全球智库信息集成服务系统

There is tremendous variability in how different countries and U.S. states measure and report on COVID-19 indicators

• In terms of testing, there have been large differences in the types of tests used, who is tested (for example, only very symptomatic patients versus anyone who may have been exposed to an infected person), lag time for reporting results, and whether such reporting is mandatory.
• In terms of hospitalization, there has been considerable variation in whether hospitalization counts include patients suspected of having COVID-19 or only those with a positive test; in whether localities report hospitalization raw counts or cumulative counts or rates (e.g., per 100,000 population); and in whether reporting of hospitalization counts or rates is mandatory.
• In terms of mortality, there has been variation in how rates are defined; in whether reported deaths include only those for which COVID-19 was the main cause versus also those in which it contributed to death; in training that physicians receive in reporting the cause of death on death certificates; in whether any post-mortem testing is conducted; and in whether out-of-hospital deaths are included. There is also variation in whether excess mortality is reported as a pandemic outcome.

All the COVID-19-related measures currently in use have limitations

Long-term care facilities and nursing homes are of particular concern

• This population is often older and frail with multiple comorbidities, and they are at higher risk for poor outcomes from COVID-19. Therefore, particular focus on tracking, testing and mortality among this population is important.

To track how well different countries and U.S. states are responding to the pandemic—and to make valid cross-country and cross-state comparisons—uniform measures are needed for key indicators, such as case identification/testing, hospitalization, mortality, and excess mortality. The authors of this report examined measures used in the early stages of the pandemic (December 2019–May 2020) and found tremendous variability in how different countries and U.S. states measure and report on COVID-19 indicators. The authors make recommendations for the use and development of measures that would allow for more standardized and valid comparisons.

• Chapter One

  Introduction

• Chapter Two

  Methods

• Chapter Three

  Results

• Chapter Four

  Discussion and Recommendations

• Appendix A

  Country-Specific Issues

• Appendix B

  State-Specific Issues

• Appendix C

  Australia Case Study

• Appendix D

  Washington State Case Study

• Appendix E

  Medical Examiner Roundtable Guide

• Appendix F

  Summary Findings from the Medical Examiner Roundtable