Latest COVID-19 Surge Highlights Need for California to Modernize Surveillance Systems For The Future

Leigh Anderson
Leigh Anderson is President of Performance Services at Premier Inc., a healthcare improvement company uniting an alliance of approximately 4,000 U.S. hospitals and health systems and more than 175,000 other providers and organizations.

It’s heartbreaking and frustrating to watch as parts of California again close down because of a resurgent coronavirus. In the past four months, COVID-19 has crashed economies and disrupted health care systems. It has filled some hospitals, emptied public spaces and, regrettably, taken more than 130,000 American lives. Our nation and America’s largest state is returning to work – but the virus isn’t cooperating. The challenge we face is becoming crystal clear: How does California stay re-opened and do so in a manner that ensures safe communities?

According to a recent California Healthcare Foundation study, hospitals are projected to lose more than $10 billion during the first four months of the COVID-19 pandemic. Virtually no entity could absorb a loss that significant and not be left reeling.

Amid the pandemic, hospitals increased inpatient bed supply, ventilators, intensive care space and stockpiled other equipment due to a concern that they would be inundated with coronavirus patients. But the pandemic caused people to stay home. Normal hospital usage patterns stopped. Patient volume declined significantly. Non-urgent medical procedures were delayed or cancelled, and patients postponed check-ups, lab procedures and other medical visits.

Four months after the pandemic’s “safer at home” order – despite their enormous efforts –  hospitals, healthcare providers and public health officials lack an early warning system to support communities’ containment and mitigation strategies. Regulators require that hospitals maintain surge capacity – the infrastructure needed to deal with the pandemic’s surges. Still, hospitals need to return to a semblance of normal operation or risk financial ruin and possible closure.

Throughout the pandemic, elected and public health officials have discussed the necessity of a robust testing infrastructure. The inability to optimally detect and respond to the pandemic is a critical missing “gating step” called for in the Trump Administration’s “Opening of America” and in Governor Newsom’s phased plan to re-start California’s economy and keep it open.

Public health is a local endeavor. Monitoring, measurements and requirements deviate across regional boundaries and state lines. Unfortunately, this outdated surveillance approach to track COVID-19 cases relies on antiquated data collection systems that are inaccurate, rendering them useless for prediction of disease spread.

This version of surveillance that relies on the regular, ongoing testing of millions of Californians alone has significant limitations and massive costs. False negatives in current tests range from 20-100 percent depending on when the test is taken after infection. At best, tests results are delivered nearly three days later, during which time a person can continue to spread the virus. California residents and businesses need confidence that a means exists to identify a new COVID-19 surge early which, in turn, will allow effective containment and mitigation without adding billions in costs to national, state and local budgets.

The on-going COVID-19 epidemic underscores the need to modernize the state’s system to real-time syndromic surveillance that can identify emerging cases before consistently delayed test results are delivered or patients are hospitalized. In fact, symptoms are the earliest and most reliable indicator of COVID’s reemergence. Identifying suspected cases early using predictive surveillance allows for immediate identification of the likely infected along with swift quarantining, which will in turn supercharge contact tracing efforts.

Policymakers, businesses and the public at-large should care because without the ability to detect surges before they happen, the economy will teeter between “return to normal” and “shutdown.” If state and county government can anticipate surges, that will inspire confidence in both businesses and consumers alike, leading to job growth and a quicker, more robust economic recovery

Today, several of the country’s largest health systems rely on an AI-enabled early warning solution that suggests COVID-19 symptoms, including Geisinger Health System serving more than 3 million patients across Pennsylvania and New Jersey. This system should be augmented and deployed here in California to help communities reopen and provide an early warning for future waves throughout the state.

A single, bird’s-eye view into the pandemic would provide public health and government officials with detailed, actionable and real-time data about potential trouble spots, enabling faster and more effective responses. Equally important, it is an investment worth making now to ensure we save lives and scarce future resources. Public confidence, and the more than 130,000 souls we’ve lost, demand it.

 

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