Lessons from COVID-19 for rescalable data collection

Abstract

Novel data and analyses have had an important role in informing the public health response to the COVID-19 pandemic. Existing surveillance systems were scaled up, and in some instances new systems were developed to meet the challenges posed by the magnitude of the pandemic. We describe the routine and novel data that were used to address urgent public health questions during the pandemic, underscore the challenges in sustainability and equity in data generation, and highlight key lessons learnt for designing scalable data collection systems to support decision making during a public health crisis. As countries emerge from the acute phase of the pandemic, COVID-19 surveillance systems are being scaled down. However, SARS-CoV-2 resurgence remains a threat to global health security; therefore, a minimal cost-effective system needs to remain active that can be rapidly scaled up if necessary. We propose that a retrospective evaluation to identify the cost-benefit profile of the various data streams collected during the pandemic should be on the scientific research agenda.

Figure

Policy questions and data needs across the different phases of an epidemic Identification of threats to public health requires continuous monitoring and surveillance. The purple arrows represent the detection of a novel pathogen or new variant. The first question is to assess (1) whether an outbreak is occurring and whether it was caused by a novel pathogen or a new variant. Once a causative agent has been identified, the second question (2) is to characterise morbidity and mortality (ie, how dangerous is the pathogen?) and the third question (3) is to understand transmissibility and its mode of transmission (ie, how quickly is the pathogen spreading?). While answering these questions, surveillance infrastructure should be rapidly scaled up to ensure that (4) the effect of the epidemic can be monitored. The final policy question that emerges simultaneously is (5) understanding how the ensuing epidemic can be controlled. Throughout the epidemic, surveillance systems must be sustained to monitor changes in pathogen transmission or severity. After an infection wave has subsided, surveillance can be downscaled as focus moves towards longer term disease surveillance and evaluating the need for changes in policy response. Flare-ups caused by a new pathogen or a new variant of a previously circulating pathogen generate similar policy questions.