This document briefly summarizes CDC’s initiatives, activities, and tools in support of the Whole-of-Government response to COVID-19.
The principal objectives of COVID-19 surveillance are to monitor the spread and intensity of the pandemic, to enable contact tracing to slow transmission, and to identify disease clusters requiring special intervention. Secondary objectives include understanding the severity and spectrum of disease, identifying risk factors for and methods of preventing infection, and producing data essential for forecasting. In addition to tracking the disease itself, monitoring of healthcare capacity and essential supplies through the National Healthcare Safety Network
(NHSN) is critical to ensure adequacy of care.
Because no single system can capture all parameters of the pandemic, CDC has implemented multiple, complementary surveillance systems (Appendix A). Key systems are case-based reporting through the National Notifiable Diseases Surveillance System (NNDSS), laboratory-based surveillance, syndromic-surveillance data reported through the National Syndromic Surveillance Program (NSSP), and data on healthcare system capacity reported through the NHSN (Appendix B). Additional systems, such as COVID-Net, provide rich, publicly available
information for meeting secondary objectives. CDC continues to explore emerging and experimental surveillance platforms with a critical eye toward proven utility. Control of the epidemic requires action at the individual, community, and population levels. CDC has provided
state, tribal, local, and territorial health departments with extensive detailed guidance on contact tracing, infection control, and a wide range of other prevention and control topics. Recent models suggest that asymptomatic and pre-symptomatic transmission and delays in case recognition can greatly reduce the effectiveness of contact tracing. To enhance the speed and thus effectiveness of contact tracing, CDC is exploring technologic methods for instantaneous voluntary notification of contacts of confirmed cases. At the community level, recent events have shown the devastating effects that outbreaks can have among vulnerable populations, especially those in congregate settings such as nursing homes, prisons, and homeless shelters. Similarly, outbreaks in food production plants and other critical industries are crippling communities
financially and threatening national food security. Rapid identification and response to these events is a CDC priority that can mitigate the immediate impact and provide critical insights needed to prevent future outbreaks in similar settings. CDC has developed extensive tools to assist states, counties, facilities, and industries in responding to and preventing these events (Appendix C). Laboratory testing of asymptomatic individuals is an evolving consideration as more is learned about the role of asymptomatic and subclinical infections in transmission SARS-COV-2. Emerging evidence suggests that asymptomatic infections may play an important role in the epidemiology of the disease. However, it is important to define the circumstances where testing asymptomatic persons is likely to be helpful in controlling the COVID-19 pandemic. Interim guidance about laboratory test usage for asymptomatic populations and for serologic testing and serologic surveillance is provided in Appendix D.
Surveillance and hospitalization indicators can aid public health and government officials in their decisions when to reopen communities. The disease occurrence and hospital gating indicators in the Opening Up America Again guideline provide states and communities insight into the trajectory of the COVID-19 pandemic in their jurisdiction. These indicators are part of the broad assessment jurisdictions should undertake when deciding when and how to adjust community mitigation strategies for COVID-19 (Appendix E).
As businesses and other organizations gradually open after the COVID-19-related slowdown, they will need to consider a variety of measures for keeping people safe. These considerations include practices for scaling up operations, safety actions (e.g., cleaning and disinfection, social distancing), monitoring possible reemergence of illness, and maintaining health operations. Interim guidance for helping establishments with these steps is provided in Appendix F.
Widespread community mitigation combined with ongoing containment activities represents both an effective intervention for limiting the spread of COVID-19 and a serious threat to the economic well-being of the country and the world.