As the pandemic of COVID-19 continues globally, one aspect of the path forward has been a renewed interest in the role public health plays in addressing the ongoing needs. Estimates suggest that about 90% of Americans experienced being locked down or practiced social distancing to slow the spread of the virus. Many states are in various stages of opening up, even as caseloads continue to rise.
A new viewpoint in the New England Journal of Medicine by Dr. Andrew Chan and colleagues from Harvard argues for putting the Public back into public health. Early modeling for COVID was based on people experiencing symptoms, those who were hospitalized, and those who died from the virus. This does not render a complete picture. Many countries have struggled with broader testing due to the availability of testing kits and mechanisms to test large numbers of people. Rare exceptions like Iceland and South Korea tested their whole population, thus enabling a complete picture of how the virus moved through their communities. The full view of this pandemic many never emerge.
Rapid advances in testing have occurred in the last three months, but broad availability remains challenging. These limitations continue to hamper a robust view of tracking new cases, symptom severity, and emerging underlying risk factors at the community level. Additional complexity has arisen in antibody testing, early work suggests wide variation in accuracy of these tests, and it is still unclear whether the presence of antibodies indicates immunity for subsequent reinfections.
New tools are emerging for population surveillance at the community level and include symptom trackers using texting and other mobile phone capabilities like geolocation. These real-time data collection efforts allow for more timely signals on how the virus is behaving locally. So, better planning to address surges and provision of services can theoretically occur. Data from sensors and fitness trackers are also being leveraged. The authors cite their COVID study app (http://covid.joinzoe.com), which has 3.5 million participants in the USA, UK, and Sweden as one example of symptom tracking. All of these depend on the trust and participation of the General Public, and broad swaths of the community may not trust these apps, so we get a limited view to base decisions upon. The privacy and data use considerations that exist with any of these tools remains unclear, as does the long term use of that data. However, smartphone-based surveillance has broad appeal since more than 80% of Americans own one. Data collection will need to be ongoing until we have a vaccine.
How can we work together to firmly place these surveillance tools in the public health domain, with data used for the public good? How can we build trust back into science and our public health departments to combat and contain this virus? Again digital health can play a pivotal role in our ongoing work on addressing COVID-19, and much infrastructure needs to be built to support the public health approaches to slow the spread of the virus and manage the impact until a vaccine exists. Public Health also has a role to play once a vaccine is developed.
Thanks for reading – Trina
(Opinions are my own)
Putting the Public Back in Public Health — Surveying Symptoms of Covid-19 https://www.nejm.org/doi/full/10.1056/NEJMp2016259