By Alexandra Blockton
ablockton@lc.edu

According to the CDC website, CDC Activities and initiatives supporting the COVID-19 response are as follows, “[a]s part of the Whole-of-Government Response, CDC has developed and is continually evaluating and improving the comprehensive surveillance program to generate essential data for tracking the pandemic and guiding the overall response to COVID-19. In addition, CDC is working with federal, state and local partners to improve testing and to advise and support communities during the phased reopening of America.”

Surveillance for COVID-19
The goals of the US surveillance are to produce timely and accurate information at national, state, local and community levels to inform decisions on public measures for implementing and adjusting disease reduction strategies, to guide clinical decisions, to educate the public and key stakeholders and to provide data for estimating and forecasting disease burden.

Surveillance Objectives

-To identify both symptomatic and asymptomatic cases and track contacts to slow transmission of COVID-19 in the United States.

-To monitor the spread and intensity of COVID-19 disease in the United States.

-To understand disease severity and spectrum of illness.

-To understand risk factors for severe disease and transmission.

-To monitor for virus changes.

-To estimate the disease burden.

-To produce data for forecasting spread and impact.

-To identify when thresholds have been met to adjust community mitigation measures.

Approach:
Using multiple surveillance systems and epidemiology networks, the CDC, in collaboration with state, local and academic partners, monitors the progression and impact of COVID-19 spread in the United States. The combination of data from the different systems is used to generate an ongoing picture of virus spread and produce data to address the key questions for directing and refining the US response. Surveillance data are used for:

Situational awareness
Timely monitoring of the spread and intensity of COVID-19 disease in the United States. Surveillance systems allow for efficient targeting of public health measures, developing timely communications and preparing health systems for increasing numbers of ill people. Data from these systems will be updated daily or weekly to create an ongoing, accurate understanding of impacted regions, affected populations, trends over time and viral characteristics.

Understanding impact and forecasting disease spread
All surveillance systems will be employed to produce data to understand overall impact and epidemic characteristics to inform future use of public health and medical resources.

Characterizing COVID-19 infection across a spectrum of conditions include:

-asymptomatic infections

-symptomatic infection

-medically attended outpatient and ambulatory visits

-hospitalizations

-deaths

Operational Plan

The plan is operational according to the following components:

-Increase laboratory testing and reporting to detect cases quickly and reliably for timely public health action

-Use robust syndromic surveillance, proactive monitoring for asymptomatic cases in settings with people at risk for infection or with known vulnerabilities.

-Use laboratory reporting systems to monitor local disease trends to identify if thresholds (gates) have been met

-Corroborate trends and risk assessment with high-quality data from sentinel surveillance and systems.

-Monitor disease and outbreaks in healthcare, institutional, workplace and group settings

-Use data for the estimation of disease burden over time and to aid disease and transmission forecasts.

Federal, State, and Local roles
The surveillance strategies rely on collaboration at federal, state, and local levels. The federal government will work with the states to establish the data platforms used by states and local jurisdictions to monitor transmission, public health and health system capacity and provide technical assistance and coordination of information sharing and decision making across jurisdictions. These data platforms will be public-facing to maximize transparency and maximize information to communities at the most granular level. Using the federal data systems, states can share data and information and communicate with residents’ decisions under consideration and clear guidance on adhering to mitigation levels. In addition to implementing federal programs, states can also coordinate resource allocation within their regions and across communities and monitor indicators closely to make decisive adjustments to mitigation measures. Finally, local governments are responsible for feeding data and information into state and federal data systems and adjoining communities.

Components of the US COVID-19 surveillance plan
The surveillance program is built on a combination of existing influenza and viral respiratory disease surveillance systems, syndromic surveillance systems, case reporting systems, proactive monitoring for asymptomatic cases in areas of demonstrated vulnerabilities, commercial laboratory reporting, ongoing research platforms employed for the COVID-19 response and new systems.