Abstract
Catastrophic epidemics, if they occur, will very likely start from localized and far smaller (non-catastrophic) outbreaks that grow into much greater threats. One key bulwark against this outcome is the ability of governments and the health sector more generally to make informed decisions about control measures based on accurate understanding of the current and future extent of the outbreak. Situation reporting is the activity of periodically summarizing the state of the outbreak in a (usually) public way. We delineate key classes of decisions whose quality depends on high-quality situation reporting, key quantities for which estimates are needed to inform these decisions, and the traditional and novel sources of data that can aid in estimating these quantities. We emphasize the important role of situation reports as providing public, shared planning assumptions that allow decision makers to harmonize the response while making explicit the uncertainties that underlie the scenarios outlined for planning. In this era of multiple data sources and complex factors informing the interpretation of these data sources, we describe four principles for situation reporting: (1) Situation reporting should be thematic, concentrating on essential areas of evidence needed for decisions. (2) Situation reports should adduce evidence from multiple sources to address each area of evidence, along with expert assessments of key parameters. (3) Situation reports should acknowledge uncertainty and attempt to estimate its magnitude for each assessment. (4) Situation reports should contain carefully curated visualizations along with text and tables.
Highlights
Short of a massive, distributed bioterrorist attack, nearly any imaginable scenario for a globally catastrophic infectious disease outbreak would involve an initially small outbreak spreading from a few infections in a limited geographic area to infect many more people in many more places
It follows that efforts to prevent such catastrophic scenarios from materializing must include successful measures to stop or limit the spread of severe, but initially subcatastrophic events (Lipsitch 2017). Such measures are more likely to succeed if key decision makers -- and those charged with implementing their decisions -- have access to reliable, timely information on key parameters of an outbreak in progress
Experts in influenza epidemiology know that viral testing and influenza-like illnesses (ILI) are both incomplete measures of incidence with particular biases that vary over time
Summary
Short of a massive, distributed bioterrorist attack, nearly any imaginable scenario for a globally catastrophic infectious disease outbreak would involve an initially small outbreak spreading from a few infections in a limited geographic area to infect many more people in many more places. It follows that efforts to prevent such catastrophic scenarios from materializing must include successful measures to stop or limit the spread of severe, but initially subcatastrophic events (Lipsitch 2017) Such measures are more likely to succeed if key decision makers -- and those charged with implementing their decisions -- have access to reliable, timely information on key parameters of an outbreak in progress. In contrast to subject-matter experts, senior decision makers are typically generalists with less detailed knowledge of these aspects of any new disease Their heuristics for interpreting raw data from surveillance systems, epidemiologic investigations, and novel data sources will be less nuanced, less informed by experience, and more variable from person to person. Motivated by these uses and the available data, we propose and discuss four criteria for high-quality situation reporting in outbreaks
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