A “COVID Compass” for Navigating the Pandemic

Note: This material is based on a paper published in the International Journal for Quality in Health Care titled A COVID Compass for Navigating the Pandemic: Oliver, Schmidt, et al: Vm 33, Supplement 2, November 2021.

https://academic.oup.com/intqhc/article/33/Supplement_2/ii78/6445914

The COVID Compass is designed as a central framework for navigating the pandemic. It could help decision makers to effectively monitor and mitigate harms caused by COVID-19 and could be adapted for future pandemics.  The Compass will track COVID mortality rates and excess deaths alongside key trends in other important areas such as economic vitality and social hardship.  This is designed to help guide policies, actions, and behaviors that together influence lives lost and livelihoods damaged.

Principal Investigator: Eugene Nelson
Co-Investigator: Brant Oliver
Team Members: Falguni Mehta, Jabeen Ahmad, Evans Amoah, Sukdith Punjasthitkul, Joel King
Partner Organization: Brody School of Medicine at East Carolina University (ECU)
Main contact: Eugene Nelson

Acknowledgments: This work is supported by funding provided by the Brody School of Medicine at East Carolina University and The Dartmouth Institute for Health Policy & Clinical Practice at Geisel School of Medicine.

Introduction

The COVID Compass provides a balanced outcomes measurement approach. The aim is to bring together publicly available data on trends in health, social hardship, and the economy and to make results available to health, business, political, community and education leaders who must make decisions on how to reduce damage from COVID-19 going forward and how to look back to see how successful they have been at mitigating health, social and economic damage associated with the pandemic.

This project is one of several collaborative initiatives that are led by the Dartmouth Institute Coproduction Laboratory and by the Brody School of Medicine at East Carolina University (ECU).  This work began with the onset of the COVID-19 pandemic and seeks to conduct research on geographic variations in a balanced set of outcomes including health, economic, and social hardship using publicly available data.

The COVID Compass offers a framework and database for navigating the pandemic. It could help decision makers to effectively monitor and mitigate harms caused by COVID-19 and could be adapted for future epidemics.  The Compass will track COVID mortality rates and excess deaths alongside key trends in other important areas such as economic vitality and social hardship.  This is designed to help inform policies, actions, and behaviors that together influence lives lost and livelihoods damaged.

COVID-19 has wrought havoc worldwide.  Many have died.  Many more have lost their jobs, suffered financially, or endured other hardships.  Disparities due to race, ethnicity, income, immigrant status and other social risks have been exacerbated.  Epidemiologists predict that COVID-19 will not disappear nor be eradicated by vaccines, and will become endemic.

Science, vested Interests and Hunches, not Comprehensive Data   

The greatest challenge confronting political, public health, business, education, and social welfare leaders is to restore the economy, businesses, and schools without further risking public health.  Most are trying to minimize mortality, economic and social problems- based on a mix of public health advice and clinical science, vested interests, and hunches.3 Useful, up-to-date information on COVID-19 case rates and case fatality rates are widely available via “trackers” offered by many prestigious organizations.

However, these focus primarily on creating “leader boards” showing COVID-19 case rates and fatality rates and do not include key trends in other vital outcomes related to economic vitality or social hardship nor do they track the “upstream” policies, actions, and behaviors that combine to produce key “downstream” results on lives lost and on livelihoods damaged.

A “COVID Compass” for Intelligently Navigating the Pandemic

The COVID Compass project aims to provide helpful information to guide decisions by tracking, national, state, and local policies over time and their impact on a balanced set of outcomes – health metrics (e.g., COVID-19 incidence and mortality), economic trends (e.g., unemployment rate) and social hardship indicators (e.g., food insecurity).

The COVID Compass includes data on COVID-19 related health outcomes as well as economic and social hardship outcomes. The data are taken from the best available public sources. The aim is to provide information to guide decisions by tracking state and local policies over time and their effect on a balanced set of health, economic and social outcomes, such as COVID-19 incidence and mortality, economic trends (e.g., unemployment rates, new job postings), and social hardship indicators (e.g., housing and food insecurity). We plan to expand the scope of these efforts to include regional, national, and international studies with time.

In brief, just as a Balanced Scorecard can be used to track and guide business decisions, the COVID Compass can track and guide health decisions that aim to decrease adverse health outcomes and at the same time minimize adverse economic and social outcomes.

Conceptual Framework

How We Got Started

We started with a simple proposition- upstream actions taken in specific geographic contexts produce key downstream outcomes, both of which are influenced by local political and social contexts.  Figure 1 illustrates how “upstream” decisions and actions will interact to produce “downstream” outcomes.

We assume that policy decisions, coupled with the specific actions and behaviors of individuals, families, and health professionals (to prevent, detect, diagnose, and care for people with COVID-19), will result in key outcomes.  Using a modified balanced scorecard approach,10 we have organized key outcomes into four major categories: (1) mortality; (2) health; (3) economic; and (4) hardship.

COVID Compass for the pandemic: Conceptual Framework Connecting Context and Actions with Outcomes

COVID Compass for the pandemic: Conceptual Framework Connecting Context and Actions with Outcomes

Data Analysis and Sources

We began the analysis by focusing on a small, manageable number of measures reflecting health, economic, and hardship outcomes and will next move to link them to actions aimed to decrease COVID-19 health effects and mitigate hardship to businesses and the economy.  Data trends are recorded monthly, including health, economic and social hardship “outcomes” (based on quantitative data), and “actions” (based on qualitative and quantitative data).

This initial work draws upon the United States data from best the available sources such as the CDC, USA Facts-U.S. Census Bureau, Opportunity Insights Economic Tracker published by Harvard University, etc. It provides economic and social welfare data and COVID-related health metrics at the national and state-level “to meet the immediate needs of federal, state, and local policymakers and other community leaders.”

We have developed two different visualization approaches using Tableau software: a snapshot in time (COVID Compass Radar Diagram) and over time (SPC chart and line chart with state-to-state comparison capability). In the future, it would be advantageous to expand this scope to provide a global view of the COVID Compass using publicly available information from Oxford University, the World Health Organization, the World Bank, and the Gates Foundation.

We also plan to conduct studies of countries that have taken different approaches to address COVID-19.  Developing international opportunities include a comparative study of a region of Sweden (Jonkoping) versus a region in Switzerland (Lausanne), and a partnership with BroadReach, Inc., a non-governmental organization with many programs in low- and middle-income countries worldwide.

Building a national, regional, and local integrated database infrastructure that captures upstream policies, actions, and behaviors and links them to downstream health, economic and social hardship outcomes will offer a more comprehensive view of the data necessary for decision-makers and citizens to monitor and mitigate harms caused by pandemics more effectively.  It will also provide researchers with a richer lens to observe and evaluate the impact of related natural experiments, policies, and leadership efforts. 

Table 1: Covid Compass Measures – Definition and Source 

Organizational Affiliations

  • Departments of Community & Family Medicine and Psychiatry, Dartmouth-Hitchcock Health and Geisel School of Medicine at Dartmouth, Lebanon and Hanover, NH
  • VAQS and HPEER advanced fellowship programs, Department of Veterans Affairs, White River Junction, VT and Houston, TX
  • Brody School of Medicine at East Carolina University, Greenville, NC.
  • The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
  • Center for Population Health, Dartmouth-Hitchcock Health, Lebanon, NH

For more information on measures, data collection, source, calculation methodology, etc. click here: Detailed Description of COVID Measures