The Missing Science: Epidemiological data gaps for COVID-19 policy in the United States

Abstract

We report on a scoping study of COVID-19 epidemiological data available for COVID-19 policy and management decisions for U.S. settings. We synthesize current US Centers for Disease and Control and Prevention (CDC) estimates for parameter of infectious transmission, infection severity, and disease burden, and summarize epidemiologic contributions to these parameters published by CDC-affiliated investigators through Oct 30, 2020. Authoritative estimates of most infectious transmission and infection severity parameters exist but rely primarily on data from studies conducted in non-U.S. populations. Estimates of secondary infection risks for household, workplace, school, or other community settings are lacking and estimates of the clinical fraction remain uncertain. The CDC reports multiple disease incidence and prevalence measures at national and state geographies, including some measures disaggregated by age group, race/ethnicity and sex; however, nationally uniform disease burden measures are not available at the sub-state level or for sub-populations defined by exposure setting, limiting opportunities for targeted interventions. CDC-affiliated investigators authored 133 quantitative studies on COVID-19 through Oct 30, 2020; however only 34 employed analytic methods. The remainder were descriptive. Of the 34 analytic studies, eleven reported on risk factors for infection, seven reported on risk factors for severe disease, three on symptomatic infections, three reported secondary infection risks, and four reported on indirect pandemic effects. Gaps remain in the epidemiological data required for an efficient and equitable public health policy response to COVID-19. The existence of these gaps one year after the onset of the COVID-19 pandemic underscores the need for standardizing data collection and research priorities and protocols in the context of a rapidly emerging infectious disease epidemics.