One COVID, Three Americas: Dynamic Panel Surveillance to Inform Health Policy

BACKGROUND: The Great COVID Shutdown aimed to eliminate or slow SARS-CoV-2, the virus that causes COVID-19 The US has no national policy leaving states to independently implement public health guidelines that are predicated on a sustained decline in COVID Operationalization of 'sustained decline' varies by state and county Existing models of COVID transmission rely on parameters such as case estimates or R0 and are dependent on intensive data collection efforts Static statistical models do not capture all of the relevant dynamics required to measure sustained declines Moreover, existing COVID models use data that are subject to significant measurement error and contamination OBJECTIVE: This study will generate novel metrics of speed, acceleration, jerks and 7-day lag in acceleration of COVID transmission using state government tallies of COVID infections including state-level dynamics of COVID infections This study provides the prototype for a global surveillance system to inform public health practice including novel standardized metrics of COVID transmission for use in combination with traditional surveillance tools METHODS: Dynamic panel data (DPD) models are estimated with the Arellano-Bond estimator utilizing the Generalized Method of Moments This statistical technique allows for control of a variety of deficiencies in the existing data Tests of the validity of the model and statistical techniques are applied RESULTS: 1) The statistical approach is validated based on the regression results;they determine recent changes in the pattern of infection;and 2) during the weeks of August 17-23 and August 24-30 there were substantial regional differences in the evolution of the US pandemic Census regions 1 and 2 were relatively quiet with a small but significant persistence effect that remained relatively unchanged over the past two weeks Census region 3 was sensitive to the number of tests administered, with a high constant rate of cases A weekly special analysis showed that these results were driven by states with a high number of positive tests reports at Universities Census region 4 had a high constant number of cases and a significantly increased persistence effect during the week of August 24-30th This change represents an increase in the transmission model R value for that week, and is consistent with a re-emergence of the pandemic CONCLUSIONS: Opening America comes with three certainties: 1) the "social" end of the pandemic and re-opening is going to occur before the "medical" end even while the pandemic is growing We need improved standardized surveillance techniques to inform leaders when it is safer to open sections of America;2) varying public health policy and guidelines unnecessarily result in varying degrees of transmission and outbreaks;and 3) even those states most successful in containing the US pandemic are still seeing a small but constant stream of daily new cases