Limitations of COVID-19 testing and case data for evidence-informed health policy and practice

Abstract

Background: Coronavirus disease 2019 (COVID-19) became a pandemic within a matter of months. Analysing the first year of the pandemic, data and surveillance gaps have subsequently surfaced. Yet, policy decisions and public trust in their country's strategies in combating COVID-19 rely on case numbers, death numbers and other unfamiliar metrics. There are many limitations on COVID-19 case counts internationally, which make cross-country comparisons of raw data and policy responses difficult.

Purpose and conclusions: This paper presents and describes steps in the testing and reporting process, with examples from a number of countries of barriers encountered in each step, all of which create an undercount of COVID-19 cases. This work raises factors to consider in COVID-19 data and provides recommendations to inform the current situation with COVID-19 as well as issues to be aware of in future pandemics.

Keywords: COVID-19; Case count; Epidemiology; Physical distancing policy; Testing.

Fig. 1

COVID-19 testing and reporting cycle. *The icons in this figure are in the public domain (Creative Commons CC0 1.0 Universal Public Domain) and were obtained from Wikimedia Commons at: https://commons.wikimedia.org/wiki/File:Medical_Library_-_The_Noun_Project.svg; https://commons.wikimedia.org/wiki/File:Home_(85251)_-_The_Noun_Project.svg; https://commons.wikimedia.org/wiki/File:Laboratory_-_The_Noun_Project.svg; https://commons.wikimedia.org/wiki/File:Noun_project_1063.svg; https://commons.wikimedia.org/wiki/File:Analysis_-_The_Noun_Project.svg