A hallmark of the current pandemic is the overwhelming volume of real-time data. It's easy to be overwhelmed by the stream of dashboards, testing counts, reopening metrics, and excessive death estimates.
An essential requirement for states in the process of reopening is outbreak surveillance: identifying community spread of the virus in real-time, without delay. Undetected outbreaks can exponentially grow and quickly re-infect other areas, especially in under-resourced and rural areas which are now the fastest growing areas of infection in the U.S.
The challenge for emergency planners and health managers is finding meaningful signals in the the volumes of data currently available. In this post, we explore a critical, overlooked source of medical intelligence: 911 dispatch data.
The Hill, 5/15/20
The most vulnerable counties in dark blue, as identified by the COVID County Vulnerability Index
Hospital and testing records are the current best, near-real-time datasets available to decision-makers. However, there is another overlooked, front-line dataset that can provide rapid, accurate measure of infection: 911 dispatch data.
Could he be infected with the coronavirus? Possibly. But he was neither wheezing nor gulping for breath. The chief explained to the man that he could become far sicker by being in the hospital. “So do you just want to stay here?” he coaxed. Looking bewildered, the man nodded and shuffled back inside. The ambulance roared off to answer another call.
*12 Fraught Hours with EMT's in a City Under Siege (New York Times, 4/1/20)*
Many cases of COVID-19 go undetected, and patients do not make it to the emergency room. Early estimates show an excess mortality rate (undetected COVID-19 cases) of 3-5X reported numbers.
Many of these patients do call 911 but either die before being tested or do not end up going to the ER. In fact, in some municipalities, first responders actively discourage patients from going to the hospital.
Data provided by FDNY. FDNY Sees Huge Uptick In DOA Ambulance Cases As COVID Ravages City TPM, 4/10/20
911 call takers follow specific protocols to identify and prioritize callers with symptoms of COVID-19, documenting their findings in Computer Aided Dispatch (CAD) systems. Once shared, these symptom logs can be mined in real-time to identify increases and decreases in front line cases of COVID-19 that may never make it to the emergency room or hospital.
Pandemic Flu and Protocol 36, International Academies of Emergency Dispatch