Before the first wave of COVID-19 infections hit Massachusetts last spring, nobody was sure exactly when it would arrive. Experts only knew that it was on the way. By the time testing showed cases were rising dramatically, thousands of people had already caught the coronavirus.
“You’re behind the virus. You’re chasing it, always trying to catch up, and speed is absolutely of the essence,” says William Hanage, an epidemiologist at Harvard University. “The pace with which some of our response has taken place has just been too slow for it.”
Because testing was only available this past spring to people who already had symptoms, they — and anyone they may have infected — might have already spread the virus before knowing they had COVID-19. Officials also got a delayed picture of the pandemic, making it difficult to intervene in time to head off a surge in cases. In Massachusetts, it took months of severe restrictions to lower and stabilize infection rates.
The specter of another swell in cases hangs over the state’s slow re-opening, but this time, health experts hope that by watching for early warning signs, officials might be able to stay ahead of the COVID-19 curve. There are several technologies that experts are employing for this purpose, Hanage says. Used together, he says they might provide a more accurate picture of the pandemic and a glimpse into what might happen next.
“Now I would expect that we can probably get some indication ahead of time,” he says. “And if [the signs] are all going in the wrong direction, you’ve got to be able to do something early.”
The gold standard for monitoring the pandemic and stopping new outbreaks is rapid, widespread testing, Hanage says.
“Meaning you actually don’t wait for the people to come to you. You go out, and you’re continuously testing people,” he says. “If I were to be asked the kind of data that I’d really like, it would be this.”
“Now I would expect that we can probably get some indication ahead of time. And if [the signs] are all going in the wrong direction, you’ve got to be able to do something early.”William Hanage, Harvard
The trouble with active, universal surveillance testing is that it’s expensive. At the moment, only a few places like colleges and universities are using it to control and forecast outbreaks.
But the city of Boston is trying to get the next best thing: encouraging as many people as possible to volunteer for coronavirus testing. Marty Martinez, the city’s chief of Health and Human Services, says Boston has been raising testing sites across the city at community health centers and mobile testing site for both symptomatic and asymptomatic people.
“It's free, no cost to the individuals [at certain sites],” he says. “The goal is to make testing as accessible as possible so that we can see if we see any spike in cases and anything that will indicate increased activity.”
Local hospitals are also testing every patient they see, as recommended by state guidelines, even if they don’t have COVID-19 symptoms, Martinez says. That adds to the city’s coronavirus surveillance.
“If the hospital sees 100 people in a day, they’re testing those hundred people. So, we would be able to see if there is even an uptick in people who don’t have symptoms,” he says.
Martinez and his team monitor the testing data multiple times a week. Although the state has seen a slight uptick in the positive test rate and occasional, if small, spikes in cases, Martinez says the rate of new coronavirus infections in the city is staying steady at about 2%.
“We saw an uptick in cases the first full week in July,” he says. “Since then, it’s sort of settled to 2.1%. We saw that uptick a bit earlier, and now we see it sort of leveled off.”
Boston has another early warning system that might help identify a coronavirus surge before it happens. Greater Boston and a few surrounding communities send sewage to the Deer Island Wastewater Treatment Plant, where the biotech firm Biobot Analytics tests the sewage three times a week for the coronavirus.
“We concentrate the viruses present in the wastewater, then extract their [genetic material],” says Mariana Matus, one of the Cambridge company’s cofounders. “Wastewater is a leading indicator for new COVID-19 cases, with four to 11 days of an early warning.”
“We don’t need to be going through lockdowns like what we’re experiencing now. There are technologies out there that can help us stay ahead of it.”Mariana Matus, Biobot
If one person out of 50,000 gets sick, Matus says Biobot should be able to detect the coronavirus in the sewage sample. As of the end of the week, the company's data showed no large increases in Boston or nearby communities. If it did, Matus says their service could give health officials time to intervene before an outbreak gets out of hand.
“We don’t need to be going through lockdowns like what we’re experiencing now. There are technologies out there that can help us stay ahead of it.”
Some of those technologies include tracking internet searches for COVID-19 symptoms and examining data from home health devices like smart thermometers. Speaking to frontline health workers and contact tracers who investigate who might be infected also provides more information that can inform health experts, Harvard’s William Hanage says. When the data streams are combined, Hanage says experts get a far more robust image of the pandemic.
“If one of them is out, you can self-correct by looking at other things,” he says. “But as much as it’s cool to be able to take together digital data screens or wastewater data, that’s only the first part of it. What is crucial is having action taken as a result.”
Hanage says when cases began spiking elsewhere in the country, officials failed to act in time. He says that should serve as a cautionary tale for this state, where cases still remain relatively low. If the data suggest a new surge in COVID-19 cases is coming, then it may not be too late for Massachusetts to pause reopening or bring back targeted restrictions to cut off the rise of further infections.
This segment aired on August 5, 2020.