An Strategy for Monitoring and Evaluating Neighborhood Mitigation Methods for COVID-19

overview

Frame: Community mitigation strategies to reduce or prevent the transmission of COVID-19 in the US are outlined in the CDC Framework for Implementing Mitigation Strategies for Communities with Local COVID-19 Transmission.1 The implementation framework describes the current goals, guiding principles, and mitigation strategies for Reduce or prevent local COVID-19 transmission.

Approach: An Approach to Monitoring and Evaluating Community Containment Strategies for COVID-19 describes the CDC's approach to evaluating community mitigation strategies and provides overarching considerations to assist state, territorial, or local health departments, tribal health organizations, or others in monitoring and evaluating Support the COVID-19 community's mitigation strategies, including a logic model, proposed monitoring and assessment questions, and potential data sources. The approach considers outcomes that minimize COVID-19 morbidity and associated mortality, the impact of community containment strategies on long-standing health inequalities and social determinants of health, and the social, emotional and economic prosperity of communities.

Monitoring and assessment results can be used to:

Educate decision-making about strengthening, focusing, and relaxing mitigation strategies
Understand individual and community factors that support or hinder mitigation behavior
Monitor disparities and social determinants of health and understand how diverse populations are involved in and influenced by community containment strategies
Communicate information effectively to the public based on culturally and linguistically appropriate strategies
Ensure that the needs of disproportionately affected populations are met
Strengthening community factors and outcomes on epidemiology, health capacity, social services and public health capacity
Disseminate the knowledge gained

Overview of the logic model

Logic model: This logic model presents the US Community Mitigation Strategy for COVID-19 at a high level and recognizes that many different stakeholders are working on certain elements of this strategy.

Roll: Governments, organizations and individuals support and promote community containment strategies in various settings and sectors, paying special attention to disproportionately affected populations.

Community Containment Strategies. Shift strategies across environments and sectors in which people live, work, study and congregate provide greater safeguards to reduce transmission. These strategies can be strengthened, focused or relaxed depending on the local context. Community containment strategies are implemented through individual, community and environmental action that:

Promote behaviors that prevent it from spreading
maintain a healthy environment,
maintain healthy operations and
prepare for when someone gets sick;

And should lead to results that:

reduce exposure of individuals,
Reduce transmission,
Reducing the burden on the health system and improving access to testing and contact tracing;
with the long-term goal of minimizing COVID-19 morbidity and the associated mortality.

Results: Achieving these results is critical to ensuring that communities thrive socially, emotionally, and economically. Working together, federal, state, and local agencies can monitor and assess social, emotional, and economic indicators, which can include: financial security, food security, and housing security; Access to and use of health care (e.g. behavior in seeking care); Physical and mental health; Security and violence in the community with special consideration and consideration of disproportionately affected population groups.

Logic model

Alternative format

Monitoring and evaluation questions, potential indicators and related data sources

Ask: The following overarching monitoring and evaluation questions can be tailored to suit community priorities and stakeholder needs.

Indicators and data sources: Indicators and data sources can be customized to match the context of the intended assessment. All indicators and data sources used to monitor and evaluate community containment strategies should be of high quality and ethical (e.g. relating to people, privacy, confidentiality) and scientific (e.g. relating to Validity, reliability and representativeness). If available, use data sources with multiple points in time available for comparison. Indicators can be analyzed as a whole or to look at specific subgroups (e.g. city vs. country, by race / ethnic population, socio-economic group, etc.). The following table contains a selected number of sample indicators and potential data sources and is not an exhaustive list. Consider data sources that best suit your monitoring and assessment needs and read CDC's publicly available data sources COVID-19 Secondary Data and Statistics. CDC does not support non-CDC data sources.

Possible evaluation question

What community containment strategies do jurisdictions implement, and how and when are they implemented?

Description and timing of the Stay-at-Home / Shelter-in-Place orders
Description and timing of orders for mass gatherings
Number / proportion of workers who report working remotely
Number of community and faith based organizations or local leaders tasked with implementing COVID-19 containment strategies at the community level

Records of state / local policies, executive ordinances, and legislative actions (e.g., home or shelters orders, school layoffs, mass gathering orders, travel orders, non-essential business closures, restrictions on non-urgent medical procedures)
Survey data on individual and organizational behavior (take into account local and national surveys)

Possible evaluation question

To what extent are individuals and organizations practicing community containment strategies?

Percentage change in mobility (e.g. time spent at home, distance traveled and by destination such as transit stations, retail / leisure and construction sites) **
Number / proportion of population who used masks outside of home in the past week
Number / proportion of the population adhering to guidelines for stay-at-home orders, on-site protection orders, and gradual reopenings
Number / proportion of the population reporting not to travel or changing their travel plans due to COVID-19
Percentage change in consumer spending in corporate sectors **

Mobility data *
Survey data on individual and organizational behavior (take into account local and national surveys)
Records of organizational policies (e.g., school and childcare policies, business policies, shared and aggregated housing policies)
Consumer spending data

Possible evaluation question

What factors do communities use to assess willingness to strengthen, focus, or relax their mitigation strategies over time?

Total number and incident COVID-19 tests / cases / hospitalizations / deaths
Percentage of airway samples that tested positive for SARS-CoV-2
Number / proportion of public spaces, workplaces, companies, schools or apartments that use appropriate cleaning and disinfection practices

COVID-19 Epidemiology, Community Characteristics, Health Care Capacity and Public Health Capacity Indicators ***
Survey data on individual and organizational behavior (take into account local and national surveys)
Records of state / local guidelines, executive orders and legislative measures

Possible evaluation question

What is the relationship between the implementation of mitigation strategies and the minimization of COVID-19 morbidity and associated mortality?

Overall and Incident COVID-19 Tests / Cases / Deaths
Percentage of airway samples that tested positive for SARS-CoV-2
Description and timing of the Stay-at-Home / Shelter-in-Place orders
Description and timing of orders for mass gatherings

COVID-19 Epidemiology, Community Characteristics, Health Care Capacity and Public Health Capacity Indicators ***
Records of state / local guidelines, executive orders and legislative measures

Possible evaluation question

What impact, if any, have community containment strategies on health inequalities or social determinants of health?

Trends in assaults, hospital stays and mortality among disproportionately affected population groups
Number / proportion of employees who submit unemployment claims
Number / Proportion of Eligible Recipients participating in Women's, Infant and Child Nutrition Programs (WIC) / Supplemental Nutrition Assistance Program (SNAP)
Number of calls to the local / state helpline requesting residential assistance
Vaccination protection (e.g. generally recommended vaccines for young children and adolescents)
Number / proportion of calls to the police in the event of domestic violence
The number / proportion of people experiencing stress related to COVID-19 has had a negative impact on their mental health

COVID-19 Epidemiology, Community Characteristics, Health Care Capacity and Public Health Capacity Indicators ***
State / local administrative records (e.g., unemployment claims, WIC / SNAP registration, foreclosures or evictions, state or local vaccination records, 911 data from emergency services)
Survey data on individual attitudes, behavior and quality of life (take into account local and national surveys)

* Mobility data sources anonymously locate personal cellular devices to understand individual movement in communities and the space between individuals.
** The methods for calculating the percentage change vary based on data availability. If available, consider comparing it to an underlying asset. Assess what is best doable in your state / local jurisdiction
*** Data sources related to COVID-19 epidemiology, community characteristics, health capacity, and public health capacity should refer to existing indicators: CDC COVID Data Tracker or https://www.cdc.gov/coronavirus/2019-ncov / php /open-america/surveillance-data-analytics.html as well as those that are monitored in your state / local jurisdiction.