Gottlieb, Mostashari propose national COVID-19 surveillance system

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A system to effectively track and trace COVID-19 is a prerequisite for gradually reopening the economy, healthcare leaders said in a recent paper. (metamorworks/Getty Images)

Five healthcare experts—including former top government healthcare officials Scott Gottlieb and Farzad Mostashari—have proposed a plan to build a  national COVID-19 surveillance system.

A system to effectively track and trace COVID-19 is a prerequisite for gradually reopening the economy, the healthcare leaders said in a recent paper issued by the Duke-Margolis Center for Health Policy.

“We need to implement the tools and policies to conduct more effective surveillance, containment, and case management of COVID-19 for the future,” the co-authors wrote. “Building these capabilities now will accelerate our ability to assure the public’s safety—the foundation for a sustainable and secure approach to reopening our communities.”

The report authors include former Food and Drug Administration commissioners and physicians Gottlieb and Mark McClellan, along with Mostashari, who served as the national coordinator for health IT. Authors also include Lauren Silvis, senior vice president of external affairs at technology company Tempus, and Caitlin Rivers, Ph.D., a senior scholar at the Johns Hopkins Center for Health Security and an assistant professor in the Department of Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health.

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The healthcare leaders propose the country build a national COVID-19 surveillance system to enable the transition from universal stay-at-home orders to case-based, regional options.

The new national COVID-19 surveillance strategy is designed to ensure a swift, effective response to contain further spread of the virus, especially as the country reduces intensive physical distancing measures and stay-at-home rules, the authors said.

The healthcare leaders outlined four benchmarks for the development of disease surveillance capabilities:

  1. Test-and-trace infrastructure: Every region needs to have the capacity for widespread rapid diagnostic testing (PDF) for everyone with COVID-19 symptoms and the ability to share data to enable swift interventions of new cases.
  2. Real-time surveillance: Use the test-and-trace results to feed a national surveillance system to monitor spikes and falls in COVID-19-related symptoms. This syndromic surveillance system will provide timely, transparent reporting of outbreaks and responses.
  3. Blood (serological) testing: Every region needs the capacity to conduct widespread blood testing to identify reliable indicators of immunity in individuals and track virus exposure in communities.
  4. Rapid response: Health systems and public health officials need to build the capacity for isolation, contact tracing and quarantine of new COVID-19 cases and the ability to treat patients effectively at home or in a hospital.

This national effort should be coordinated and largely funded through the Centers for Disease Control and Prevention (CDC) in collaboration with state and local public health authorities, according to the authors. The effort could leverage federal funding and oversight through COVID-19 grants to states.

“The federal government should coordinate goals and resources, while state and local authorities should manage operational details of implementation,” the co-authors wrote.

The authors also propose that the Centers for Medicare & Medicaid Services (CMS) and private payers should provide support for healthcare providers, with support tied to high quality reporting on testing.

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Increasing testing capacity throughout the country is a key strategy of the plan. But the authors also focus on other health IT infrastructure requirements to help get the right information to public health officials.

There needs to be increased investment in electronic data sharing to support test-and-trace capabilities, for example, they said.

The CDC should work with CMS and the Office of the National Coordinator of Health IT to encourage the adoption and widespread use of electronic standards and reporting to enable rapid electronic reporting of COVID-19 related laboratory test results from health care providers, laboratories, or other testing sources using existing automated electronic reporting infrastructures. they said.

The CDC should also work with state officials and the Department of Health and Human Services to develop a common platform to query data from hospital electronic health records, health information exchanges and organizations like CommonWell and Carequality, according to the report.

Going forward, the CDC should work with healthcare organizations to use technology to manage case-based isolation. The authors noted that some primary care groups and health systems are already using telemedicine services and digital apps supported by electronic algorithms and dashboards to manage their populations.

Health plans including Humana, UnitedHealthcare and Blue Cross Blue Shield of North Carolina are also implementing similar supports for their patients who test positive for coronavirus.

The report also builds on a previous paper published by Gottlieb and McClellan that provides a road map for reopening the country.

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