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For all the confusion and suspicion it has raised during the public health emergency, the District’s COVID-19 data dashboard is among the nation’s best. Resolve to Save Lives, an initiative run by former Centers for Disease Control and Prevention Director Tom Frieden, says the dashboard on coronavirus.dc.gov is among the top four in the country, alongside Minnesota, Oregon, and Utah. “These dashboards provide robust information, enabling communities to be better informed on the local spread of COVID-19 and risk of infection,” a November report states.
“There is always room for improvement,” says Jennifer Bianca Browning, an analyst in the Office of the D.C. Auditor.
She led and authored a newly released report about DC Health’s collecting and presenting of coronavirus data. Using benchmarks from Resolve to Save Lives, auditors concluded that the agency has significantly improved its data reporting over the course of the pandemic, especially considering there is no national standard. But auditors also point out that D.C. does not publicly report a lot of data, some of which public health officials already collect, that could be helpful in controlling the spread.
“When we look at how our government is doing, in terms of public health, I think on the health side, we’re doing a great job,” says D.C. Auditor Kathleen Patterson, emphasizing officials are good at the scientific research side of things. “On the public side of public health, I think that’s where we can do a lot better in terms of communicating and sharing.”
There are a number of data points that DC Health can publish on its coronavirus website, according to auditors, like new infections among health care workers and cases broken down by individual schools. As the District enters another wave of coronavirus cases, the auditors and the public writ large are interested in learning what drives transmission.
Sometimes during press conferences, DC Health provides a list of activities where individuals may have been exposed to the virus. The exposure data, based on contact tracing interviews, always shows small, private gatherings as the top activity people have done two weeks prior to testing positive. But even more people report attending no higher-risk activity—be it a gathering, restaurant, or work—suggesting the prevalence of household transmission. Whether these get-togethers really cause the surge has come under scrutiny by some epidemiologists. “It seems like they’re passing off the responsibility for controlling the outbreak to individuals and individual choices,” Ellie Murray, an epidemiologist at Boston University, tells the New York Times. Having a fuller picture of how people are getting infected could help.
DC Health does not not publish data about outbreaks, or clusters of cases, nor does the department report superspreading events, where an individual is known to have infected an unusually large number of people. When asked about superspreading events at a Nov. 12 press conference, DC Health Director Dr. LaQuandra Nesbitt harkened back to exposure data that suggests small gatherings are driving transmission.
“This really is a construct where folks who are out in these social environments or attending a social-related event are more in these smaller, intimate settings where social distancing and mask wearing is not adhered to consistently,” Nesbitt said.
Among the recommendations that the Office of the D.C. Auditor identified is arranging the data so outbreaks are distinct from community spread. “When many cases are originating from unknown sources, the risk in the community is much higher than when known outbreaks are the primary source of new cases,” Resolve to Save Lives explains in its own report. Having D.C.’s new cases and daily case rates stratified by outbreak versus community could be worthwhile, auditors believe, as well as listing outbreaks in congregate facilities and essential workplaces.
“Granular data is more actionable,” says Patterson, echoing her favorite quote from the Resolve to Save Lives report.
It’s unclear if DC Health is collecting but just not reporting outbreak or superspreading event data. The auditors do not know if DC Health is collecting outbreak data already, nor do they know how DC Health defines outbreak. “It would surprise me greatly if they had not thought about it,” says Browning. “My impression is when I go to DC Health and ask them a question, they’ve thought about it and they have a reason. It’s not this new thing I’m bringing up.”
City Paper asked DC Health whether the agency identified any superspreading events in recent weeks and a spokesperson declined to answer the question, saying instead, “DC Health requests that all residents practice social responsibility when planning activities. Even if you are not at high risk for serious illness with COVID-19, consider that you could spread the virus to more vulnerable members of your household or community. Many traditional holiday season activities are high risk for spreading the virus that causes COVID-19. Virtual events or activities at home involving only members of your household are safest.”
A few states report outbreaks, including Utah and Colorado. Colorado has a tab designated to outbreaks on its coronavirus website, and these outbreaks are broken up by week and setting. According to the Colorado Sun, the state health department defines an outbreak “as two people testing positive for COVID-19 in a span of two weeks.” During the week of Nov. 15, camps, schools and childcare facilities accounted for the most outbreaks, followed by inpatient health care, then bars, restaurants, and entertainment. Gatherings and social events did not account for any outbreaks that week, nor do they make up a large share of outbreaks when they are documented. Colorado also lists exactly where outbreaks happen and whether they are still active.
Superspreading events are also of interest because they can be major drivers of transmission. New research from MIT published in the peer-reviewed journal Proceedings of the National Academy of Sciences of the United States of America found that superspreading events, which they defined as anyone who directly infects more than six people, are not as rare as one would expect and play an outsized role in overall transmission.
“One analogy is lighting a pile of kindle. You might have a bunch of wood burning, but to initiate the flame, you need a match. And basically understanding who the matches are—who the super spreaders are—can kind of help point us to what’s really driving the outbreak,” says lead author Felix Wong, a postdoctoral researcher at MIT. “All you need is one match to light up the fire.”
He and another MIT researcher analyzed 60 superspreading events against traditional models in epidemiology, and determined these events happen more frequently than the models predicted. Wong says contact tracing in the United States and other Western countries generally speaking does not focus on identifying the super spreaders, but instead focuses on any one infected person in the hopes of isolating them and preventing them from infecting more people. “Forward contract tracing,” as it’s called, is not conducive to identifying super spreaders, he says.
“Countries like South Korea and Taiwan and Japan, nowadays, what they’re doing and what they have done since the start of the pandemic is to do the opposite, namely backward contact tracing in which they don’t go down the transmission chain [but] they go up the transmission chain,” says Wong. “What that really does is that helps identify super spreaders because super spreaders are typically the ones that transmit to more people.”
DC Health seldom publicly identifies local outbreaks and superspreading events. Nesbitt was reluctant to call the September 26 gathering in the White House Rose Garden for Supreme Court Justice Amy Coney Barrett a superspreading event, even when the rest of the country did. She also declined to say whether cases connected to the Rose Garden gathering were included in D.C.’s case count. To learn about superspreading events in D.C., you’d have to look at crowdsource data. A team of researchers at the London School of Hygiene and Tropical Medicine created a public database of superspreading events and identified four separate ones that occurred at the White House, St. Elizabeths Hospital, DC Jail, and a rehabilitation facility.
The challenge underpinning this data is it is just very difficult to definitively identify a source of spread. It is especially difficult now, when D.C. sees more than 100 new cases daily and the disease is so prevalent in the population. That is why understanding the coronavirus biology helps us make policy decisions around lowering cases, says Dr. Justin Lessler, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health.
“When we get rid of the indoor dining and the mass gatherings, we get rid of some of these bigger transmission events that allow things to more quickly move between households and move between communities,” he says. “In a way we get rid of the more dramatic outbreaks we can trace. But that doesn’t mean small gatherings can’t sit there and be a driver of transmission.”