Disease surveillance and laboratory detection are at the heart of CDC’s mission and fundamental to the COVID-19 public health response. They underpin CDC’s work with federal, state, tribal, local, and territorial (STLT), academic, and commercial partners to better understand the burden of COVID-19 disease and efforts to mitigate its diverse impacts, including the disproportionate impacts of COVID-19 on people at increased risk for health disparities and inequities. CDC supplements surveillance and laboratory methods with the modern tools of viral genomics and mathematical modeling.
Objective 1. Develop new, or modify existing, methods of epidemiologic surveillance for COVID-19
CDC has established multiple systems of surveillance to monitor trends in COVID-19 disease in the United States and measure the impact of interventions. Surveillance studies are helping to estimate the proportion of cases that are asymptomatic or mild versus those that are severe or fatal. A key priority is the development, implementation, and evaluation of innovative, targeted strategies to rapidly detect early signals of COVID-19 in communities or settings of special interest such as schools, workplaces, or congregate living facilities.
CDC is utilizing serology testing to better understand how many infections with SARS-CoV-2 have occurred at different points in times in different locations. Seroprevalence surveys include large-scale geographic surveys, community level surveys, and smaller-scale surveys focusing on specific populations such as healthcare workers.
Surveillance strategies in international settings may include adaptation of established disease testing systems for other diseases (e.g., human immunodeficiency virus [HIV]) and leveraging existing partnerships (e.g., polio eradication programs).
Objective 2. Develop and optimize testing for SARS-CoV-2
Identifying new detection methods and strategies that improve the speed, accuracy, and sensitivity of diagnostics and are not reliant on reagents that can limit testing are a high priority.
CDC is pursuing multiple lines of research including evaluation of different types of specimens, assays, and serial testing strategies to optimize detection of acute and past SARS-CoV-2 infection; development of rapid, point-of-care diagnostic tests and multiplex testing systems to concurrently detect SARS-CoV-2 and influenza A and B; and identification of the most useful assays to advance understanding of community levels of protection needed to interrupt transmission (i.e., herd immunity). Determining the optimal testing approach to differentiate natural infection from vaccination and developing other laboratory tools are essential to support the development and monitoring of COVID-19 vaccines.
CDC is continuing its work with the U.S. Food and Drug Administration and the National Institutes of Health to validate tests produced by commercial labs and other entities.
Objective 3. Utilize viral genomics to advance understanding of COVID-19 and mitigate its impact
CDC is using genomic sequencing to investigate the evolution, emergence, and spread of COVID-19 infections in communities and defined populations. Incorporation of viral genomic data with patient genomic, clinical, and epidemiologic data can lead to a better understanding of patient risk factors, clinical outcomes, and transmission dynamics. CDC, through its establishment of a new national viral genomics consortium,3 is accelerating the release of SARS-CoV-2 sequence data into the public domain.
Large-scale sequencing studies to monitor the genetic diversity and stability of SARS-CoV-2 have the potential to offer clues on the impact of new virus variants on diagnostics, therapeutic agents, and vaccines.
Objective 4. Use mathematical modeling and other technological tools to forecast COVID-19 trends and measure the impact of interventions across a range of populations
Mathematical modeling is an important tool to help inform public health decision making. CDC, working with academic groups, uses probabilistic models to forecast the timing and trajectory of COVID-19 infections; the demand for hospital-based services; and deaths at the national, state, and sub-state levels. Models to forecast the impact of therapeutics, testing, vaccine, and mitigation strategies are also a priority.
Novel technological tools such as cell phone mobility data, for example, when used in combination with social, behavioral, and ethnographic information, offer the potential to assess the impact of community mitigation efforts, but require a thorough assessment of their practical utility.
Objective 5. Assess and limit the impact of the COVID-19 response on healthcare services and public health programs in domestic and international settings
The COVID-19 pandemic is affecting people’s healthcare seeking behaviors for routine preventive and medical care. CDC is working with domestic and international clinical and public health partners to assess pandemic-related impacts on healthcare, special-needs care, routine public health activities, and priority disease elimination/control programs such as HIV, tuberculosis (TB), and neglected tropical diseases. Findings from these studies can be used to identify the best strategies and policies to maintain access to care, treatment, and preventive services with a focus on populations at increased risk for health disparities and inequities.