Surveillance challenges, and the Tour de France and COVID-19

Surveillance is a core instrument of public well being, basic to capturing the course of illness and the implications of interventions. Alexander Langmuir, who based the CDC’s famend Epidemic Intelligence Service (EIS), supplied the still widely used definition of surveillance in a 1963 New England Journal of Medicine article: “The continued watchfulness over the distribution and tendencies of incidence [of a disease] by means of the systematic assortment, consolidation, and analysis of morbidity and mortality reviews and different related knowledge.” 

Since its begin, now we have tracked the COVID-19 pandemic with indicators of an infection, illness, and demise. Case reviews and outbreaks, like that on the Diamond Princess cruise ship, signaled the pandemic’s begin. Surveillance mechanisms had been rapidly applied, following the established paradigm of monitoring constructive checks, circumstances and outbreaks, hospitalizations, and deaths. With this pandemic, advances in knowledge sciences supported the profitable implementation of worthwhile, encompassing nationwide and international databases, such because the Johns Hopkins Coronavirus Resource Center. The tracking of virus concentration in wastewater has proved to be an informative addition to the surveillance toolbox.

An article in Friday’s Denver Publish addressed the decision by the Colorado Department of Public Health and Environment (CDPHE) to stop publicly reporting outbreaks in schools. The article quotes college officers who had been shocked by the announcement and issues in regards to the implications of the change. CDPHE made the change to bring reporting of COVID-19 into alignment with how reporting for other respiratory pathogens is handled, a part of the state’s plan for a return to normalcy. A change was made earlier to now not publish every day hospitalization depend.  

Langmuir’s definition didn’t straight acknowledge that the relationships of indicators with the underlying public well being drawback might change over time. For COVID-19, that’s actually the case, complicating interpretation of tendencies over longer durations of time. The Los Angeles Times commented on this topic on Saturday. The case-fatality charge fell as medical care improved over the pandemic’s first months; vaccination decreased the chance of extreme illness and demise as did the arrival of therapeutic brokers, e.g., paxlovid; and the provision of dwelling testing has undoubtedly affected reported case numbers and take a look at positivity, as ascertained by public well being companies. The Colorado Modeling Group has used hospitalization depend in its mannequin to explain the pandemic’s course in Colorado and venture the place the epidemic curve is heading. Starting round March of this 12 months, the state’s hospitals stopped routine testing of all individuals admitted. The hospitalization depend had included individuals admitted due to COVID-19 and individuals by the way discovered constructive due to testing on admission. The modeling workforce now makes an adjustment for this variation.  

Surveillance stays essential for monitoring the pandemic and tendencies within the established indicators within the shorter-term. The response to the change in reporting described by the Denver Publish is reflective of how intertwined the pandemic has change into in our lives. I nonetheless monitor CDPHE’s dashboard, however now not each day. And what does surveillance present for Colorado? Remarkably, the plateau at 300+ hospitalized Coloradans continues into its fifth week. 

Throughout the Lance Armstrong period, my spouse and I grew to become avid watchers of the Tour de France, which is in progress by means of this month. COVID-19 is affecting the race, sending some necessary riders dwelling. To date, eight test-positive riders have left the tour, however two have been allowed to stay. Fellow tour afficionados are conscious that the prospects of 2021 winner, Tadej Pogačar, have probably been harmed by the departure of two key workforce members.  

What’s the most delicate technique to monitor COVID-19 amongst riders and their help crews on the Tour? Testing protocols come from the Union Cycliste Internationale or UCI. They require pre-race testing and testing on relaxation days, and groups might do further testing. A rule has been dropped that required any workforce with two or extra riders testing constructive by PCR in seven days to desert the tour. The dealing with of riders (or different personnel) affords the opportunity of preserving riders testing constructive within the tour, as with two riders judged to have viral titers low enough to make them non-infectious and were allowed to remain in the race. This determination is left to the workforce doctor, the tour COVID doctor, and the UCI Medical Director. I’m unaware of standards for making such a choice, however I do know that the race should go on.

Jonathan Samet, MD, MS
Dean, Colorado Faculty of Public Well being