Harvard Global Health Institute / Microsoft AI / NPR screenshot
How serious is the spread of COVID-19 in your community? If you are confused, you are not alone. Although state and local dashboards provide many numbers, from counting cases to deaths, it is often not clear how to interpret them – and difficult to compare them to other places.
“There is no unified, national approach to risk communication,” says Danielle Allen, professor and director of the Edmond J. Safra Center of Ethics at Harvard University. “This made people more difficult,” he says.
Allen, together with researchers from the Harvard Global Health Institute, is conducting a collaboration of top scientists from institutions across the country who have joined forces to create a unified set of metrics, including a shared definition of risk levels – and tools for communities to fight coronavirus.
The collaboration launched these tools on Wednesday, including a new online risk assessment map which allows people to check the state or county in which they live and see a COVID-19 risk classification of green, yellow, orange or red. Risk levels are based on the number of new cases per 100,000 people per day.
A community that has less than one new case per 100,000 a day is green. One in 10 is yellow; between 10 and 25 it is orange; and above 25 it puts you in red. “When you walk into that orange and red area it means, in all likelihood, you’re seeing a lot of speed, a kind of rapid upward trend,” says Allen.
This is by no means the only attempt to rank risk levels in the United States. There are numerous frameworks that use different measures. And this can be confusing, says Allen. “What we really need is a shared vocabulary and a shared way of presenting data in all jurisdictions,” he says. This effort represents the consensus of eight institutions and over a dozen individual experts who agreed on these metrics.
Of course, there are other important metrics when it comes to tracking the spread and severity of COVID-19. Local public health leaders need to know how many people die and how many people are hospitalized. They need to know how many tests are turning positive in an area. (The lower the positivity rate, the more likely a community is testing enough to accurately detect the spread of the virus.)
But the group has decided to link the alarm level to numbers of new cases per 100,000, because it is a good indicator to show the current picture of the outbreaks and compare them consistently. It is a standard way of measuring risk compared to the total population.
“It allows you to compare a rural area in northern New York City to New York City and compare apples to apples by relative impact and relative workload,” says Ellie Graeden of Talus Analytics and the Center for Global Health, Science and Security at Georgetown University, which is part of the convergence team that developed the metrics.
Also, by sticking to a standard standard metric you can compare trends over time. “You want to know if things are going up or down,” says Allen.
For the public, this means that you can now compare the incidence of the case you live with that of, say, a neighboring county where you are considering running a commission. Or the county your parents live in if you’re thinking of visiting. It gives you a way to assess your community’s risk level compared to others, at a glance, and change your behavior accordingly.
For policy makers, risk levels are intended to signal the intensity of the effort needed to control COVID-19 and trigger specific interventions. The collaboration published guidance on how state and local leaders should manage their response, depending on the level of risk.
“Like this [pandemic] explained, many of us were waiting for the federal government to get up and really produce … some practical advice on how those at the state and local level should respond, “says Graeden. But in the absence of this clear orientation, this collaboration aims to bridge the void.
If a jurisdiction is green, they are well on their way to contain the virus. At the yellow level, a community should implement measures such as masking and social estrangement and have an active testing program, contact traceability and isolation, including targeted tests for those in high-risk environments. Orange is considered “dangerous” and requires impetuous testing and the search for contacts – or if this is not possible, it can request residence orders.
On a red level, “jurisdictions have reached a point of no return for uncontrolled dissemination” according to the collaborator’s guide. At this level “you really have to go home [advisory]”Says Graeden.
Currently, two states – Arizona and Florida – are at the red level and 13 are orange. Only Hawaii is green. But there is a great variety of variations from county to county. In orange Texas, for example, more than 20 counties are red.
The idea is to eliminate some of the guesswork from local policy response, says Graeden, and offer a more standardized way to communicate risk and response options.
“We have all changed our metrics to align them more precisely between the different platforms,” he says. “We are now communicating and we all agree on the same basic thresholds for the types of actions that need to be taken.”
The shared metrics and guidelines will be incorporated into a series of COVID-19 response-focused initiatives and sites, including Covidlocal.org, led by a group of disease outbreak experts and former public health officials, CovidActNow, led by former technology executives and a group of academics. The convergence group hopes to see it adopted more widely and used by local and state governments.