Enabling Hotspot Detection and Public Health Response to the COVID-19 Pandemic

Randi Foraker, PhD, MA; Joshua Landman, MS; Ian Lackey; Matthew D. Haslam, MSc; Alison L. Antes, PhD; Dennis Goldfarb, PhD

Disclosures

Prev Chronic Dis. 2022;19(6):e35 

In This Article

Abstract and Introduction

Abstract

Introduction: Public-facing maps of COVID-19 cases, hospital admissions, and deaths are commonly displayed at the state, county, and zip code levels, and low case counts are suppressed to protect confidentiality. Public health authorities are tasked with case identification, contact tracing, and canvasing for educational purposes during a pandemic. Given limited resources, authorities would benefit from the ability to tailor their efforts to a particular neighborhood or congregate living facility.

Methods: We describe the methods of building a real-time visualization of patients with COVID-19–positive tests, which facilitates timely public health response to the pandemic. We developed an interactive street-level visualization that shows new cases developing over time and resolving after 14 days of infection. Our source data included patient demographics (ie, age, race and ethnicity, and sex), street address of residence, respiratory test results, and date of test.

Results: We used colored dots to represent infections. The resulting animation shows where new cases developed in the region and how patterns changed over the course of the pandemic. Users can enlarge specific areas of the map and see street-level detail on residential location of each case and can select from demographic overlays and contour mapping options to see high-level patterns and associations with demographics and chronic disease prevalence as they emerge.

Conclusions: Before the development of this tool, local public health departments in our region did not have a means to map cases of disease to the street level and gain real-time insights into the underlying population where hotspots had developed. For privacy reasons, this tool is password-protected and not available to the public. We expect this tool to prove useful to public health departments as they navigate not only COVID-19 pandemic outcomes but also other public health threats, including chronic diseases and communicable disease outbreaks.

Introduction

Public-facing maps of COVID-19 cases, hospital admissions, deaths, and vaccination rates are commonly displayed at the state, county, and zip code levels, and low case counts are suppressed to protect confidentiality.[1] Although state laws and public health departmental regulations vary, a standard approach is used to suppress case counts of fewer than 10.[2] Geographically, this approach applies to areas smaller than a county (ie, zip codes and US Census tracts), and case counts are not typically suppressed at the county or state level.

An exception to this rule can be made if data are to be used for quality improvement purposes. Public health departments may prepare reports for internal use that do not suppress case counts. However, such reports cannot be publicly disclosed without approval from a public health authority. Small case counts may be released during a public health emergency, in which, for example, a threat of person-to-person transmission of a communicable disease exists and action must be taken to protect public health.

Public health authorities at the local, regional, and state levels are tasked with case identification, contact tracing, and canvasing for educational purposes during a pandemic. Such authorities have been asked to track vaccination implementation geographically to help ensure equitable distribution of vaccines. Given limited resources, conducting these activities across an entire jurisdiction (ie, a county) or zip code area can be daunting. Rather than being assigned to a high-risk zip code in which to perform public health activities associated with the pandemic, authorities would benefit from the ability to tailor their efforts to a particular neighborhood or congregate living facility.

To address the immediate needs of public health authorities to effectively respond to hotspots of infection in real time, we developed an interactive street-level visualization that shows new cases developing over time and resolving after 14 days of infection. The Health Insurance Portability and Accountability Act (HIPAA) considers residential address to be a direct identifier that must be removed for data to be considered de-identified.[3] Thus, access to the identifiable data and visualizations must be restricted to authorized personnel who are proficient data stewards, especially given that such data could be used in harmful ways.[4] For privacy reasons, this tool is password-protected and not available to the public. In this article, we describe the methods of building a real-time visualization of patients with COVID-19–positive tests, which facilitates timely public health response to the pandemic.

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