COVID-19 Data Dispatch

Tag: public health emergency

  • Tips for following COVID-19 trends this winter

    Tips for following COVID-19 trends this winter

    This chart from Biobot Analytics shows that current coronavirus levels in wastewater (the light green line) have followed a similar pattern to fall 2021 (light blue).

    The U.S. is heading into our first winter since the end of the federal public health emergency for COVID-19. Those of us still following COVID-19 trends might need to change which data sources we use to track the disease this winter, and how we think about trends.

    The pandemic certainly hasn’t ended: COVID-19 still leads to hundreds of hospitalizations and deaths each day, not to mention millions with Long COVID. Since the U.S. government ended its emergency response to this disease, we now have significantly less information—but not zero information—about how it’s spreading.

    To recap the key changes to COVID-19 data following the emergency’s end (see this post from May for more details):

    • The CDC is no longer collecting case data, as it lost authority to require reporting from PCR testing labs.
    • Following the CDC’s lead, many state and local health departments have also stopped tracking COVID-19 cases.
    • The CDC is still tracking COVID-19 hospitalizations, though these data are more delayed and less comprehensive following the PHE’s end.
    • Death reporting is also more delayed and less comprehensive.
    • The CDC is using networks of testing labs and healthcare centers (like the National Respiratory and Enteric Virus Surveillance System) to estimate COVID-19 trends, similar to its strategies for tracking flu and RSV.
    • To track variants, the CDC is relying on a mix of continued PCR samples, wastewater testing, and travel surveillance.
    • Vaccinations are no longer reported directly to the CDC, leading the agency to track the 2023-24 vaccines through other means.

    In short, we lost a few of the primary data sources that people have used to follow COVID-19 over the last three years. But there’s still a lot of data available, primarily from wastewater surveillance, the CDC’s sentinel networks, and local health agencies.

    Here are my tips for tracking COVID-19 this winter.

    Look at multiple sources for your community.

    Following COVID-19 in your city or state used to be easy: you could just look at case numbers. Now, with that metric unavailable in many places, I would recommend having two or three go-to data sources that you check in tandem. Don’t be certain about a trend (like a new surge) until you’ve seen it in multiple sources at once. These sources might be local wastewater pages, local health department pages, and regional trends from the CDC.

    For example, when I want to check on COVID-19 spread in New York City (where I live), I look at:

    Wastewater is the best early indicator.

    It’s pretty universally acknowledged among epidemiologists and public health experts at this point in the pandemic that, without case data, wastewater surveillance is now our best way to spot new changes in COVID-19 spread. When a new surge occurs, coronavirus levels in wastewater tend to go up days or weeks before other metrics, like hospitalizations.

    So, as you track COVID-19 for your community, I would highly recommend that one of your top sources is a wastewater surveillance dashboard.

    Test positivity is still helpful for trends.

    Test positivity—the rate of COVID-19 tests that returned positive results—was a popular indicator early in the pandemic, with policy decisions like whether students could attend school in-person tied to this metric. While test positivity numbers are less available now, people are still getting tested for COVID-19: these tests mostly occur in healthcare settings among people who present with COVID-like symptoms or had recent exposures to the virus.

    I still find test positivity to be a helpful metric for watching trends in COVID-19 spread. When the positivity rate goes up, more people are getting COVID-19; and when the rate goes over 10%, that’s a decent indicator that the disease is spreading in significant magnitudes.

    Two places to find test positivity data:

    Acknowledge data delays, especially around holidays.

    Many COVID-19 dashboards used to update on a daily basis. Now, we get weekly updates from most health agencies—and even less frequency in some places. With these update schedules, all data are inevitably delayed by at least a few days. So, when you look at a dashboard, it’s important to keep the update schedule in mind and ask yourself how a trend might have continued following the most recent data available.

    Data delays become particularly prominent after holidays: remember, public health officials take days off just like the rest of us. Holiday reporting delays often lead to appearances of low COVID-19 during the immediate week of a holiday, followed by appearances of higher COVID-19 in the weeks after as cases (and other metrics) are retroactively reported. The weeks around Christmas and New Year’s are particularly bad, as most people take both of those holidays off.

    Compare current trends to past surges and lulls.

    With interpreting COVID-19 data, context is everything. Spread of the virus is usually either rising or falling; comparing current numbers to historical data can help you understand the magnitude of those recent patterns. Is your community seeing as much COVID-19 as it has at past times commonly recognized as surges? Or are you in more of a lull between waves?

    One helpful tool that I often use for such context is a chart on Biobot’s COVID-19 dashboard that provides year-over-year comparisons between coronavirus levels in wastewater in the U.S. Right now, for example, you can see that current viral levels have followed a similar trendline to what we observed in the fall 2021 Delta surge (before Omicron appeared), but lower than this time last year (when different BA variants were spreading quickly).

    The original Omicron surge in winter 2021-22 is often a popular point for these comparisons, as pundits love to assure us that a new variant won’t cause as intense a wave as we saw with Omicron’s first appearance. While this can be reassuring, I think it’s important to not just look at the highest peaks for comparison. The summer/fall of Delta in 2021 wasn’t a great time either, and we’re on track to repeat it right now even if no wildly competitive new variants appear.

    Keep an eye on variants.

    As we watch for a likely COVID-19 surge this winter, viral variants could have an impact on how much the virus is able to spread during our holiday travel and gatherings. You can keep an eye on variant development through a couple of CDC data pages:

    • The CDC’s variant proportions, which estimate levels of different variants based on PCR testing;
    • Variant patterns from wastewater, which the CDC and local health departments track from select sewage testing sites (many state and local wastewater dashboards include these data as well);
    • Travel-based genomic surveillance, a CDC program in which international travelers can opt into PCR testing as they return to U.S. airports, contributing to the agency’s understanding of variants circulating globally.

    If you have further data tracking questions or suggestions, please reach out via email or in the comments below.

  • This summer, COVID-19 safety is more individualized than ever

    This summer, COVID-19 safety is more individualized than ever

    Current coronavirus levels in wastewater are close to the summer 2021 Delta surge, according to Biobot.

    COVID-19 metrics have been on the rise in the U.S. for about a month now, indicating that we’re experiencing a summer surge. This is pretty unsurprising for many public health experts, as the country has experienced increased transmission during the last three summers.

    Unlike past years, though, this summer’s surge comes after the end of the federal public health emergency. We now have less data than ever to follow COVID-19 trends, combined with less access to health measures than ever.

    We’re also dealing with continued minimization of the problem. Coverage of the current surge in mainstream media sources tends to downplay any concerns, suggesting that hospitalizations are low (even though those data are delayed), or that masking isn’t necessary (even though this tool works best as a preventative measure), or that all infections are now mild (even though Long COVID remains a risk for any case). The People’s CDC offers more critique here.

    Despite these challenges, enough information is out there that anyone committed to safety can keep up with COVID-19 news and protect themselves. Unfortunately, this practice now requires much more individual effort—a far cry from the collective measures that we took back in 2020. But we still have opportunities to show leadership, by sharing information and resources with our communities.

    Here are a few things I’m doing in the current surge, and recommendations to consider sharing:

    • Assume all data are delayed and undercounted. COVID-19 data sources are sparser than ever, so the trends we see are likely to be small reflections of larger issues. Biobot’s wastewater dashboard, for example, provides results from a sample of sewersheds across the U.S.; the same increases are likely happening in places where we aren’t tracking them.
    • Watch your local wastewater numbers. Despite the uneven coverage of wastewater surveillance, this is still the best tool for advanced warnings on COVID-19 now that case data are no longer available. If your city or county doesn’t have a wastewater testing site, you can likely find a nearby one to follow for trends. See the CDD’s resource page for links to dashboards.
    • Stock up on high-quality masks. N95s and KN95s are really necessary to protect yourself from the ever-evolving Omicron variants. There are a lot of places to buy these online; Project N95 is my personal favorite, as you can get masks directly from their manufacturers and contribute to mask donations for less-resourced communities.
    • Consider a higher-value respirator for riskier activities. If you’re traveling or going to a higher-risk event this summer, a reusable respirator might be helpful. I wrote more about why I bought one in this post last summer.
    • Stock up on rapid tests. Most health insurance plans no longer cover these (following the end of the federal health emergency), but some local governments are still giving them out for free in public spaces, like libraries in NYC. You might also buy tests in bulk online. I personally use iHealth Labs, because they sell packs of five tests that are easy to bring while traveling and frequently run sales.
    • Make a plan for isolation/quarantine. In case you or a member of your household gets sick, it can be helpful to have an advance plan on where you might isolate, how to keep air clean in shared spaces, where to get Paxlovid, etc. Your Local Epidemiologist has more tips on how to deal with a positive test.
    • Share information and resources. Surveys have suggested that many Americans would mask and take other public health measures during surges, but those people might not know about the current rise in transmission. Sharing information with your community (along with masks, rapid tests, and other tools, if you have surplus) can help broaden safety measures.
    • Remember why you’re taking precautions. During increased social pressures against COVID-19 safety, I personally find it helpful to remember why I find these behaviors important. Some reasons are selfish (for example, taking a week or two off work would be difficult) while others are more philosophical (such as a dedication to the principles of broader public health)—but all of them are valuable.

    If you have questions or additional suggestions, please share them below.

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  • Ending emergencies will lead to renewed health equity issues

    Ending emergencies will lead to renewed health equity issues

    The header image from a story I recently had published in Amsterdam News about declining access to COVID-19 services.

    Last week, I gave you an overview of the changes coming with the end of the federal public health emergency (PHE), highlighting some shifts in publicly available COVID-19 services and data. This week, I’d like to focus on the health equity implications of the PHE’s end.

    COVID-19 led the U.S. healthcare system to do something unprecedented: make key health services freely available to all Americans. Of course, this only applied to a few specific COVID-related items—vaccines, tests, Paxlovid—and people still had to jump through a lot of hoops to get them. But it’s still a big deal, compared to how fractured our healthcare is for everything else.

    The PHE allowed the U.S. to make those COVID-19 services free by giving the federal government authority to buy them in bulk. The federal government also provided funding to help get those vaccines, tests, and treatments to people, through programs like mass vaccination sites and mobile Paxlovid delivery. Through these programs, healthcare and public health workers got the resources to be creative about breaking down access barriers.

    Now that the emergency is ending, those extra supplies and resources are going away. COVID-19 is going to be treated like any other disease. And as a result, people who are already vulnerable to other health issues will become more at risk for COVID-19.

    I wrote about this health equity problem in a recent story for Amsterdam News, a local paper in New York City that serves the city’s Black community. The story talks about how COVID-19 services in NYC are changing with the end of the PHE, and who will be most impacted by those changes. It’s part of a larger series in the paper covering the PHE’s end.

    Most of the story is NYC-specific, but I wanted to share a few paragraphs that I think will resonate more widely:

    Jasmin Smith, a former contact tracer who lives in Brooklyn, worries that diminished public resources will contribute to increased COVID-19 spread and make it harder for people with existing health conditions to participate in common activities, like taking the subway or going to the grocery store.

    COVID-19 safety measures “make the world more open to people like myself who are COVID-conscious and people who might be immunocomprmised, disabled, chronically ill,” Smith said. “When those things go away, your world becomes smaller and smaller.”

    The ending federal public health emergency has also contributed to widespread confusion and anxiety about COVID-19 services, [said Dr. Wafaa El-Sadr, a professor of epidemiology and global health at Columbia University’s Mailman School of Public Health]. “People have so many questions about this transition,” she said, and local leaders could do more to answer these questions for New Yorkers.

    The near future of COVID-19 care in the U.S. could reflect existing health disparities for other endemic diseases, like the seasonal flu and HIV/AIDS, [said Steven Thrasher, a professor at Northwestern University and author of the book, The Viral Underclass]. For example, people with insurance and a primary care physician are more likely to get their annual flu shots, he said, while those without are more likely to face severe outcomes from the disease.

    After May 11, COVID-19 outcomes are likely to fall along similar lines. “More people have died of AIDS after there were HIV medications,” Thrasher said. “More people have died of COVID when there were vaccines in this country than before.”

    For more news and commentary on COVID-19 emergencies ending, I recommend:

  • WHO ends the global health emergency for COVID-19

    As the U.S. gears up to end its federal public health emergency for COVID-19, the World Health Organization just declared an end to the global health emergency. WHO Director-General Tedros Adhanom Ghebreyesus announced the declaration on Friday, following a meeting of the organization’s COVID-19 emergency committee the day before.

    Here’s what this declaration means, pulling from Helen Branswell’s article in STAT News and Katelyn Jetelina’s Your Local Epidemiologist post:

    • The world is at a point of transition from considering COVID-19 an unexpected emergency to considering it a part of our daily lives, a disease that we’ll be dealing with in the long term.
    • The WHO will have fewer resources for an international response to COVID-19, such as coordinating between countries and sharing data at a global scale.
    • The WHO will also have less authority when it comes to issuing international guidance to control COVID-19 spread.
    • There will be fewer incentives for countries to accelerate vaccines, treatments, and tests for COVID-19.

    The declaration does not mean that COVID-19 is “over.” We have plenty of long-term issues to deal with here: millions suffering from Long COVID, continued COVID-19 waves around the world, potential new variants, healthcare worker shortages, and declines in childhood vaccination rates, to name a few. Tedros may set up a new committee to make recommendations on long-term COVID-19 management, according to Branswell’s article.

    In fact, the WHO recently publicized the impacts of Long COVID: Tedros delivered a PSA explaining that one in ten coronavirus infections leads to some form of Long COVID, and suggesting that “hundreds of millions of people will need longer-term care.” Shifting out of the emergency phase of our global COVID-19 response should be a call to action for scientists and health experts to now focus on Long COVID needs.

    Still, a lot of people might interpret the WHO’s declaration as an announcement that they no longer need to worry about COVID-19. Some mainstream publications that have covered the change haven’t done a great job of conveying the nuances here, and I’ve already seen some misinterpretation on social media.

    COVID-19 may not be an emergency at this point. But we’re probably going to be living with it for the rest of our lives, and there’s a lot of work left to do.

    More on international data

  • 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

  • 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 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

  • Sources and updates, February 19

    Just a couple of updates today!

    • Test positivity will become less reliable after PHE ends: CBS News COVID-19 reporter Alexander Tin flagged last week that, after the federal public health emergency for COVID-19 ends this spring, private labs that process PCR tests will no longer be required to report their results to state health departments. States will still report any results they get to the CDC, but federal officials expect that this data will become much less reliable, according to a background press briefing from the Department of Health and Human Services (HHS). Case data are already unreliable; soon, we won’t even have consistent test positivity data to tell us how unreliable they are. This may be one of several data sources that get worse after the end of the PHE.
    • HHS is supporting improved healthcare data sharing: The inability to connect different health records systems (or lack of interoperability, to use the technical term) has been a big problem during the pandemic, as researchers and health officials often couldn’t answer questions that require multiple health datasets. HHS has taken some steps to improve this situation, while also making it easier for individual patients to access their personal records. Most recently, HHS announced that it’s chosen six companies and organizations to develop data-sharing platforms, according to POLITICO. It’ll take some time for these organizations to start actually sharing data, but I’m glad to see any movement on this important issue.
    • Yes, vaccination is still the best way to get protected from COVID-19: A new study from the Institute for Health Metrics and Evaluation, published in the Lancet this week, has been making the rounds on social media recently. Anti-vax pundits are claiming the study shows that immunity from a prior coronavirus infection is more effective than immunity from vaccination at preventing future severe COVID-19. While the study does show that a prior infection can be helpful, the authors found a significant drop in the value of this type of protection after Omicron variants started circulating in late 2021. And, as some commentators have pointed out, infections can always lead to severe symptoms and Long COVID—the risks from vaccination are much lower. Basically, this XKCD comic remains accurate.

  • What the public health emergency’s end means for COVID-19 data

    This past Monday, the White House announced that the federal public health emergency for COVID-19 will end in May. While this decision might be an accurate reflection of how most of the U.S. is treating COVID-19 right now, it has massive implications for Americans’ access to tests, treatments, vaccines—and data.

    I wrote about the potential data issues last September, in anticipation of this emergency ending. Here are the highlights from that post:

    • Outside of a public health emergency, the CDC has limited authority to collect data from state and local health agencies. And even during the emergency, the CDC’s authority has been minimal enough that national datasets for some key COVID-19 metrics (like breakthrough cases and wastewater surveillance) have been very spotty.
    • When the federal emergency ends, the Department of Health and Human Services (HHS) may lose its ability to require reporting of some key data, including: PCR test results (from states), hospital capacity information and COVID-19 patient numbers (from individual hospitals), COVID-19 cases and deaths in nursing homes.
    • It’s possible that the HHS and/or CDC will negotiate new data reporting requirements with states and other entities that don’t rely on the public health emergency. They have about three months to do this. I haven’t seen much news on that yet, but I’ll keep an eye out and share updates as I find them.
    • Regardless, I expect that reporting COVID-19 numbers to federal data systems will become even more voluntary than it already is for health agencies, hospitals, congregate facilities, and other settings. We will likely have to rely more on targeted surveillance systems (which compile data from a subset of healthcare facilities) rather than comprehensive national datasets, similar to our current surveillance systems for the flu and other endemic diseases.

    At the same time, the public health emergency’s end will lead to changes in the distribution of vaccines, tests, and treatments. The Kaiser Family Foundation has a helpful explanation of exactly what’s changing. Here are the highlights:

    • Vaccines will remain free to all as long as the stockpile of doses purchased by the federal government lasts. However, the ending emergency will likely impact the government’s ability to buy more vaccines—including future boosters that might be targeted to new variants. Vaccine manufacturers are planning to raise their prices, and cost will become a burden for uninsured and underinsured people.
    • At-home, rapid tests will no longer be covered by traditional Medicare, while Medicare Advantage coverage will vary by plan. Most private insurance providers will likely still cover the tests, but prices may go up (similarly to the prices for vaccines).
    • PCR tests are also likely no longer going to be covered by a lot of insurance plans and/or are going to get more expensive. Notably, Medicaid will continue covering both at-home and PCR tests through September 2024.
    • Treatments (primarily Paxlovid right now) will remain free for doses purchased by the federal government, similar to the situation with vaccines. After the federally-purchased supply runs out, however, we will similarly see rising costs and dwindling access.

    KFF also has produced a detailed report about how the end of the federal emergency will impact healthcare coverage more broadly.

    In short, the end of the public health emergency will make it harder for Americans to get tested, receive treatments, and stay up to date with COVID-19 vaccines. The testing access changes, in particular, will lead to official case numbers becoming even less accurate, as fewer people seek out tests. At the same time, Americans will lose access to the data we need to know how much of a threat COVID-19 presents in the first place.

    It’s also worth noting that, on the same day the White House announced the end of its emergency declaration, the World Health Organization announced the opposite: the global public health emergency is continuing, though it may end later in 2023. As Americans largely ignore COVID-19, millions of people around the world are unvaccinated, facing new surges, dealing with new variants, etc.

    COVID-19 clearly remains a looming threat at the global level. In the U.S., we technically have the best vaccines and treatments to deal with the disease—but these tools are going underutilized, and the Biden administration’s decision this week will only make it harder for people to get them. Maybe we shouldn’t have to rely on an emergency declaration to get basic data and access to health measures in the first place.

    More federal data

  • Looking ahead to the big COVID-19 stories of 2023

    Looking ahead to the big COVID-19 stories of 2023

    The number of sites reporting to the National Wastewater Surveillance System (see the black line) has declined in recent weeks. This may be a worrying trend going into 2023.

    It’s the fourth year of the pandemic. I’ve written this statement in a few pitches and planning documents recently, and was struck by how it feels simultaneously unbelievable—wasn’t March 2020, like, yesterday?—and not believable enough—haven’t we been doing this pandemic thing for an eternity already?

    As someone who’s been reporting on COVID-19 since the beginning, a new year is a good opportunity to parse out that feels-like-eternity. So this week, I reflected on the major trends and topics I hope to cover in 2023—both building on my work from prior years and taking it in new directions.

    (Note: I actually planned to do this post last week, but then XBB.1.5 took higher priority. Hence its arrival two weeks into the new year.)

    Expansions of wastewater, and other new forms of disease surveillance

    As 2022 brought on the decline of large-scale PCR testing, wastewater surveillance has proven itself as a way to more accurately track COVID-19 at the population level—even as some health departments remain wary of its utility. We also saw the technology’s use for tracking monkeypox, polio, and other conditions: the WastewaterSCAN project, for example, now reports on six different diseases.

    This year, I expect that wastewater researchers and public agencies will continue expanding their use of this surveillance technology. That will likely mean more diseases as well as more specific testing locations, in addition to entire sewersheds. For example, we’re already seeing wastewater testing on airplanes. I’m also interested in following other, newer methods for tracking diseases, such as air quality monitors and wearable devices.

    At the same time, these surveillance technologies will continue to face challenges around standardization and public buy-in. The CDC’s big contract with Biobot expires this month, and I’ve already noticed a decline in sites with recent data on the agency’s dashboard—will CDC officials and local agencies step in to fill gaps, or will wastewater testing become even more sporadic?

    New variants, and how we track them

    For scientists who track the coronavirus’ continued evolution, 2022 was the year of Omicron. We didn’t see all-new virus lineages sweeping the world; instead, Omicron just kept mutating, and mutating, and mutating. It seems likely that this pattern will continue in 2023, but experts need to continue watching the mutation landscape and preparing for anything truly concerning.

    With declining PCR testing, public agencies and companies that track variants have fewer samples to sequence. (This led to challenges for the CDC team tracking XBB.1.5 over the holidays.) As a result, I believe 2023 will see increased creativity in how we keep an eye on these variants—whether that’s sequencing wastewater samples, taking samples directly from healthcare settings, increased focus on travel surveillance, or other methods.

    Public health experts—and journalists like myself—also need to rethink how we communicate about variants. It’s no longer true that every new, somewhat-more-contagious variant warrants alarm bells: variants can take off in some countries or regions while having relatively little impact in others, thanks to differences in prior immunity, seasonality, behavior, etc. But new variants still contribute to continued reinfections, severe symptoms, Long COVID, and other impacts of COVID-19. Grid’s Jonathan Lambert recently wrote a helpful article exploring these communication challenges.

    Long COVID and related chronic diseases

    As regular readers likely know, Long COVID has been an increased topic of interest for me over the last two years. I’ve covered everything from disability benefits to mental health challenges, and am now leading a major project at MuckRock that will focus on government accountability for the Long COVID crisis.

    Long COVID is the epidemic following the pandemic. Millions of Americans are disabled by this condition, whether they’ve been pushed out of work or are managing milder lingering symptoms. Some people are approaching their three-year anniversary of first getting sick, yet they’ve received a fraction of the government response that acute COVID-19 got. Major research projects are going in the wrong directions, while major media publications often publish articles with incorrect science.

    For me, seeing poor Long COVID coverage elsewhere is great motivation to continue reporting on this topic myself, at MuckRock and other outlets. I’m also planning to spend more time reading about (and hopefully covering) other chronic diseases that are co-diagnosed with Long COVID, like ME/CFS and dysautonomia.

    Ending the federal public health emergency.

    Last year, we saw many state and local health agencies transition from treating COVID-19 as a health emergency to treating it as an endemic disease, like the many others that they respond to on a routine basis. This transition often accompanied changes in data reporting, such as shifts from daily to weekly COVID-19 updates.

    This year, the federal government will likely do the same thing. POLITICO reported this week that the Biden administration is renewing the federal public health emergency in January, but will likely allow it to expire in the spring or summer. The Department of Health and Human Services has committed to telling state leaders about this expiration 60 days before it happens.

    I previously wrote about what the end of the federal emergency could mean for COVID-19 data: changes will include less authority for the CDC, less funding for state and local health departments, and vaccines and treatments controlled by private markets rather than the federal government. I anticipate following up on this reporting when the emergency actually ends.

    Transforming the U.S. public health system

    Finally, I intend to follow how public health agencies learn from—or fail to learn from—the pandemic. COVID-19 exposed so many cracks in America’s public health system, from out-of-date electronic records systems to communication and trust issues. The pandemic should be a wakeup call for agencies to get their act together, before a new crisis hits.

    But will that actually happen? Rachel Cohrs has a great piece in STAT this week about the challenges that systemic public health reform faces, including a lack of funding from Congress and disagreements among experts on what changes are necessary. Still, the window for change is open right now, and it may not be at this point in 2024.

    More federal data