We need an early warning system to prevent the next COVID surge

Public health guidance should be based on leading, not lagging, scientific indicators. The recent Centers for Disease Control and Prevention (CDC) guidelines and the White House’s National COVID-19 Preparedness Plan represent steps in the right direction: It is time to move away from a one-size-fits-all COVID-19 response strategy and to right-sized responses for each community. 

For example, the White House “One-Stop Test to Treat” plan is a great idea and should be rolled out immediately and equitably. We now have pharmaceutical tools to prevent the progression of COVID-19, but these don’t work unless the infection is diagnosed early. Only rapid access to both testing and treatment will assure that people can be treated promptly and equitably. 

Yet the recent COVID-19 guidance doesn’t go far enough to provide communities, workers and students with the protections they need to prevent suffering and save lives in the next pandemic surge. 

Public health guidance must include policies that leaders can implement before, during and after a COVID-19 surge. While politicians and opinion pieces flood the media with demands for “off-ramps,” the U.S. is still in the process of developing a strategy that will allow for the early identification of, and response to, the next surge.   

After the omicron variant emerged and CDC forecasted its rapid spread, the U.S. could have responded immediately with stricter masking guidelines and other measures to protect public health. Such a rapid, decisive response would have benefited the economy and saved thousands of lives. We need a system that triggers COVID preparedness on the basis of new pandemic waves developing anywhere in the world. 

Think of it this way: An early warning system for a tsunami does not wait until the waves reach the shore. These warning systems detect seismic activity and — with as much lead time as possible — warn people in high-risk areas to move to a safer place. 

Since Nov. 24, when omicron was first reported, the U.S. has confirmed more than 30 million new infections and more than 155,000 deaths. The omicron surge has killed more Americans than delta, and the U.S. has recorded more COVID deaths per capita than other large, high-income countries. 

The CDC’s latest guidance relies primarily on hospital data to determine community risk, but this data is limited in important ways. Certainly, hospital indicators are the most reliable and consistent COVID data that we have nationally. But hospitalizations occur weeks after infections; they are a lagging indicator of COVID transmission. Moreover, hospitalization rates in a specific county do not necessarily indicate COVID risk in that county, given that many sick people have to travel to nearby counties for advanced care. While hospitalization is very predictive of risk of death, it is too late to take effective preventive measures and is not a precise indicator of transmission in a specific county. 

We need better, faster, and more data to allow for near real-time decision making. Two years into the pandemic, the U.S. still does not have enough sequencing data to identify new variants as they emerge. The new White House preparedness plan aims to improve data collection to quickly identify new variants, but further detail and funding are needed.

The nation has not invested in high-quality tracking data to monitor the prevalence of COVID. The increased availability of home-test kits is, of course helpful, but in this regard has made COVID tracking even murkier since most negative and even many positive results are not consistently reported to the local and national data systems. The One-Stop Test to Treat initiative, if implemented broadly and equitably, should be linked closely to CDC’s surveillance efforts. Extensive testing and reporting in real-time could provide a robust and credible early warning system for our communities about the risk of another surge and to provide the opportunity to save lives. We hope that plans are underway to link this important service to public health tracking efforts. 

Here is what we need to be doing now. First, increase rates of immunization across the board with special attention to ensuring access to hesitant, underserved, or vulnerable communities. Vaccine equity is the right thing to do, and it’s good for public health. 

Second, we now know what works to prevent the spread of COVID. However, we do need clear guidance so that we can take action at the first sign of the next surge. Public health interventions like masking and distancing can stop the spread of COVID when we act together. All of us, including children, need to have and use high-quality, well-fitted masks, like N-95s or K-95s. Masking shows respect for others; it is certainly NOT a “scarlet letter.” 

Third, the CDC needs to establish an early warning system and better disease tracking tools that are useful nationally as well as locally. Linking such a system to monitoring global trends, intensive surveillance for variants and extensive test-and-treat efforts would be a much better strategy than the current reliance on hospital data and inconsistent and unreliable case tracking data. 

As much as we would like to, it isn’t possible to wish the pandemic away. A premature declaration of victory will almost certainly prolong the crisis and make it more likely we are unprepared for the next wave. 

Lynn Goldman is the dean of the George Washington University’s Milken Institute School of Public Health; Emily Smith is an assistant professor of global health at the George Washington University’s Milken Institute School of Public Health.