The goal of our COVID-19 dashboard reporting is to present information describing the COVID-19 pandemic throughout Lancaster County and identify inequities. Specific objectives included: describing the volume of transmission and new cases identified, promoting vaccination, informing the community of healthcare capacity limitations and strains, educating the public on the risk of infection based on current data, describing inequities by race, ethnicity, age, sex, and geography, and to ensure a coordinated emergency response by keeping the public and primary partners well-informed.
To achieve our goals and objectives, each objective was reviewed regularly and, depending on the circumstance and the stage of the pandemic, action was taken accordingly.
- We described the volume of transmission and new cases identified effectively using the COVID-19 dashboard. This objective was met as maps were made available showing variation by zip code for cases that were identified and showing how the cases were occurring by race/ethnicity and age. Variations by sex were not significant and other factors were more predictive of risk so that information was not presented in the dashboard to maintain as concise a message as possible.
- Promoting vaccination as an objective was met as indicated by regular communications using the information presented in the COVID-19 dashboard application aligning with significant improvements in vaccination rates. The community used this dashboard to communicate the need for vaccinations with their partners. Regularly, stakeholders would return to the dashboard as a point of information for evaluating equity in specific communities.
- Informing the community of healthcare capacity limitations and strains was critical. Hospitalization data was incorporated into the dashboard application showing the significant increase and the strain on the healthcare system. These data were regularly referred to by emergency response personnel and other stakeholders to evaluate whether specific interventions were necessary.
- Educating the public on the risk of infection based on current data was a key component of the COVID-19 dashboard and risk communication. LLCHD uses a COVID-19 risk dial (green, yellow, orange, and red) to communicate the risk of COVID-19 to the community. This is a multi-factorial risk dial including risk of infection, hospitalization, and death as well as the benefit of vaccination rates. This risk dial aligned with data from this dashboard and was critical to press briefings and keeping the community updated through that avenue. Generally, the community was well-known to be accessing the dashboard application for their own situational awareness, while emergency response partners regularly used the application as well for their own situation awareness. Many who engaged in planning and response efforts used both the risk dial and dashboard together.
- A key feature of the COVID-19 dashboard is to identify inequities by race, ethnicity, age, and geography. The dashboard application, where data was available, was stratified by race/ethnicity, age, and geography. Maps have been available since the beginning showing cases counts, testing counts, and vaccination counts throughout the community. Vaccinations, cases, and deaths were all stratified by age group, race/ethnicity and gender were all presented to describe inequities in the community.
- To ensure a coordinated emergency response keeping the public and primary partners well-informed, emergency response partners and the Incident Command System used this COVID-19 dashboard for situational awareness. This helped to ensure that consistent, reliable information was being shared with the public while also informing emergency response operations.
The previous narrative helps highlight how the goals and objectives were met. The following helps to frame the COVID-19 dashboard and public health communication strategy relative to dates.
- First, data needs were identified in February 2020, early in the pandemic based on available data. Partnerships were developed with community members to ensure necessary data was available, including situational summaries prepared for city leadership, emergency response and community partners starting February 29th, 2020.
- The dashboard application was drafted during March 2020. This framework was reviewed with community partners and public health leadership to confirm data was adequate. This ensured that GIS experts in our community were engaged to assist with developing a robust geospatial reporting system. These data were also distributed in a daily situational summary to community partners, including the healthcare community, ensuring a coordinated message.
- Dashboard application was launched in April 2020. This outcome meant that we were able to report to the community the data that was available. This system would be updated daily throughout the pandemic, but this milestone had the impact of informing the community. Our engagement with the dashboard application was consistently high throughout the pandemic and community partners regularly used it to inform their practices, while we also used these data to inform risk communication with regards to COVID-19 to the public.
- The COVID-19 Risk Dial was launched in May 2020. This risk dial presented a simplified depiction of risk to the community so that interventions could be adopted based on current recommendations. The risk dial categorization is based on the same measures presented in the dashboard.
- Between May 2020 and the rollout of vaccinations in December 2020, regular press briefings (daily to weekly) summarizing the current situation in the lens of this dashboard and the risk dial helped to increase the community's situational awareness and guide interventions.
- Vaccination data was incorporated December 2020. Incorporating the vaccination data was a critical component of communicating the need for vaccination to the public and for people to be able to see the relationship between vaccinations and the improving case situation. With the arrival of Delta, it became clear that vaccination practices would need to be adapted as well, which was able to be clearly communicated using this system.
- All throughout the pandemic, regular press briefings were used to inform the public. This dashboard application was aligned with public health messaging to ensure that consistent and reliable information was shared with the public, preventing confusion, and increasing trust in the public health community at a critical time.
This timeline generally describes the evolution of the dashboard, but who we engaged with throughout the process must also be described to understand how our public health communications strategy centered on the COVID-19 dashboard was a result of collaboration between LLCHD and the community. Today, the dashboard is being revised to incorporate more information about ‘up-to-date' vaccinations, while also being planned to expand reporting into other areas potentially, based on feedback from public health stakeholders in our community. All throughout this response, LLCHD engaged a wide array of partners in the healthcare system, government, cultural centers, community leaders and other community members to not only evaluate the COVID-19 information being shared, but to also ensure that any information being shared was helpful. Regularly, information in the COVID-19 dashboard would be adjusted based on community needs and feedback, as was also the case with all COVID-19 public health communications.
The primary stakeholders and collaborators involved were:
- Executive leadership in city and county: Mayor's office, public information officer at City of Lincoln and Lincoln-Lancaster County Health Department, Health Director
- Information Services & Finance Department in City of Lincoln: GIS team
- Health department COVID-19 planning team
- Community-wide COVID-19 incident command system
- Community feedback regularly obtained through reporting channels (email, calls)
- Educational setting partners identifying information needs
- Healthcare system partners describing the issues and information needs
- Press regularly requested information and identified information needs
It's been previously described, but to be clear, each of these partners had a voice in the planning and development of the COVID-19 dashboard. They also were regular participants in meetings that helped to identify data needs and where public health communications needed to focus. These relationships, while frequently strong leading into the pandemic, were further strengthened through this difficult time. Future public health endeavors in Lancaster County have a great deal of growth potential thanks to the partnerships that were reinforced in responding to the pandemic. This obviously had a huge impact on our ability to expand the reach of the COVID-19 dashboard and public health risk communication, while also helping us reach specific objectives outlined previously.
Through our partnerships, LLCHD regularly presented the dashboard application in public communications via social media, press releases and video briefings. These communications frequently included COVID-19 dashboard updates and members of the groups mentioned above as collaborators. In these communications it was regularly requested that if more information is needed, people submit these requests for information. The press was also able to ask questions. Whenever possible, common information requests identified were incorporated into the information presented in this dashboard application. This engagement helped to adapt the reporting to community information needs, and not only what public health professionals in our health department found to be valuable. This also helped contribute to community members feeling heard and feeling better served by LLCHD. Overall, trust was increased through this standardized, reliable COVID-19 information reporting process.
Equity is critical, always. Steps were taken to ensure equitable, meaningful, and representative collaboration with target populations. Academic partners were regularly engaged to discuss the COVID-19 pandemic and the dashboard we used was a central tool in public health communications with these partners. This ensured that academic partners were able to communicate information needs and design interventions to address inequities and other issues in a timely manner. They aligned their responses frequently with the COVID-19 dashboard and the related risk dial communications. Other community partners, such as Cultural Centers of Lincoln and other key stakeholders for different racial, ethnic, age-specific, and geography-specific groups, were able to communicate information needs and this contributed to what information was incorporated into the dashboard application. This helped ensure that inequities were identified, and our designed interventions addressed these inequities. This was not the only outreach to ensure equity, and equity was always central to conversations around the COVID-19 dashboard and our public health communication strategy, but these were two of the most critical.
As a final note, the start-up or in-kind costs and funding services associated with this practice are difficult to reproduce. The GIS software can be obtained from ESRI, or from open-source resources. The epidemiological expertise required to gather, manage, analyze, and report these data is critical. The expertise to incorporate public health professionals from an array of backgrounds and to mobilize the community is particularly challenging and varies by local health jurisdiction. In general, while Lancaster County has a great array of resources available, the baseline technology and data accessed is available for all jurisdictions in Nebraska and the framework designed can easily be duplicated elsewhere. This is clear by the adoption of COVID-19 dashboard reporting and the risk dial communications that Lancaster County was the first to establish in Nebraska.
In summary, our local health department can utilize other city and county agencies, the healthcare system, cultural centers, the educational system, the press, emergency respondents and so many other individuals representing our community. This great system of collaboration and relationships that have been established, fostered, and grown throughout the pandemic helped us reach our goals and objectives. Without those partnerships, much of what was accomplished by our public health system likely would have been less effective