COVID-19 Response by Prevalence

The Edmond J. Safra Center for Ethics at Harvard University has released Pandemic Resilience: Getting it Done as part of the centers  COVID-19 Response Initiative. This report serves as a supplement to the Roadmap to Pandemic Resilience white paper and focuses on guiding state and local governments in implementing TTSI (testing, tracing, and supported isolation) programs.

It is important to note that TTSI and the degree to which it is implemented is dependent on the prevalence of COVID-19 (coronavirus disease 2019) in each specific community. Communities can be divided into three prevalence zones: “green zones” with low prevalence, “yellow zones” with moderate prevalence, and “red zones” with high prevalence. Prevalence can be partially determined by the number of deaths per 1000 people on a daily basis, with high prevalence communities experiencing 1 or more deaths daily. The number of confirmed COVID-19 cases can also be used to help determine prevalence. However, both of these indicators can be problematic as, according to the report, fatality rates will be a “lagging indicator” and confirmed cases can be misleading if a community is “not testing at a very high rate.” It is suggested that areas look at “excess deaths (deaths today vs deaths same time last year) rather than with COVID-attributed deaths, especially in places where there is little to no testing.”

After establishing COVID-19 prevalence guidelines, the paper proceeds to detail the following by zone: “strategies for non-pharmaceutical interventions other than testing”, “strategies for testing and tracing”, infrastructure, implementation, and public messaging. Concerns, such as stay-at-home orders, mask wearing, large gatherings, TTSI, sentinel testing, sample processing infrastructure, information technology infrastructure, and risk communication messaging, are all addressed. To help communities successfully establish and follow these guidelines, recommended congressional investments in “local and country public health offices, contact tracing personnel, voluntary self-isolation facilities, income support for voluntary self-isolation, test kits and test processing, point-of-care testing machines, and mega-labs” are also outlined.

Additional papers in this series address pandemic issues related to  technology, law enforcement, mass testing, privacy, politics, and the economy. The full collection of COVID-19 related papers from the Edmond J. Safra Center can be found by following this link.

For more information on related topics visit the HSDL In Focus on Pandemics and Epidemics or view other resources included in the COVID-19 Resource Archive. Please note that an HSDL login is required to view some of these resources.

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