Unraveling COVID-19 Has Been Like Starring in a Michael Crichton Novel | U.S. News Hospital Heroes
On March 14, as the coronavirus pandemic swept into the U.S., Sema Sgaier and her team of scientists huddled in an urgent, impromptu meeting with a single item on the agenda: Find a way to fight the virus and save lives – and find it quickly.
The brainstorming session at Surgo Foundation, a health data analytics nonprofit, yielded a groundbreaking idea. The team would create an online data tool that can pinpoint regions, cities and even neighborhoods at risk for coronavirus infections, and the economic and social consequences that come with it.
Building it amid a fast-moving contagion killing hundreds by the day, filling hospitals to capacity and forcing entire states into lockdown, however, meant inhabiting a nail-biting Michael Crichton novel: Intense, marathon workdays scrambling for answers, restless nights worrying about what might have been missed, an imaginary clock ticking in the background.
“It was like living in a thriller, and we were the protagonists,” says Sgaier, an accomplished medical scientist and global health expert who is Surgo’s co-founder and executive director.
The result of that work is the COVID-19 Community Vulnerability Index, or CCVI, an online tool that combines on-the-ground data with the science of human behavior. Together, the information can help users assess the probability a community will be hit by the pandemic, and the likely effect it will have on its residents.
Created with publicly available information, including from the Centers for Disease Control and Prevention, the U.S. Census Bureau and other official sources, the tool is designed to help municipal officials and public-health analysts assess levels of risk for individual communities, anticipate what could happen if the virus strikes and prepare accordingly.
“Every community in the US will be affected by COVID-19 – but the impacts will not be the same in each,” according to a description on the CCVI home page. The index, it continues, “identifies which communities may need the most support as coronavirus takes hold. Mapped to US census tract, county, and state levels, the CCVI helps inform COVID-19 planning and mitigation at a granular level.”
The level of detail perhaps isn’t surprising, given Sgaier’s background.
An accomplished neuroscientist with advanced Ivy League degrees in cellular and molecular biology, she did work helping to map the human genome as a research fellow at Harvard University School of Medicine. But her public-health bonafides are as impressive: Before joining Harvard’s T.H. Chan School of Public Health as an adjunct professor, she spent six years working on HIV/AIDS prevention in India and Africa for the Bill and Melinda Gates Foundation, using behavioral science and data mapping to fight transmission of the virus.
In creating the CCVI, “Our goal was to think through how we make public health more effective – how we bring greater precision” to the discipline, Sgaier says. Regarding COVID-19, she says, “For too long, we were stuck in this moment of ‘now,’” reacting to an ongoing storm rather than forecasting where it might strike next.
Using the data, she says, experts can ask themselves whether a community can weather that storm, and what resources should be marshalled ahead of time to help it recover. “It can be on health and mortality, but it also can be on other issues,” like access to food, housing quality and medicine as well as transportation and residents’ ability to shelter in place or self-isolate if necessary.
“I was really interested in the notion of how we protect our most vulnerable communities,” Sgaier says. “Where are you in that level of vulnerability? Are you high, middle or low? As a community, are we prepared? Is (the pandemic) going to be a death sentence for some communities?”
The CCVI can also help policymakers identify “testing deserts” – urban and rural communities without a coronavirus testing infrastructure, Sgaier says. It’s important, she says, because the coronavirus “is going to be with us to stay.”
For example, the CCVI tool found that nearly two-thirds of all rural counties in the U.S. don’t have a coronavirus testing site, a gap that has 20.7 million people living in what the Surgo Foundation identifies as “rural testing deserts.” But the analysis also revealed inequalities within that inequality: It found that 1.27 million rural African Americans live in testing deserts, more than a third of the Black rural population.
Moreover, CCVI found that rural Black residents are twice as likely as the general rural population to live in a testing desert, and nearly three times as likely to live in a highly vulnerable testing desert – defined as a rural community with no test sites and a rising COVID-19 infection rate.
The analysis shows how the tool drills down on data to reveal at-risk communities that tend to be overlooked, Sgaier says.
“Is it an elderly population we need to shield and protect? Or is it a very poor community” with high-density, multigenerational households, she says. “We need to think about (those factors) when we’re putting in, for example, social-distance policies that the community would have a hard time” following.
That seems to be the case in Arizona, a state the Surgo Foundation zeroed in on not long after the CCVI tool was developed. A resulting case study seems irrefutable: “We find that our granular data and analysis predicted the outsized impact of the pandemic on Arizona’s most vulnerable communities,” it reads.
A series of “underlying vulnerabilities, identified months before the pandemic hit its peaks” – including testing deserts and a dearth of medical care – “have exacerbated the impacts of policy decisions and led to significantly higher viral spread in Arizona’s Native American and border regions.” The spike came after the lifting of stay-at-home orders, according to the study.
The data accurately predicted that Arizona counties along the U.S.-Mexico border “are driving recent rapid per-capita case growth in Arizona, joining the already hard-hit Native American communities,” according to the study, published in July. At the same time, counties that Surgo identified as highly vulnerable in early March have been disproportionately hit with infections in the weeks after Arizona Gov. Doug Ducey, a Republican, began to re-open the state.
And dramatic drops in social distancing in the state’s inland communities, including Coconino and La Paz counties, could be leading indicators of rising per-capita case growth, according to the study.
Though Sgaier has worked on the ebola crisis in Africa and HIV prevention in poverty-stricken areas in India, “I’ve never really worked on a crisis where (a contagion) was so new,” she says. “What we know (about coronavirus) today as opposed to what we knew on March 14 is so different.”
But most public-health emergencies have one thing in common, Sgaier says: They can be mitigated – or defeated – with preparation.
“The impact of COVID is preventable if we act early, and if we do the right thing, we could actually win this virus. It doesn’t have to be the way it is right now,” she says. “The key message is we are all at risk. But more importantly, we all have a duty to protect each other.”