This summer’s new COVID-19 variants descend from the JN.1 Omicron lineage and include the FLiRT variants (KP.2, KP.2.3, KP.3 and KP.3.1.1) and the LB.1 variant. As of Sep. 17, 2024, the FLiRT and LB.1 variants are estimated to represent roughly 89.5% of new cases across the U.S. (78.6% and 10.9%, respectively). During similar spikes in transmission in the first four years of the pandemic, health and public health officials relied on a host of metrics to inform their response, including local case and hospitalization rates, percent positivity of diagnostic tests, viral concentration in wastewater and vaccination coverage. However, as the circumstances surrounding COVID-19 have changed, surveillance has become much more challenging.
As fewer requirements remain in place for COVID-19 data reporting, valuable data streams are decreasing in update frequency, granularity, coverage and reliability, or are discontinued altogether. Since May 1, 2024, hospitals are no longer required to report COVID-19 inpatient and ICU occupancy data to the National Healthcare Safety Network, though they are encouraged to do so voluntarily. Unfortunately, after the expiration of mandatory reporting, the percentage of hospitals reporting to NHSN dropped by half, from 94% on May 4, 2024, to 46% just one week later on May 11. Currently, only 33.6% (n=1,669) of hospitals continue to share data with NHSN (NHSN, August 2017). Some states are still not included in CDC’s efforts to model the reproductive growth of the COVID-19 epidemic, which is based on emergency room visit data through the National Syndromic Surveillance Program.
Furthermore, data disaggregated by demographics like sex, age and race can be frustratingly difficult to obtain at the local or even state level. CDC has publicly available disaggregated hospitalization data for states that participate in COVID-NET, but the network is only comprised of 300 hospitals in 13 states — leaving much of the country without information relevant to their specific locality. This gives health and public health officials limited insight into the ongoing burden of COVID-19, particularly for key populations.
A Lack of Data Hinders an Equitable Response
A lack of quality information means health and public health officials must make decisions that are less data-driven compared to earlier in the pandemic. Vulnerable populations, including residents of long-term care facilities and historically marginalized populations, could be negatively impacted, as there may be significant delays in identifying localized outbreaks, inadequate levels of vaccination, or a lack of access to testing and treatment. A lack of information diminishes the ability to identify and respond to new or existing health inequities.
Better information at the community level can lead to more equitable responses and outcomes. Geospatial analyses of cases, hospitalizations and vaccination data have previously helped identify areas with a disproportionately high burden of disease and disproportionately low vaccination rates, allowing public health agencies to bring resources to where they were needed most. For example, intervention strategies rooted in data and health equity helped address major disparities in mortality rates among Black Americans compared to their White counterparts. These types of targeted responses are much more difficult without data to help identify disparities.
Where Do We Go From Here?
Data disaggregated by demographics and geography are valuable for evaluating risk in specific populations, and it is imperative to build on data infrastructure efforts established during the pandemic. This data should continue to be collected and made publicly available for researchers, public health authorities and community organizations to help understand the ongoing impact of COVID-19. Health care professionals and organizations should encourage their hospitals to continue to report COVID-19 hospitalizations to CDC through NHSN to maintain robust surveillance on hospital utilization and capacity. Similarly, expanding RESP-NET and COVID-NET to states not currently participating would improve coverage and reliability of network data.
Data sharing and collaboration at all levels of the health care ecosystem will help ensure readiness for future public health threats. These efforts must be viewed and crafted through a health equity lens to address disparities through culturally competent interventions. We have a responsibility to safeguard the well-being of all Americans, especially the most vulnerable and marginalized populations.