Slow Covid-19 Data Call For a Smarter Approach
(Bloomberg Opinion) -- Covid-19 has been devilishly difficult to monitor, and therefore to control, in part because of the degree to which data lag reality. This happens because each link in the chain of illness is long: Exposure to the coronavirus takes time to manifest as illness, which in turn takes time to register positive on a Covid test, which result then takes time to be reported — and so on down a long line. Delays are a feature of any infectious disease outbreak, but they are especially lengthy for this virus.
Also, because the novel coronavirus doesn’t immediately or consistently produce symptoms, the germ can spread quietly. In the U.S., public health strategies that vary from state to state, inconsistent support from the federal government, and a fragmented health system with antiquated record-keeping systems only make it harder to discern a clear picture of the epidemic.
The unfortunate result is that many state leaders underestimate trouble ahead. California, with its growing case count, has just imposed significant new restrictions on indoor activity — a sign that at least one state sees the writing on the wall. Others remain too reluctant to act.
Covid has been hard to manage from the beginning in the U.S., thanks to the shortage of testing. But since reopening began, the problem has grown worse in some respects. Governors have had to find their way without firm national guidance. The only clear message from Washington has been encouragement to reopen as fast as possible.
Guidelines issued by the White House’s coronavirus task force were sensible, but widely ignored. They advised states to watch the data and, before taking steps to emerge from lockdown, make sure they saw 14-day declines in the number of cases and in the rate of positive tests. That two-week benchmark wasn’t set in stone, but was recommended as a precaution to ensure that each successive phase of reopening could go forward without a worrisome outbreak or surge. Two weeks was enough time to account for lags in the data.
However, several states didn’t bother to wait even long enough to meet the first threshold. Some sped through subsequent data gates without conducting robust contact tracing or logging declining infection rates.
Then, even as case counts and positive-test rates began to rise, state leaders said it was OK not to worry, because hospitalizations remained low and deaths, lower still. The first of those data points has caught up, and daily deaths, the slowest of metrics, are catching up in several states enough to cause a significant boost in the national data.
Renewed testing delays make the near future look pretty grim. Testing giant Quest Diagnostics Inc. now reports a seven-day average turnaround time for anything but high-priority tests. That suggests outbreaks will again get ahead of any rise in state case numbers.
More than a dozen states are already seeing positive-test rates above 10%. To make matters worse, they’re reporting ongoing difficulties procuring tests, which will make it harder to identify, inform and isolate the infected.
California’s new restrictions on indoor activity acknowledge the Covid data lag. The state’s current infection numbers — which are concerning, if not as high as those in other states — reflect the behavior of Californians as much as two weeks ago. And the new mitigation steps will take time to bring the numbers down. Other states should note that the larger an outbreak is, the more untracked infections there will be, and thus the more the data will lag.
And the looser the restrictions on movement and behavior, the longer it will take to turn things around. Earlier action brings faster results.
Although California’s new rules do not amount to a full spring-style lockdown, they will still hamper the state’s economy. To allow uncontained spread would be just as harmful, however, and would make it impossible to safely open schools.
The rollback will slow case growth, give testing capacity time to catch up, and enable the state to schedule a more patient and sustainable re-reopening.
More states may need to follow California’s example, especially as flu season arrives. While this will disappoint anyone hoping for a linear recovery, it might help all states come to better understand how the Covid data chain works, and why it’s essential to monitor it carefully. The alternative is to continue muddling through a pandemic with a strategy based not on data but only on hope.
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
Max Nisen is a Bloomberg Opinion columnist covering biotech, pharma and health care. He previously wrote about management and corporate strategy for Quartz and Business Insider.
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