No time to fly blind: To beat COVID 19, Canada needs better data

As we always do! Bit surprised no discussion of what role the Canadian Institute of Health Information (CIHI) could play:

Accurate information is critical to fight a health emergency like the COVID-19 pandemic. Robust data identifies the scale of the problem. It enables the prioritization of human, financial and material resources for an effective and efficient response. It allows for public scrutiny, advocacy and accountability. It builds trust. It provides authorities with tools to counter misinformation. It will enable us to slowly and safely return to economic and social activity.

In short, good data can mean the difference between life and death – or in the case of a pandemic, tens of thousands of deaths. Yet in the face of the greatest international health crisis in a generation, Canada is falling short.

Prime Minister Trudeau promised better data. To deliver on this promise, the Public Health Agency must mandate standardized information reporting for provincial and district public health authorities. These standardized templates would outline the data and information to be reported, how it should be collected and how it should be shared. Moreover, the Agency should urgently provide financial and technical resources to improve information management at all levels of the public health response.

At first glance COVID-19 data appears to be plentiful – case numbers and graphs are splashed across news reports and public health websites. Public health agencies produce epidemiological reports with colourful graphs and charts. Officials quote modelling estimates of projected case numbers and fatalities.

But in reality the value  of this information is limited. Efforts to fill in information gaps with modelling is a short-term and imperfect substitute for real-time data.  The data that does exist is of questionable validity given low testing numbers within the population and delays in receiving test results. Moreover, the data is not gathered, compiled or presented in a consistent manner by health authorities across the country. Different case definitions make comparison within and across provinces difficult. Sex and age disaggregated figures are not always provided. Some areas report hospitalization and intensive care unit numbers, some do not. Warnings of medical equipment and personal protective equipment (PPE) shortages are widespread, yet inventories of PPE stockpiles are frequently not given.

Moreover, public health officials report cases but do not discuss population context. They do not present important statistics about communities including age, sex and socio-economic data and specific vulnerabilities. Authorities rarely provide information on the number of health workers employed in the response, hospital beds available or PPE stockpiles. Officials cite testing numbers with little concrete data on laboratory capacity or efforts to expand it.

It is confusing. Overwhelming. And unhelpful.

Without accurate data and information, authorities cannot identify and manage human, financial and material resources to engage in the fight against COVID-19.  Nor can they monitor the effectiveness of interventions and stop its spread.

We can do better. During humanitarian crises, which often occur in data-scarce contexts, central coordinating bodies prioritize the collection and transparent dissemination of information. They develop standardized “Situation Reports” at multiple levels – the community, the region and the country – to identify need, prioritize interventions and target scarce human, material and financial resources. In the health sector, reports include population size disaggregated by sex, age and vulnerability; the number of health facilities in operation; key causes and rates of illness and mortality; medical procedures and treatment courses. These reports are published openly and disseminated widely. Information is critical for an effective and efficient response in complex and rapidly changing environments. It allows resources to be targeted to save lives.

COVID-19 warrants something similar. We need to understand the progress of the disease and our response – in real time. Proper information management will not only improve the effectiveness of our interventions, but it will also enable the safe resumption of economic and social activity.

A standardized reporting template would include case numbers and hospitalizations (sex and age disaggregated).  But counting the numbers of outbreak cases is only one piece of the information puzzle. Reports should include community baseline data. Important information includes population demographics (age, sex and particular vulnerabilities), neighbourhoods with higher risks, and the number of vulnerable institutions (retirement and nursing homes, corrections facilities). Authorities would identify financial, human and material resources available and required. Reports should document laboratories with COVID-19 testing capacity and provide inventories of PPE.

Better data would allow us to identify critical intervention points to stop the spread of COVID-19 and to slowly get our lives and economy back on track. The lack of prioritization on testing is both a symptom and a consequence of Canada’s failure to prioritize information management. Given testing capacity, public health officials discourage tests for those with mild symptoms. This undermines the validity of most of the numbers used by public officials to track the COVID-19 outbreak. Without the total ‘real’ numbers of individuals infected, we lack an accurate denominator, which undermines the accurate calculation of hospitalization or case fatality rates. Lag times in test results also make accurate contact tracing very difficult.

More critically, without expanded testing, we lack the ability to quickly test health workers and those employed in other essential services (such as retirement homes) to protect them, their co-workers, patients or residents and the public. Nor do we have the ability to test people to gradually and safely scale up economic and social activity. Instead we are told to wait for testing innovations while COVID rates numbers rise. Yet many private labs as well as lab facilities in university and colleges remain unutilized over three weeks into Canada’s full scale COVID-19 response. With better information would come increased accountability for mobilizing such capacity.

COVID-19 has sparked one innovation in information production – the use of outbreak models to guide public health responses to COVID-19, often funded by public health authorities. The federal government recently provided $192 million to BlueDot – a Toronto based digital health firm, not a university research department – to support its modelling activities. After calls to release modelling estimates, some provincial governments have provided projections of case and mortality numbers.

But transparency warrants more. Modelling in general is extremely challenging and COVID-19 modelling is particularly complex. Population demographic characteristics appear to determine the speed of COVID-19 transmission as well as severe illness, hospitalization and fatality rates. While the professionalization of the modellers is not in question, research driving policy decisions should be published openly and subject to scrutiny. The lack of clarity contrasts unfavourably to models published in scientific journals, or those published online by Professor Neil Ferguson of Imperial College, University of London. If governments release model estimates, they should release the assumptions and data that inform these estimates.

Moreover, modelling is an imperfect and flawed substitute for real data and concrete information about the response. Policy makers urgently need to pay attention to the generation and management of accurate and valid data, mandate standardized reporting from all public health authorities and provide public funds to make it happen.

We are in unprecedented public policy territory. Yet we lack the information needed to effectively navigate the COVID-19 pandemic and get our economy and our lives back on track. Prime Minister Trudeau’s commitment to better data and improved information management provides Canada’s Public Health Agency with the opportunity to exercise leadership. It is time to up our game.

Source: No time to fly blind: To beat COVID 19, Canada needs better data

About Andrew
Andrew blogs and tweets public policy issues, particularly the relationship between the political and bureaucratic levels, citizenship and multiculturalism. His latest book, Policy Arrogance or Innocent Bias, recounts his experience as a senior public servant in this area.

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