I know more about Singapore’s outbreak than the US’s. I know that 95% of yesterday’s cases there were in dormitory residents, and I know there have been an average of 18 unlinked cases in the past week there. In the US I know…whatever this plot shows. 1/

I get lots of requests for comment on trends in this state or that. It’s impossible to keep a finger on the pulse - US epidemiology means visiting 50 state websites, the New York Times, CovidTracking, and other unofficial websites. 2/

What’s the picture in the US? Are cases still occurring all over as early in the outbreak, or are they disproportionately in certain settings? Are superspreading events factoring in? What role do children play in transmission? These are all questions we urgently need to answer 3/

I want to clear that this is not public health’s fault. CDC, state and local health departments have been pushing for modernized data systems for *years* (links at end). We are seeing now how brittle our existing systems are. 4/

It’s frustrating knowing we will be managing the biggest public health crisis in modern times without the best tools. We’re going to need to rethink our disease surveillance in a big way if we want to do better. We have some ideas led by @DukeMargolis https://healthpolicy.duke.edu/sites/default/files/atoms/files/covid-19_surveillance_roadmap_final.pdf

And there are also important visions from the major public health networks that we should pursue 5/5
[1] https://www.naccho.org/uploads/downloadable-resources/17-04-Local-Public-Health-Informatics.pdf
[2] https://www.astho.org/generickey/GenericKeyDetails.aspx?contentid=20399&folderid=5156&catid=7203
[3] https://www.cste.org/general/custom.asp?page=data-strategy