CDC COVID - 19 Surveillance Enhancement Plan

February 14 , 2020

This document provides a high-level summary ofCDC ' s sequential steps for increasing COVID - 19surveillance in the U .S ., building on existing influenza and other surveillance systems. The totalestimated funding level is $ 100million for year one , of which $50million should be available to CDCimmediately and the remainder should bemade available within two months.

Step 1 (current)

PUIidentificationNational in scope , focused on high -risk groups

o Identification of at international points of entry into the US and atmedical carefacilities

o Gaps/Chokepoints: Testing atpublic health laboratories delayed due to reagentmanufacturing issues

Syndromic surveillance for respiratory illness (ILInet)National in scope, identifies influenza- like illness among persons of allages visiting

outpatient settings as part of existing influenza surveillance

Detect signals of increased activity that can be followed up with targeted investigations

o Less sensitive during influenza season but willbemore sensitive as influenza wanesGaps/ Chokepoints: Surveillance is notspecific to flu or COVID - 19 and can only indicate

changes in respiratory illnesses

Step 2 implement within 2 weeks):

Focused community surveillanceInitial testing in 5 locations Seattle, Chicago, NYC

Respiratory swab testing ofoutpatients with influenza- like illness, additional collection

sites over routine influenza surveillance

Testing conducted atpublic health laboratories as part of existing influenza virologicsurveillance system

Chokepoints: Dependent on available laboratory reagents; States/ Locals will needsupport to implement

Step 3 (implement within 2 months):

National community surveillanceScaled from 5 states to all states within 2 months;many could beon line in 2 -4 weeksRespiratory swab testing of outpatients with influenza-like illness

o Testing conducted at public health laboratories aspart of existing influenza virologicsurveillance system

Gaps/Chokepoints : Dependent on available laboratory reagents early until manufacturing

surge quantities aremet; implementation would be staged with geographically strategiclabs brought on first ; States/Locals willneed support to implement

Surveillance for hospitalized patients (EIP , NVSN) 1,2

DRAFTDRAFT: PRE-DECISIONAL

Existing influenza program ' s systems to bemodified to gather data on laboratory

confirmed 19Gaps/Chokepoints : Will require addition of testing by public health laboratories since no

commercial COVID - 19 tests are available yet, States/Locals /Academic Partners will needsupport to implement

Enhanced household and community surveillance (Mosaic )

o Existing influenza program ' s systems to bemodified for assessing characteristics of

household and community transmissionGaps/Chokepoints: Will require modification of protocols, will require validation of selfswabbing for COVID - 19 , States/Locals/ Academic Partners willneed support to

implement

Surveillance for deaths (NCHS)

Existing electronic death certificate reporting system for influenza will be modified to

report COVID - 19 mortality

Gaps/Chokepoints : Dependent on ICD codes for COVID - 19, will need validation of use

ofpneumonia and respiratory illness codes as surrogates for COVID -19 NCHS will needsupport to implement

Step 4 implement within 6 months)

Clinical laboratory testing (NREVSS )Ongoing system used to monitor circulation ofviral respiratory disease in > 140 clinical

labs through CDC' s NationalRespiratory and Enteric Virus Surveillance System

(NREVSS), currently used by influenza program .

System collects positive test results using commercial assays at hospital and ED labs.

Gaps/ Chokepoints : System only possible when commercial COVID - 19 tests are

available , BARDA responsible for facilitating development ofthese tests , program will

need support to implement

Large commercial laboratory surveillance (LabCorp , Quest)

CDC , States , and Locals currently receive real- time electronic reporting from LabCorp

and Quest for reportable diseaseso Gaps/Chokepoints : Reporting will only be possible when LabCorp and Quest get

approved COVID - 19 tests under EUA, BARDA can support development of tests, CDC

program will need support to implementEnhanced vaccine effectiveness monitoring (USFluVE Network , HAIVEN ) 14

Existing influenza program ' s vaccine effectiveness network to bemodified at 5 sites (WI,

WA, PA ,MI, TX )

Gaps/Chokepoints: Dependenton availability of a licensed vaccine,

States/Locals/Academic Partners will need support to implement

Other systems for use:Surveillance in intensive care networks (PICU and ICU)

Vulnerable population surveillance (i. e., pregnant women )

1. Overview ofInfluenza Surveillance Systems. https //www . cdc. gov / flu/weekly /overview . htm2 . New Vaccine Surveillance Network . https :/ /www . cdc .gov /surveillance / index .html

DRAFT PRE-DECISIONAL

3. . Am Epidemiol. 2014 Dec 15 180 12): 1196 -1201.

. CDC. Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN ).

https: //www .cdc.gov / flu / vaccines -work /haiven .html

5 . NationalRespiratory and Enteric Virus Surveillance System (NREVSS).

https: / /www .cdc. gov/surveillance /nrevss/ index html

6 . Electronic reporting from national labs.https://www .cdc. gov/MMWR/ preview /mmwrhtml/mm6412a5.htm

DRAFT