVID-19 situation look better than it really is over the last year, since these metrics relied on hospitalizations, a lagging indicator, and were set to high thresholds for recommending safety measures. Even so, the metrics gave Americans an easy way to look at the COVID-19 situation in their county or region.

    On May 11, that county-level information will no longer be available, according to Goodman’s reporting. When the public health emergency ends, the CDC will no longer be able to require COVID-19 testing labs to report their results—so this already-spotty information will become even less accurate. While test results at the national level might still be helpful for following general trends, it will be harder to interpret more local data.

    “We’re not going to lose complete surveillance, but we will lose that hyperlocal sensitivity to it perhaps,” an anonymous source at the CDC told Goodman. These more local metrics “simply cannot be sustained” due to reporting changes, the source said.

    In absence of county-level case data, the CDC plans on utilizing hospitalizations and wastewater surveillance to track COVID-19, according to the CNN report. The agency might focus on tracking COVID-19 at specific healthcare settings in a reporting network, similar to its surveillance for endemic diseases like flu and RSV, rather than trying to count every single severe COVID-19 case.

    Hospitalization data tend to lag behind cases, so wastewater surveillance will be important to provide early warnings about potential new coronavirus variants or surges. However, the country’s wastewater surveillance network is still patchy: some states have a sewage testing site in every county, while others only have a handful. Our data will be biased, based on which health departments have invested in this technology.

    It’s unsurprising to see the CDC plan this COVID-19 reporting change, given the powers it will lose on May 11. But I’m still disappointed. I’ve followed the U.S.’s incomplete surveillance for endemic diseases, and I hoped that continued COVID-19 tracking would provide an opportunity for improvement. Instead, it looks like we’re going to revert to something like our flu tracking, with wastewater surveillance unevenly tacked on.

    The May 11 changes will inevitably have a huge impact on the Americans who are still trying to stay safe from COVID-19, especially those with health conditions that make them more vulnerable to severe symptoms. Without reliable data, people will be unable to identify when spread is high or low in their community. I expect some will simply shrug off the risks (but may regret that choice later), while others will anticipate that COVID-19 is everywhere, all the time, and retreat from public activities.

    And from the public health perspective, less data will make it harder to identify concerning new variants or potential surges. For more on these challenges, I recommend this article by KFF Health News reporter Sam Whitehead, published in CNN and other outlets.

    “We’re all less safe when there’s not the national amassing of this information in a timely and coherent way,” Anne Schuchat, former principal deputy director of the Centers for Disease Control and Prevention, told Whitehead.

    More on federal data

  • Sources and updates, April 23

    • External review of the CDC: The People’s CDC, a group of public health experts, scientists, and educators dedicated to advocating for increased COVID-19 precautions, released a new report reviewing the federal CDC’s actins during the pandemic. The report incorporates feedback from a survey of almost 500 experts and from over 200 reports. Overall, the People’s CDC “found that the CDC has prioritized individual choice and short-term business interests over sharing accurate scientific evidence with the public and protecting population health.” (Disclaimer: I was one of the experts surveyed for this report!)
    • Use of COVIDTests.gov: This new paper, published in the CDC’s Morbidity and Mortality Weekly Report (MMWR), reports on how Americans used COVIDTests.gov, the USPS/HHS effort to distribute free at-home tests. Since the site’s launch in January 2022, about one in three U.S. households received a test kit from this program, the research team found. They also found that this program may have helped improve equity in COVID-19 test access, as Black and white Americans utilized the free tests at similar rates. Of course, the program has been discontinued as of this spring.
    • Impact of racial discrimination on vaccination: Speaking of health equity: another report published in MMWR this week shares a correlation between discrimination and vaccination status. Researchers at the CDC and their collaborators analyzed data from the CDC’s National Immunization Survey, including about 1.2 million survey results from April 2021 through November 2022. Among the respondents, people who reported experiencing racial or ethnic discrimination in a healthcare setting were less likely to be vaccinated for COVID-19. The findings confirm many health experts’ equity concerns from early in the vaccine rollout.
    • Declining childhood vaccinations worldwide: Vaccine equity is a concern on the global scale, too. A new report from UNICEF shows that 67 million children worldwide missed at least one vaccination between 2019 and 2021, as healthcare systems were strained. The report also presents new data on global confidence in childhood vaccines: in some countries, this confidence has dropped by up to 44 percentage points. Vaccine confidence only improved in three countries (China, India, and Mexico). “The threat of vaccine hesitancy may be growing,” UNICEF warns.
    • Healthcare workers present while sick: One more paper that caught my attention this week: researchers at the Veterans Affairs healthcare system in Boston tracked a cohort of about 4,000 healthcare workers between December 2020 and September 2021. In addition to PCR testing, the workers conducted daily COVID-19 symptom reviews, and received guidance to stay home or leave work if they didn’t feel well. But the researchers found that many workers didn’t actually stay home: among 255 workers who had symptomatic COVID-19 during the study period, almost half reported that they were present, at work, at the time they received a positive test result. The paper indicates why it’s important to keep masks in healthcare settings, even when community cases are lower.

    All featured sources

  • FDA and CDC simplify COVID-19 vaccine guidance

    This week, the FDA made some adjustments to the U.S.’s COVID-19 vaccine guidance in order to standardize all new mRNA shots to bivalent (or Omicron-specific) vaccines, and to allow adults at higher risk to receive additional boosters. The CDC’s vaccine advisory committee and Director Rochelle Walensky both endorsed these changes.

    Here are the main updates you should know. For more details, I recommend reading Helen Branswell’s reporting in STAT News and/or Katelyn Jetelina’s coverage in Your Local Epidemiologist.

    • Adults are now considered “up to date” on their COVID-19 vaccines if they have received at least one dose of a bivalent/Omicron-specific vaccine. These are the vaccines manufactured by Pfizer and Moderna that became available last fall.
    • Any unvaccinated adult should receive one dose of a bivalent vaccine, rather than the former primary series (which was based on the original coronavirus strain). The prior vaccines will essentially go out of use in the U.S.
    • Seniors (65 or older) and immunocompromised adults may receive an additional bivalent vaccine dose, starting at four months after their prior dose. Recent research has demonstrated that protection from these shots wanes over a couple of months, so there’s a good case for seeking out a new booster if you fall into one of these high-risk categories.
    • Immunocompromised adults may receive more bivalent doses going forward, in consultation with their doctors. This guidance intends to provide more protection to people who are severely immunocompromised, such as those undergoing cancer treatment.
    • A new version of the bivalent booster will likely be available in the fall, designed to protect against more recent coronavirus variants. We don’t know much about this yet, but prior FDA and CDC meetings have suggested it will roll out on a similar schedule to the annual flu shot.

    These recommendations mostly apply to adults. While the FDA and CDC are also working on simplifying their guidance for children (to similarly prioritize vaccines aligned to current variants), that’s still a more complicated situation right now. See the YLE post for more details.

    Another open question, at the moment, is what non-mRNA vaccines may be available, for people who may be allergic to those vaccines or who had severe reactions to earlier doses. Novavax is reportedly working on a bivalent/Omicron-specific option, which people might be able to get this fall. The Johnson & Johnson vaccine is no longer widely used at all.

    It makes sense for the FDA and CDC to shift towards bivalent vaccines. Numerous studies have demonstrated that these vaccines perform better against Omicron variants, and this move simplifies the immunization process for everyone involved (doctors, pharmacies, patients, etc.).

    However, this shift reveals how poorly the bivalent booster rollout has gone in the U.S. so far. Only 17% of the population has received one, compared to 81% who’s received at least one dose overall, according to the CDC. Even among seniors, only 42% have received a bivalent booster. It would be a massive task for the country to move towards “up-to-date” coverage among all adults.

    And the federal government doesn’t appear to be pushing for this in any meaningful way. I’ve already seen several reports on social media of people trying to get an additional booster, and failing—whether because of an insurance issue or because pharmacies have simply stopped offering the shots. This process will only get more challenging when the federal public health emergency ends next month. While the Biden administration has announced funding to cover vaccines for uninsured Americans, that’s just one hurdle among a growing number.

    More vaccine coverage

  • COVID source callout: Iowa ends COVID-19 case reporting

    As of April 1, Iowa’s state health department is no longer requiring public health laboratories to report positive COVID-19 test results—and no longer reporting statewide data to the CDC. This decision, announced in late February, is part of a growing trend away from relying on case data as people use at-home tests instead of PCR tests.

    Iowa’s health department “will continue to review and analyze COVID-19 and other health data from several sources,” including hospitalization metrics and syndromic surveillance, according to the agency. It’s essentially treating COVID-19 similarly to the flu and other common respiratory viruses.

    As a result of this change, Iowa is now no longer reporting COVID-19 case data to the CDC, the national agency said in this week’s data update. National, regional, state, and county-level CDC data exclude the state of Iowa, starting on April 1.

    This move seems like a natural extension of the state health reporting changes that we’ve seen across the country since last spring. I wouldn’t be surprised if more state health departments similarly stop reporting every COVID-19 case when the federal health emergency ends in May. Unfortuantely, this will become another driver of increasingly-less-reliable COVID-19 data in the U.S.

    more source spotlights

  • Sources and updates, April 2

    • CDC publishes list of archived data pages: As the CDC prepares to shift its COVID-19 data publication efforts when the federal public health emergency ends in May, the agency has published a list of COVID-19 data and visualization pages that are no longer receiving updates. These archived pages include vaccination demographics, COVID-19 outcomes among pregnant people, data from correctional facilities, and more. I expect the list will get longer as we approach May 11, though the CDC is still updating core COVID-19 metrics (like cases, deaths, wastewater surveillance, etc.).
    • One federal COVID-19 emergency may end sooner: Speaking of ending emergencies: you might have seen some news this week about a Republican bill to end COVID-19’s emergency status, which President Biden has announced he would not veto if it comes to his desk. It’s important to note that this is actually a different emergency declaration than the public health one, which is under the control of the federal Department of Health and Human Services (HHS). The public health emergency is still slated to end on May 11, and its implications for COVID-19 tests, treatments, and vaccines have not changed. Also, related: this story in STAT explains the federal funding that’s currently left over for COVID-19 response.
    • Firearm injuries rose during COVID-19: A new report from the CDC shows how emergency department visits due to firearms rose during the pandemic. Compared to a 2019 baseline, these vitis were 37% higher in 2020, 36% higher in 2021, and 20% higher in 2022, the researchers found. Firearm injuries and deaths are another example of how COVID-19 contributed to higher excess morbidity and mortality; while these injuries weren’t directly caused by the coronavirus, they may be connected to the social and economic unrest that the U.S. faced over the last three years.
    • County Health Rankings 2023: This week, the County Health Rankings initiative at the University of Wisconsin Population Health Institute released its 2023 data. These rankings cover a wide array of health-related metrics, from health behaviors like alcohol and drug use to physical environment factors like air quality. The database may be a helpful resource for reporters or researchers looking to understand how their communities compare to others, while the organization’s 2023 report offers national health trends.
    • Global health workforce statistics: This database from the World Health Organization details how many health workers are employed around the world and over time. Statistics cover a variety of different health professions (doctors, specialists, nurses, dentists, pharmacists, etc.) and up to 20 years of data, depending on the country. While the dataset doesn’t cover through the pandemic—2020 is the most recent year included —it still shows how health workers have declined in many places over the last couple of decades. (H/t Data Is Plural.)
    • Public health worker declines: Speaking of health workers: a new study, published in the journal Health Affairs, shows how the public health workforce in the U.S. has severely declined during the pandemic. The researchers used data from a workforce survey conducted in 2017 and 2021, comparing past “intent to leave or retire” with actual rates of workers leaving. Nearly half of the state and local public health workers in the survey sample left between 2017 and 2021, the researchers found. This paper shows how recruitment and retention among health workers drastically needs improvement.

    All featured sources
  • How wastewater surveillance is funded, and concerns for its future

    How wastewater surveillance is funded, and concerns for its future

    My attempt to explain the wastewater surveillance funding ecosystem in one diagram. (Credit: Betsy Ladyzhets)

    This week, I have a new story out in Scientific American about why the wastewater surveillance infrastructure built during the pandemic may not last in the long term. While current monitoring projects aren’t likely to go anywhere right now, issues with funding, uneven commitments at state and local levels, and the overall novelty of this field may lead those programs to shut down in the coming years.

    Here’s the story’s opening paragraphs:

    During the past three years of the pandemic, testing sewage water for the virus that causes COVID has become a valuable tool: it has spotted surging infections and new variants weeks before they showed up in medical clinics, for instance. The technology has also warned of other health threats such as seasonal viruses and increased opioid use.

    But now its long-term ability to protect public health is in jeopardy. Funding uncertainty from the federal government and uneven commitments from state health departments have raised the specter that wastewater monitoring programs may shut down in the future.

    The U.S. Centers for Disease Control and Prevention’s National Wastewater Surveillance System (NWSS), which includes the majority of wastewater testing sites in the U.S., is “fully funded through 2025,” says Amy Kirby, director of the program. But after that, “new sources of sustainable funding” are needed, Kirby says, ideally through the CDC’s regular budget rather than resources tied to COVID. Uncertainty about money—along with logistical challenges and questions about how to interpret data from this relatively novel source—has made some state governments hesitant to invest in the technology, leading to an uneven national system.

    My reporting for this piece involved interviews with the CDC, state and local public health agencies, and other major wastewater organizations (Biobot, WastewaterSCAN). I learned a lot about the overall ecosystem for funding wastewater surveillance, including a lot of somewhat-technical details that didn’t make it into the SciAm story. So, I’m sharing some of those details here.

    Where wastewater surveillance funding comes from:

    The primary funder for wastewater monitoring programs across the U.S. is CDC NWSS. The CDC itself received funding through the American Rescue Plan in 2021, sufficient to fully fund NWSS through 2025.

    That CDC funding has gone in two main directions. First, the CDC has funded state and local public health agencies to set up (and maintain) their own wastewater testing projects. This is how most of the states with robust programs (places like New York, Utah, Virginia, Ohio) have funded their efforts. State and local health agencies may also receive funding from their own local governments, though most of the agencies I talked to for my story said they were primarily relying on the CDC. New York State is one major example of a state government funding wastewater surveillance right now.

    And second, the CDC has set up national contracts with wastewater testing companies to supplement NWSS in places where monitoring otherwise might not be happening. The agency first contracted with LuminUltra in early 2022, then switched to Biobot Analytics last spring. Earlier this year, Biobot’s contract with the CDC was extended for six months, through July. After that, the agency plans to enter a new, five-year contract with a wastewater testing company that will cover COVID-19 as well as other emerging diseases, like mpox. This contract could go to Biobot or another company; the CDC is currently going through an application process.

    Biobot and other private companies like it are also receiving funding from private sources, such as venture capital firms. In addition, individual water treatment facilities, local governments, and even businesses might set up contracts with private companies to help them test the wastewater in their jurisdiction. For example, Toronto’s Pearson Airport has contracted with LuminUltra to test wastewater from the airport terminals. In these cases, funding is coming from the specific organization that wants testing, rather than a larger program. Biobot also tests at hundreds of sites for free through its Biobot Network, in exchange for sharing the data publicly.

    Finally, there’s a whole separate ecosystem of academic wastewater surveillance efforts, mostly run by university labs or research centers. WastewaterSCAN is the biggest example of this right now; the project was founded at Stanford and Emory Universities, but has since expanded through grants and philanthropic funding to cover about 150 sites across the country. Most academic projects either partner with specific treatment facilities in their areas or test the sewage on their campuses—SCAN is an exception with its broader scale.

    Concerns for wastewater surveillance’s long-term future:

    As you can probably tell by this description of the funding landscape, wastewater surveillance in the U.S. is pretty complicated. When scientists started testing wastewater for SARS-CoV-2 in spring 2020, this was basically a grassroots effort with different research projects across the country trying out different things. CDC NWSS has worked hard to compile data into one national system and develop standards, but the system is still far from unified.

    For the CDC program to continue its efforts, the agency needs more long-term funding—and this funding shouldn’t be tied to COVID-19. The potential for wastewater surveillance to inform public health decisions goes far beyond this pandemic, and funding should reflect that potential; also, no COVID-specific funding packages have passed Congress since the American Rescue Plan, in 2021.

    One way Congress could do this would be by expanding a funding system called “Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases,” or ELC. Most wastewater grants to state and local health agencies over the last couple of years have gone through ELC, though the funding came from the American Rescue Plan. Many of the health officials I talked to for my story like ELC, know how to fill out the annual applications, and would want to keep using it to receive wastewater funding.

    Before the pandemic, the ELC program was drastically underfunded, I learned from experts at the Association of Public Health Laboratories (APHL). States’ applications historically “vastly exceed the money that CDC is given to put out for them,” APHL policy officer Peter Kyriacopoulos told me. APHL recommends that Congress should expand the program’s funding from $300 million per year (its pre-pandemic benchmark) to $800 million per year, or more. The ELC program is up for renewal this year, which could be an opportunity for Congress to add more permanent funding for wastewater surveillance and other epidemiological efforts.

    More permanent funding could go a long way in convincing more state health agencies to invest in wastewater surveillance programs, rather than relying on outside assistance from companies like Biobot or academic partners. More data and guidance on how to actually use wastewater data to inform public health decisions would help, too, since many agencies are still figuring this out. Such investment at the state level would help make the country’s wastewater infrastructure more comprehensive, and more capable of responding to new health threats.

    Instead, right now, we have an uneven system. Some places are regularly monitoring for COVID-19 and easily able to expand to new testing targets, while others might lose this valuable data source in the next year or two. For any local reporters reading this, I highly recommend digging into your community’s wastewater surveillance system, and figuring out whether it’s set up for the long term.

    More wastewater data

  • COVID-19 dashboards that haven’t shut down yet

    COVID-19 dashboards that haven’t shut down yet

    The Health Equity Tracker, run by the Morehouse School of Medicine’s Satcher Health Leadership Institute, is one of a few COVID-19 dashboards that is not shutting down at this time.

    We are in an era of dashboard shutdowns. Government agencies, research groups, and media organizations alike are winding down their COVID-19 reporting efforts. Some of these changes are directly tied to the end of the federal public health emergency in May, while others are more broadly attributed to shifting resources.

    In the last couple of weeks alone: the Johns Hopkins COVID-19 dashboard stopped collecting new data, the New York Times switched its COVID-19 tracker to show CDC data instead of compiling original information from states and counties, and the CDC itself announced that its COVID-19 data newsletter will end in May. The White House COVID-19 team will also be disbanded in May, according to reporting from the Washington Post.

    I haven’t done a comprehensive review of state and local COVID-19 dashboards, but I’m sure many of those are similarly shutting down, reporting less frequently, and reducing the types of data that they offer to the public. This is a trend I’ve been following since early last year, when state health departments started to declare COVID-19 was now “endemic” and didn’t require special monitoring resources, PCR testing infrastructure, etc. But it’s been accelerating in recent weeks, following the White House announcement about the end of the federal emergency.

    When explaining why their COVID-19 reporting efforts are ending, organizations often state that the disease is “no longer a major threat” or say that public interest in tracking COVID-19 has waned. I’m skeptical about both of those claims. First of all, we know that COVID-19 is still killing hundreds of Americans each week, with a majority of those being people who have had multiple vaccine doses. And we know that millions are facing activity limitations from Long COVID. As I wrote last month, the U.S. didn’t have a “mild” winter this year; we’re just getting better at ignoring COVID-19’s continued impacts.

    And second of all, I know there’s still an audience for this work—including many of the people who remain most vulnerable to COVID-19. Thank you to everyone who regularly reads this newsletter and blog, sends me questions, shares my work on social media, etc. for constantly validating that the interest is still here.

    With all of you great readers in mind, I’ve compiled this list of COVID-19 dashboards that I know haven’t yet shut down. The list is focused on national sources rather than state/local or international ones, in the interest of being most helpful to the majority of readers.

    • CDC COVID Data Tracker: The CDC’s COVID-19 dashboard is, of course, the primary source for federal data at this point in the pandemic. It provides weekly updates for most metrics (cases, hospitalizations, deaths, vaccinations, variant estimates, etc.); wastewater surveillance data are updated daily, with individual testing sites reporting on different cadences (usually about twice per week).
      Post-PHE update: Still active, but greatly changed. Cases and testing metrics are no longer available (with testing labs and state/local health agencies no longer required to report to the CDC), while other key metrics are updated less frequently or with more of a delay. See this post for more details.
    • Census Household Pulse Survey: Since early in the pandemic, the U.S. Census’ Household Pulse Survey has provided data on how COVID-19 impacted Americans’ day-to-day lives. This survey’s most recent iteration is scheduled for March through May 2023. The Census collaborates with other federal agencies on its surveys, including the CDC for Long COVID questions.
      Post-PHE update: The Pulse survey is typically conducted in two-month installments, with several weeks between each installment to adjust questions and process data. Its most recent installment ended in early May, and the next one has yet to be announced; we should know within the next month whether this data source is ending with the PHE or if it will continue.
    • Morehouse Health Equity Tracker: This project, from the Satcher Health Leadership Institute at the Morehouse School of Medicine, tracks COVID-19 metrics and a variety of other health conditions by race and ethnicity. The COVID-19 data are based on a CDC restricted access dataset; updates will continue “for as long as the CDC gives us data,” software engineer Josh Zarrabi said on Twitter this week.
      Post-PHE update: For COVID-19 data, this tracker utilizes a CDC dataset of cases with detailed demographic information, compiled from case reports sent to the CDC by state health agencies. The CDC dataset was last updated in April 2023, and it’s unclear whether it’ll be updated again (but my guess is it’ll end with the PHE). The Morehouse tracker includes plenty of other health metrics, though, so I expect this dashboard will be able to adjust to the CDC change.
    • APM Research Lab: This research organization, run by American Public Media, has several ongoing COVID-19 trackers. These include COVID-19 deaths by race and ethnicity (national and by state), vaccination rates (national and by state), and Minnesota-specific data, in collaboration with Minnesota Public Radio.
      Post-PHE update: APM is continuing to update its tracker; the most recent update to its COVID-19 deaths by race and ethnicity page occurred on May 17. Its staff will likely need to make some changes to their underlying data sources, since the CDC is now reporting COVID-19 deaths differently, but the basic metrics remain available.
    • Walgreens COVID-19 Index: Walgreens shares data from COVID-19 tests conducted at over 5,000 pharmacy locations nationwide. The tracker includes test positivity (national trends and state-by-state), variant prevalence, and positivity by vaccination status.
      Post-PHE update: Still active, with no change due to the PHE’s end.
    • COVIDcast by CMU Delphi: COVIDcast is a COVID-19 monitoring project by the Delphi Group at Carnegie Mellon University. The dashboard pulls in COVID-19 data from the CDC and other sources, such as Google search trends and antigen test positivity.
      Post-PHE update: No longer includes cases and deaths (which were pulled from the CDC), but still updating other metrics, including hospital admissions, symptom searches from Google trends, and COVID-related doctor visits.
    • Iowa COVID-19 Tracker: Despite its name, the Iowa COVID-19 Tracker displays data from across the country, sourced from the CDC. It’s run by Sara Anne Willette, a data expert based in Ames, Iowa. Willette frequently shares data updates on social media and streams on Twitch when updating her dashboard.
      Post-PHE update: Still active, but with some changes due to the new limitations in CDC data. Dashboard manager Sara Anne Willette shares frequent updates on Twitter about what she’s changing and why.
    • COVID-19 dashboard by Jason Salemi: This dashboard by University of South Florida epidemiologist Jason Salemi is another page displaying CDC data in somewhat-more-user-friendly visualizations. The dashboard is focused on Florida, but shares national state- and county-level data.
      Post-PHE update: Salemi shared on Twitter last week that he is currently assessing whether to keep the dashboard running or decomission the site.
    • Biobot Analytics: Biobot Analytics is the leading wastewater surveillance company in the U.S., tracking COVID-19 at hundreds of sewershed sites through its partnership with the CDC National Wastewater Surveillance System and independent Biobot Network. The dashboard has helpful national- and regional-level charts along with county-level data for sites in Biobot’s network.
      Post-PHE update: Still active, no changes due to the PHE’s end. In fact, Biobot continues to add more wastewater testing sites to its network.
    • WastewaterSCAN: WastewaterSCAN is another leading wastewater project, led by professors at Stanford and Emory Universities. The project started with sites in California, but has since expanded nationwide; it’s tracking several other common viruses in addition to COVID-19.
      Post-PHE update: Still active, similarly to Biobot’s dashboard.
    • For more wastewater data: Check out the COVID-19 Data Dispatch resource page with annotations on state and local dashboards.
    • KFF COVID-19 Vaccine Monitor: Since late 2020, the Kaiser Family Foundation has monitored American attitudes around COVID-19 vaccines and other pandemic issues. Updates were initially released monthly, but have become less frequent in the last year (the latest update was published on February 7, 2023).
      Post-PHE update: This KFF project appears to be ongoing, but at a lower frequency of updates; the most recent update is still February 2023. A newer KFF dashboard (tracking Medicaid enrollment and unwinding) is also receiving ongoing updates.
    • Axios-Ipsos COVID-19 polls: Axios has partnered with the polling firm Ipsos on regular polls tracking COVID-19 views and behaviors. The polling data are available in PDF reports and in spreadsheets from Roper. In 2023, Axios and Ipsos shifted their focus from COVID-19 to broader questions about public health, with a new series of quarterly polls.
      Post-PHE update: These two organizations will continue their new series of quarterly polls about public health, launched in early 2023. The most recent installment was posted this past week and includes questions about the PHE’s end, gun violence, opioids, and more.

    Have I missed any major data sources? Send me an email or comment below to let me know, and I’ll highlight it in a future issue.

    Editor’s note, April 2, 2023: This post has been updated with two additional dashboards (APM Research Lab and Walgreens), and additional information on the CDC’s wastewater surveillance dashboard.

    Editor’s note, May 21, 2023: This post has been updated with notes about changes impacting these dashboards due to the end of the federal public health emergency (PHE).

    More federal data

  • COVID source callout: CDC ends its data newsletter

    This past Friday, the CDC’s COVID-19 data team announced that its newsletter, the COVID Data Tracker Weekly Review, will send its final issue on Friday, May 12. That’s the day after the federal public health emergency for COVID-19 ends.

    For the last two years, the Weekly Review newsletter has been a great source of accessible updates on the state of COVID-19 in the U.S.; it includes summary statistics on cases, hospitalizations, vaccinations, variants, wastewater surveillance, and deaths. I’ve frequently referenced the newsletter in my own National Numbers updates, and have pointed other journalists to it.

    But this newsletter hasn’t been as reliable as one might expect from the CDC. Its writers have frequently taken the week off for federal holidays, even when the holiday falls on a Monday—and the newsletter is sent on Fridays. In recent months, the CDC has only compiled this newsletter every other week, making the “weekly review” title a misnomer. And now, the CDC has announced there will be only three more issues: sent on March 31, April 14, and May 12. (Seems like the newsletter is briefly shifting to a monthly schedule before it ends?)

    While the CDC will continue to regularly update its main COVID-19 dashboard and other data sources, the agency’s failure to maintain even a fairly basic update newsletter really speaks to its deprioritization of COVID-19. It honestly boggles the mind that I, a freelance journalist writing about COVID-19 data in her spare time, send updates with more continuity than the entire national public health agency.

    Yet somehow, here we are! This newsletter may see continued shifts to its format, but it isn’t going anywhere.

    more source spotlights