New CDC team: A weather service to forecast what's next in pandemic
The Washington Post April 20, 2022
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A new team of federal health scientists officially embarked Tuesday on a mission to provide what has often been absent from the nation's response to the coronavirus pandemic: better, faster information about what is likely to happen next in this public health emergency and in future outbreaks.
"We think of ourselves like the National Weather Service, but for infectious diseases," said Caitlin Rivers, an epidemiologist and associate director for science at the initiative, run by the Centers for Disease Control and Prevention.
About 100 scientists will analyze technical data and communicate policy options to decision-makers and the public about how the virus is behaving and who is most at risk — in user-friendly terms.
"We would love to be able for people to look to us to say, 'I'm about to commute on the Red Line. . . . Should I bring a mask based on what's happening with respiratory disease in my community? Should I have my birthday party outside or inside?' Those kinds of decisions, I think, are where we would like to move toward," Rivers said.
The Center for Forecasting and Outbreak Analytics, which starts with $200 million in funding, was created last summer to improve understanding by the CDC and the government more broadly of the coronavirus - and future outbreaks - in real time. White House officials formally launched the effort Tuesday at a summit hosted by the Office on Science and Technology Policy on strengthening U.S. early-warning systems for health threats.
Jake Sullivan, President Biden's national security adviser, noted that the creation of the center was enshrined in the administration's first national security memorandum, issued Jan. 21, 2021.
Newly appointed White House coronavirus response coordinator Ashish Jha said public health leaders have scrambled during the pandemic to do the best they can.
"But it's also been really clear, this is no way to run a response to a pandemic," Jha told panelists at the event.
Without a centralized, trusted source for forecasting, "policymaking in that context is nearly impossible," Jha said. "That, to me, is going to be a major contribution of this center. I feel like we are embarking on a process that will put us in a totally different footing for the rest of this crisis and future ones."
CDC Director Rochelle Walensky said the "very small but very mighty" team will analyze every stage of a health threat, from its epidemic potential to a comparison of health interventions. The center will also prioritize identifying vulnerable groups who are often invisible because they are not captured in data.
The center comes into existence at an uncertain moment in the pandemic.
As the United States plods wearily into the third year of the health crisis, Covid-19 cases are rising. But it remains unclear whether new, highly transmissible versions of the omicron variant in New York state and Europe will trigger a new wave of infections.
If there is another surge, elected leaders could be wary of reinstituting restrictions such as mask mandates, given the availability of vaccines and therapeutics and a political environment in which many Americans express ambivalence, or even outright hostility, toward vaccines and public health recommendations.
When Walensky tapped outside experts to head the new outfit, the move was widely viewed as an acknowledgment of long-standing and systemic failures regarding surveillance, data collection and preparedness that were put into high relief by the pandemic.
There is no national system in the United States for infectious-disease forecasting. During the last major health threats — the 2009 H1N1 swine flu pandemic, the 2014 to 2016 Ebola epidemic, the 2016 Zika outbreak — the CDC had some experts, but the public health agency also enlisted volunteer academic experts.
"Academic experts have been acting as volunteer surge capacity, but that's not sustainable," Rivers said.
Experts, including Rivers and others on the team, have long advocated for an infectious-disease forecasting center.
The center will provide support and analyses to decision-makers in the federal government and in states. That includes forecasting how many covid cases might be expected in coming days and weeks by analyzing the number of new cases and hospitalizations, and examining the population groups most affected.
Scientists will also look at who is infecting whom, how well vaccines protect against infection and severe illness, and how that depends on the vaccine, variants and the time since vaccination, said Marc Lipsitch, an epidemiologist and the center's science director.
The center will work with other experts in government and the private sector to answer practical questions about how well certain measures — contact tracing and isolation, closing borders, masking, testing travelers — work to reduce transmission. That will "help decision-makers choose policies that are the most effective and the least costly and disruptive," Lipsitch said in an email.
Health officials and experts are eager for information, especially at a time when guidance is often confusing and official case counts and testing data are increasingly less reliable because so many people are testing at home and aren't required to report the results.
Anne Zink, an emergency physician and chief medical officer for Alaska, said the pandemic's lessons must be applied going forward.
"We're reaching almost a million deaths, huge economic consequences, schools shut down for large periods of time, travel plans and everything interrupted in one way or another," Zink said. "How can we learn from the challenges of the past couple of years to know what will happen this fall, this winter? Should I plan my wedding? . . . Can I plan on international travel?"
The center's scientists expect new waves of covid cases as immunity wanes and variants emerge. There is a strong possibility that the pattern for the coronavirus will not behave akin to seasonal flu, which typically arrives during the winter, "but instead, surges come at different and not fully predictable times of year," Rivers said in an email.
Center scientists expect that vaccination for children younger than 5 - which is awaiting Food and Drug Administration authorization — will have a "modest impact" on the pandemic's trajectory.
The center's scientists have no insights yet into two new omicron subvariants, dubbed BA.2.12 and BA.2.12.1.
Rivers is on leave from Johns Hopkins University. Lipsitch is dividing time between the CDC and Harvard University. The center's other leaders include Rebecca Kahn, senior scientist, also splitting time between Harvard and the CDC; Dylan George, director of operations and a former adviser in the White House Office of Science and Technology Policy in the Obama administration; and Alison Kelly, deputy director and a CDC veteran.
The center will be based in D.C. and will eventually have about 100 staff members, including some at CDC's Atlanta headquarters. It will report to Walensky.
Even before its official launch, the team pivoted quickly when news broke about omicron at Thanksgiving. U.S. officials knew that the variant would spread rapidly. The key question, Lipsitch said, was, "How bad are these cases going to be? That's where we didn't have American data at all."
Working with Kaiser Permanente of Southern California and researchers at the University of California at Berkeley, the team produced the first U.S. estimates showing that illness from omicron was not as severe as what the delta variant caused. Walensky presented results to the White House on Jan. 11.
The team also recognized early that omicron would cause a surge in the United States, and alerted federal and state health officials in December about the forthcoming cases in January, according to George.
Despite the initial funding, the center's work needs to be sustained for the long term, and must be matched at state and public health departments by a skilled workforce that understands methods for modeling diseases.
"I do worry that we don't have enough resources invested in ensuring the necessary level of community testing, surveillance and access to other data sources to get the most out of this new high-quality modeling center," said Jeffrey Duchin, health officer for Seattle and King County in Washington state. Models, he said, are only as good as the quality of the data informing them.
One of the center's priorities is communication. Pandemic guidance and information about vaccine effectiveness have been confusing. It's largely up to individuals now to assess risk and to make sense of a blizzard of data.
"We shouldn't be asking people to be like, hey, in order for you to be safe, we'd like you to have a PhD in epidemiology or a medical degree. And we'd also like for you to have a master's degree in biostatistics and, maybe, a bachelor's degree in economics," said Maria Sundaram, a scientist at the Marshfield Clinic Research Institute, part of the Marshfield Clinic, a Wisconsin health system.
One-third of the new CDC center's staff will be devoted to communication. Its website will grow to include information "to help people understand and make decisions about what infectious diseases are in their community," Rivers said.
The center will also designate experts whose job will be to reach vulnerable communities that don't have easy access to the Internet.
To understand the mission of the new CDC center, Rivers points to the Weather Service, which used to put out bulletins that referred to falling barometric pressure. The problem was, people did not know how to interpret that information.
After conducting research to better understand how consumers assess risk, the Weather Service adjusted bulletins to give specific advice.
"They say things like 'wind may uproot small trees and flying debris may crack windows,'" Rivers said.