April



April 2020 NSSP Community of Practice CallTuesday, April 21, 2020Trending Topic of the Month: Syndromic Surveillance & COVID-19Use of Syndromic Data for COVID-19 – Mike Coletta (NSSP)Sharing NSSP Data with White House Task Force and NRCCIn the sake of national interest, the White House Coronavirus Task Force asked NSSP to share data with the National Response Coordinating Center (NRCC) for the purpose of integrating data into a national, operational picture across different agencies. On April 2, Paula Yoon (DHIS Division Director) sent an email to stakeholders stating that NSSP data was being shared with HHS. Syndromic data has been critical and invaluable in tracking the COVID-19 pandemic and understanding the outbreak in near real-time. CDC, FEMA, ASPR, and other federal partners have used the data for public health purposes (e.g., decision-making, tracking infection, identifying highly impacted areas, identifying infection decline by location, allocating federal resources where needed)Shared data includes syndrome categories and demographics (I.e., sex, age, location). Data does not include chief complaint, admit reason, clinical impression, triage notes, MRN, DOB, nor discharge diagnosis. NSSP staff are working with the White House Task Force and NRCC to ensure 1) proper use of data and 2) understanding of the data. Aiming to alert the syndromic community before data is shown outside the federal government/publicly when possible, NSSP will continue to work with the NSSP CoP to discuss use of data for the crisis. Use of Syndromic Data for COVID-19 – See slides for more detailTimeline of definitionCreated fever and (cough or shortness of breath or difficulty breathing), negating influenza diagnosis (dx)CDC issues guidance on what ICD-10 codes clinicians should use for suspected COVID-19 caseMerged coronavirus dx with CLIWA State shared list of early cases Used the COVID-Like Illness (CLI) definition and an influenza-diagnosis based definition to show divergence between CLI and fluNational Divergence Trend map shared NSSP team developed and deployed R Shiny-based dashboard (ESSENCE API) for CDC Emergency Operations Center (EOC) and community useDashboard is interactiveIncludes data from John Hopkins Global Case Counter, ESSENCE, CDC FluView, NREVSS dataShows all data interacting in one environment Working with sites to share NSSP dashboards and to modify existing dashboardsNSSP team developed CLI, pneumonia, and coronavirus diagnoses alerts by county and age groupNSSP notified sites of alerts – has served beneficial for sites to have extra set of eyes on dataNSSP data used to demonstrate impacts/trends in communities – developed R code to identify areas that heavily impacted by COVID-19R Shiny Dashboard – Aaron Kite-Powell (NSSP)NSSP Data Used for Hotspot Analysis – See slides for more detailHotspot analysis of alerts developed in R through different alert lists for a 3-day window per county to indicate higher levels of coronavirus intensityTends to match where other data has suggested higher coronavirus levelsCLI as Indicator of COVID Infections – See slides for more detailNumber of cases coming in ED and where did the signals occur within the data itselfPresentation of this data is of great interest – versions of data have been shown during White House briefings and is a request across the boardInforming Hospital Surge – See slides for more detailExpectation that facility vol volume might increase dramatically across the boardWorked with team to determine methods for detection of increased volume – replicating ESSENCE algorithms in R to look at locations with an overall increased facility volumeHow Know When Situation Improving? – See slides for more detailUsing a binomial regression algorithm to take rolling period of time (minus the most recent 2 to 3 days) to review trends and group stratifications in meaningful waysStatus of Expanded CLI Syndrome among ED Visits by County – See slides for more detailBroken up into green (decreased), red (increased), yellow (stable)Stable = no significant statistical changes but slopes can still provide meaningED Volume Dropped with Onset of Social Distancing – See slides for more detailSignificant ED volume drop – national trend of all ED visits has dropped half almost at the time of shown graphSwift interpretation poses challenges but interesting trend to considerProportion of visits is interesting but important to understand total volume is still decreasingOne indicator of things “moving back into normal” may be related to total volume increases. If that happens, what does that indicate, though? Analysis Strategy Addresses Changing ED Volume – See slides for more detailLooking at percent change if ED volume by county to get a national sense of overall decrease – seems people are avoiding ED visits when possibleConsolidation of Things Coming through the ED – See slides for more detailLooking at current period of time (during the decreased ED volume), and the same time period last year – determining different ways to calculate percent change for different chronic disease indicators. Comparing this year to last, what are people being seen for today vs then? What’s different based on ICD codes?Concern that people are avoiding care – what does that mean for when things start to return to normal? What have people been avoiding being seen for and how will that impact treatment and care decisions?Will share more as the work is finalizedCommercial Lab Data – Kathleen Harnett (NSSP)Timeline – See slides for more detailFebruary 2020: Started receiving data from 1 commercial lab for all reportable conditions and drug tests – were trying to figure out how to make usable and started doing data quality checksMarch 5, 2020: COVID-19 tests and commercial lab data turned on – started seeing data come inApril 2020: 6 labs companies reporting directly to ESSENCE – identified by letters in systemOverall Statements on DataData can be accessed via dashboard – can view daily percent (+) down to county levelSome data will be visualized publicly at the state level, such as percent (+) rangeHave noticed increase in tests coming from prisons and organizations serving homeless with residential components – will start alerting with those populations as wellOften know HCP name but not facilityUsing data for modeling requests re: COVID-19 hotspotsData available in R Shiny dashboard Nursing Home Alerts – See slides for more detailA lot have asked questions on taking action on alerts – it depends on number of nursing homes affected and resources availableESSENCE Dashboard: Percent Lab Positive by County – See slides for more detailReceive data at the time of order – can see how orders are trendingReceive positive and negatives results, allowing obtainment of percent positive tests calculationTracking number of confirmed cases, number of lab positives, and testing per capitaComparing percent positive to CLI – saw increased percent positive in areas, and then 3-7 days later, cases started to go upESSENCE > dropdown menu > show positive results, negative results, all ordersCompanies started rolling out antibody tests– separate categories for each antibody testFinding Best Indicator of Pandemic Severity – See slides for more detailLooking at how ED indicators compare to lab dataExamining what are best and earliest indicators of severity in a given areaQ&A – Open forum Q: For the White House Opening Up America Again effort’s CLI and ILI analysis, what is the data source for the ILI data? Is it ILINet? ILINet data is the primary data source for some urgent care visits.A: NSSP unsure what using – on NSSP website, the expanded CLI as well modified ILI are included.Q: Hospital trends are useful and informative – however, we are noticing impacts in outpatient primary care volume. Health seeking behaviors have changed, and now seeing drastically decreased visits for primary care, which also leads to financial issues, closures, staff reduction, etc. Is there anything in place to review PCP capacity changes for monitoring of disruptions in outpatient capacity?A: NSSP does not have insight into this.Q: What % of laboratories are estimated to be represented in lab data available in ESSENCE?A: A little over 50%Q: Can dashboards be shared with listeners?A: The link for the R Shiny dashboard will be shared with Hayleigh – use your BioSense password for access. To access the lab data dashboard in ESSENCE, email nssp@.Q: How was % change in ED volume by county metric created?A: Averaged 2020 Weeks 1-10 ED visits and compared to the last week – not sure best way, but current method.Q: Are employer/occupation elements going to be available in ESSENCE?A: NSSP to circle back.Q: Can interpretation of titers be shared? What level is needed for immunity?A: Information being gathered on this topic by others at CDC.Q: Are there dashboards or other ways folks are tracking hospital capacity/ventilator openings?A: Not included in data NSSP managing. NHSN has modules collecting data on hospital capacity, beds, ventilators, etc. and data is available to states – recommend reaching out to HAI Coordinators for information/access.Q: Does ESSENCE lab data only provide information on COVID tests or does the lab data provide information on every test received?A: Original lab (Lab A) provided data for all reportable conditions and strep. Labs B-F were brought on specifically for response and provide COVID only data. Q: Can the R Shiny dashboard be made available separate from admin-level access?A: Can be seen by anyone with a BioSense login.Q: How access the ESSENCE library and queries mentioned?A: To see query definitions > ‘More’ tab. If see dashboards > ‘Overview’ tab > ‘Library’ button. People can share and manage tabs/queries in ESSENCE. Q: Is it possible to have access to updated nationwide maps on a regular basis?A: NSSP to work with CSTE to determine best method of sharing such maps. Additionally, NSSP is open to sharing R code for those maps.Q: How can I get the password to access data?A: If looking for access to BioSense, please work with state/local health department – then can access ESSENCE and R environment/Shiny applications.Q: Concerns on coordination between state percent positive reporting and national percent positive reporting.A: NSSP aiming to receive data from 100% of labs – to do so, need to get data from states, which is in progress. The idea is data would then be deduplicated.Q: Are there examples of states sharing data with neighboring states?A: In the R Shiny app, there is the ability to see trends for different states and HHS regions.Q: For the NRCC data sharing, is data being shared at the aggregate level?A: Data is not aggregated, but key fields were removed.Q: Which of the various CLI queries (or others) do folks feel best track the outbreak?A: Seems the latest CLI with ILI modified excluding flu records with coronavirus ICD code is a good leading indicator. Pneumonia seems to lag about a week as well. Requests for the Community – NSSP and CSTEShare your experiences (best practices/lessons learned) by emailing syndromic@and/or nssp@NSSP is working with 3 sites to pilot mortality data – if interested in participating, email nssp@ Next Call – Tuesday, May 19th at 3pm EDT ................
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