Dr. Tom Frieden on 19 Critical Data Gaps Limiting our Effectiveness Responding to the COVID-19 Pandemic
The more we know, the better we can protect people against COVID-19. Here’s a set of the most important questions to be answered. Although we learn more about this virus every day and have some information on some of these questions, much of that data is preliminary, imprecise, or potentially inaccurate. Furthermore, answers may differ among areas and over time in the context of COVID-19. And of course, there are other important questions, including those that will be generated by the emerging answers to these questions.
Transmissibility
1. How is the virus spreading?
2. How contagious is the virus (the Ro, or basic reproductive rate)?
3. How common is spread from contaminated surfaces?
4. How effective is increasing ventilation at reducing risk?
5. How much spread is from asymptomatic cases?
Testing
6. How sensitive are PCR assays – what is the false-negative rate from properly collected nasopharyngeal samples?
7. Is serology accurate, and what is the time course of antibody response?
8. Can an accurate, rapid point-of-care test be developed?
Severity
9. How deadly is the virus? Reported case fatality rates are likely to greatly over-estimate death rates because there are so many undiagnosed cases.
10. Which are the most vulnerable groups we need to protect – which underlying diseases increase risk the most?
11. Do different types of virus cause different levels of severity?
12. Is the virus changing genetically in important ways as it spreads?
Treatment
13. What treatments work to decrease the severity of COVID-19 disease? If there are effective anti-viral treatments, not only can patients’ lives be saved, but the duration of intensive care stay can be reduced. This would allow more patients to be treated and reduce the risk to health care workers, and contacts could potentially receive preventive treatment to reduce spread.
14. Can a preventive medication be identified to be given to contacts of patients with COVID-19 as is done for influenza with oseltamivir (Tamiflu) in nursing homes and other areas?
15. Is there any role for steroid treatment of patients with severe pneumonia caused by SARS-CoV-2?
Control
16. What works to change behavior, including hand-washing and cough hygiene? Telling people what to do gives leaders a sense they are doing something, but does it actually work? We can only know and improve our messaging by objectively monitoring how people respond.
17. What works to limit spread? For example, will school closures make a difference? Since children don’t appear to get ill even if infected (unlike with influenza), they may not be important as sources of infection – and school closures may (or may not) have limited value. We will only know as we learn more and rigorously evaluate our attempts to do more to control spread.
18. What are the most important ways to protect health care workers and patients in health facilities? If cases increase rapidly, it will be crucial to be able to continue to provide care, and do so without risk to health care providers or other patients.
19. How can creation of a safe and effective vaccine be accelerated?
Good data is the lifeblood of good public health. The sooner we get answers to these questions, the sooner and more completely we can do what’s needed to reduce infections, improve survival, and reduce societal harms.
Dr. Tom Frieden is former director of the US Centers for Disease Control and Prevention and former commissioner of the New York City Health Department. He is currently president and CEO of Resolve to Save Lives, a global non-profit initiative funded by Bloomberg Philanthropies, the Chan Zuckerberg Initiative, and the Bill and Melinda Gates Foundation and part of the global non-profit Vital Strategies. Resolve to Save Lives works with countries to prevent 100 million deaths and to make the world safer from epidemics. Dr. Frieden is also Senior Fellow for Global Health at the Council on Foreign Relations.@DrTomFrieden.
