Why we need continued pandemic surveillance

While we wait for the accelerated development of medical treatments or vaccines to ease the COVID-19 crisis, measures known as non-pharmaceutical interventions such as contact tracing, enforced quarantines and universal mask-wearing are increasingly in the spotlight. But resistance to these interventions is also on the rise. Suggestions that we adopt the strategies that countries like Taiwan have enacted to successfully rein in the virus are met with online comments such as “we are NOT going to allow the government to track us” and “the government cannot lock us up in quarantine.”

New data lets us see in precise terms how effective non-pharmaceutical interventions have been. The strict lockdown in Hubei, China, from January to April reduced new COVID-19 cases by more than 70 percent. The lockdown in France, implemented in mid-March, has decreased the R value, or the average number of people an infected person will pass the virus on to, by 77 percent. In the U.S., early physical distancing and stay-at-home orders enacted in Washington and Illinois have decreased rates of COVID-19 in both states.

It’s irrefutable that shutdowns work.

It’s also irrefutable that shutdowns have taken a massive toll on the economy.

And so, many states have decided to re-open. In fact, by the end of May, only New Jersey will still have state-wide stay-at-home orders in place. As a medical consultant at Covid Act Now, I work on models that predict how non-pharmaceutical interventions will affect COVID-19. Unfortunately, further outbreaks are all but certain. Both historical examples of past pandemics as well as the latest mathematical models suggest that subsequent outbreaks, if not well-controlled, can be even more destructive.

What can we hope for? Some have suggested allowing the spread of COVID-19 through the population to create herd immunity. But for natural herd immunity to take effect, up to 70 percent of the population will need to be infected. Given the estimated death rate, millions more people would die before we reach herd immunity. Not the best plan.

What we can hope for, however, is for vaccines to give us herd immunity without the deaths. Even though the race for a COVID-19 vaccine has drastically scrunched the usual timeline for vaccine development, it will still be months — at the very least — before we can deploy them for public use.

What we must do, then, is to maintain a high level of pandemic surveillance until vaccines become available, and couple this with non-pharmaceutical interventions such as keeping travel to a minimum, social distancing and mask-wearing. It’s ambitious, but not unattainable.

Testing is quickly becoming faster, easier, and cheaper. The FDA recently approved an at-home saliva test. But since almost half of COVID-19 patients are infected by people who are pre-symptomatic, it’s not enough to only test (and isolate) those with symptoms; we must also trace and test their contacts.

Because using human contact tracers is time- and resource-intensive, many governments have begun using cell phone apps for digital contact tracing. These apps have been met with widespread concerns about privacy and excessive government control.

However, there are ways to address these concerns. In my role as a research coordinator at Stanford Medicine’s Center for Policy, Outcomes, and Prevention, I assist in the development of contact tracing apps.

For example, using Bluetooth beacon technology, these apps can transmit signals to nearby phones without recording any location data. The data — which doesn’t include the time, location, or identity of contacts — can be encrypted and stored locally on the phone until a user tests positive and gives permission for the data to be unlocked. The data can also be deleted after a certain period of time.

Granted, this may all sound like a lot to do. But unlike stay-at-home orders, these measures may give us a semblance of normal everyday life.

If you need any more persuasion that these strategies work, look again to Taiwan, which, despite having eradicated local spread of COVID-19 for over a month, has never implemented any stay-at-home orders. 

Perhaps most importantly, we need experts and policymakers to clearly communicate why pandemic surveillance is needed. We need to acknowledge that apprehensions about these government-mandated measures are warranted, and to reassure the public that every effort will be taken to protect individuals’ civil liberties.

We can navigate the balance between public health and individual freedom and emerge on the other side of this crisis stronger, healthier and better prepared for the next challenge.

Henry Bair is a medical consultant at Covid Act Now, a research coordinator at Stanford Medicine’s Center for Policy, Outcome, and Prevention, and a medical student at Stanford University.