Precision Public Health and the COVID-19 Response
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This blog is a summary of our recent paper in the Journal of the American Association. The public health response to COVID-19 requires a mix of general and targeted public health interventions, i.e., precision public health. Precision public health uses data from traditional and emerging sources to target interventions for populations by person, place, and time, with a focus on reducing health disparities.
Analogous to the use of genomic information in precision medicine, pathogen genomics has become the leading prototype of precision public health, with numerous applications in tracking and control of infectious disease outbreaks. Beyond genomics, granular data from public health surveillance are essential to target public health interventions. Data on levels of COVID-19 infection and disease in a community need to be available so clinicians and public health professionals can provide the best guidance to communities about optimal interventions to prevent illness and death and to target public health interventions to regions of most need. Geographic information and other technologies can be integrated to identify hot spots to allow targeting of interventions.
Increasingly focusing prevention efforts on communities at the highest risk will have greater benefits than if those efforts are used in lower-risk communities. For example, if a population has a higher proportion of persons at increased risk for severe disease, messages could be provided to educate persons on when to seek medical attention. Although these data might vary by location, they are sufficient to begin to tailor guidance for communities at most risk; ongoing research will be needed to identify other high-risk populations that could benefit from additional protection. Data are also accumulating on infection risks based on neighborhood factors. If neighborhood factors suggest that isolation of a person identified as SARS-CoV-2- positive will be difficult, ensuring that other options for isolation outside the family home could be offered to decrease household transmission.
The use of emerging digital big data should also be explored. These include cellphone mobility data, information from wearable fitness trackers, and geographic information systems. These data sources could be used to identify communities where risks of transmission or of severe disease may be high. Information on areas of high disease transmission could be used to target prevention strategies. Although some of these emerging data sources require careful consideration of ethical, legal, and social implications, they hold promise in informing the pandemic response by serving potentially as an early alert system.
Just like precision medicine, precision public health will still need a strong evidentiary foundation. Careful evaluation of the validity and utility of these new technologies as applied to precision public health and their effectiveness in reducing COVID-19 cases and decreasing morbidity and mortality will be essential, along with consideration of the ethical, legal and social implications.
For the latest publications on the impact of precision public health technologies on COVID-19, search the CDC COVID-19 Genomics and Precision Health portal.
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This is well written with a number of important point presented – nicely done. There is a perspective I wish to add. The notion of precision public health stops short. It needs to encompass to a greater extent socioeconomic and cultural factors to a greater extent. Getting beyond the politics, some data support people/communities are scared, challenged, and uncertain about their and their family’s current and future well being that includes, health, cultural, and socioeconomic factors. This likely compromises our capability to locally implement public health measures; interventions that are evidence based that are effective when implemented as intended. Now bringing politics back into the discussion and taking into account the decision behavior of our leaders, both public and private, is equally important to inform a precision public health response. These are not mutually exclusive issues. When we have an opportunity to debrief about our response to the pandemic, these concepts are worthwhile to consider in preparation for future public health responses.