Don't Touch that Dial: Alert Level Dashboards

Background:

The Covid-19 pandemic has presented a public health information communication challenge. From data collection to its analysis and timely reporting, the Texas Department of State Health Services has had its work cut out for it. Along with https://www.dshs.texas.gov/news/updates.shtm#coronavirus more than just a few websites, traditional news media outlets, social media, and government officials have attempted to digest the results and spread the message to the public. This messaging has come under fire whenever, for example, the data is incomplete, the data is misused in a calculation, or the response action is too severe/insufficient. Early on, Governor Abbot asserted his authority to issue Executive orders and mandate bans. This has left local Public Health offices and their staff in a bind since, on the one hand, the Governor seeks responsible behavior from the public; however, on the other, such standards are tied to the spread of infection.

Since a Public Health Emergency was declared in March 2020, Texas's Covid-19 data was consolidated and "broadcast" with dashboard software. Public officials and their staff solicited technical advice from experts (e.g. Epidemiologists, Public Health academics, Texas Medical Center executives) interpreting the data. From the Medical Center to the individual County offices (all 254 of them), many did what they could to post local daily and keep the public informed. Their approaches ranged from sending out letters from the County Judge with all the data from the previous 24 hours to very sophisticated metrics with links to scientific articles. Whatever style is used, the present alert level should be prominent, current, and include the date of the last change.

Summary: Eight Covid-19 Alert Dashboards were evaluated in terms of how easy they were to find, how well they communicated risk, and whether actionable information was provided. Harris County's was the best with several good features noted from the others. In almost all cases, a date did not appear on the image causing me to question whether the alert was current or not.

Dashboard Examples: Best Practices and Suggestions for Improvements:

Unfortunately, as a simple Google Search will confirm, the alert level for a county, city, or other entity in Texas is very difficult to come by. I tried a number of different keywords: Covid-19, 'Threat Level', 'Alert Level', Emergency, Hospitalization. Also, I limited my search to 30 days.

No one does better than Harris County https://covid-harriscounty.hub.arcgis.com. The hub has the alert level front and center. The dial has the standard color code, is easy to read, and documentation which explains where metrics are currently vs. their target (and why it is important).

The Dallas County "alert" came from the Public Health Committee and was broadcast via press release. The above search had hits from all the local and regional news channels which provided a video and transcript with the information. The top hit, for example, posts a copy of the Committee's letter and County Judge Jenkin's Twitter reply. From there, tweet-by-tweet, the public can learn where to get vaccinated and where to get tested if recently exposed. https://www.nbcdfw.com/news/coronavirus/dallas-county-increases-covid-19-threat-level-to-red/2847672/

The Amarillo Dashboard came out of a search that included the term Panhandle but did not have a 30-day time focus. As shown, the site governs the city of Amarillo, Canyon, Texas, and Potter County. The Dashboard header defines the Threat Level. Unfortunately, there is no date that let's the reader know whether the Dashboard is current; some fine print states that the Alert will be in force for two weeks but we do not know where we are in this holding period. If we put a 30-day limit on the search, the hit goes away completely and not a single piece of news concerning a Panhandle-specific dashboard can be found.

The Alert criteria and actions are defined in text columns to the right of the Alert Colored Squares. The criteria is based on how stressed hospitals are in TSA-A. There were no similar dashboards for TSA-B which covers Lubbock County and Texas Tech University. Finally, the "Recommendations" column provide suggested actions that individuals can take

to reduce the demand for Hospital Resources (i.e. flatten the curve). These include "use face masks in public settings", "avoid public gatherings", and "avoid non-essential interactions". The word "vaccination" does not appear once in this chart.

There is a link to the Vaccine portion of the site; however, it is two screens up in fine print. I took this link and found all the eligible age groups covered, including Boosters. One item which stood out because I have not seen this anywhere else is a phone number to call if you need a ride to and back from the vaccination site.

El Paso's dashboard was nowhere to be found despite the fact I had been there many times. In fact, at the beginning, I found myself reading the material for Colorado's El Paso community. So, this means that Texas is an essential keyword that belongs in front of any other location search term.

The alert level is found in the header on each of in the nine screens that comprise the www.elpasostrong.com site. This way, the alert is always visible; it contains a color-coded score along with the current date. Screen 4 shows the individual ratings on each of the criteria: Infection Rate, Testing, Investigations, Hospitalization Resources, At Risk Populations (e.g. Congregate Facilities). El Paso's approach is to cast the alert level as what they call a "Community Scorecard" : how quickly test results are turned around from taking the specimen to notifying the individual and posting the result; how long a decreasing positive case profile is sustained; and how many cases come from congregate facilities. I like the concept of a partnership between government officials and the residents of their jurisdiction; the scorecard promotes the joint ownership for the status quo and minimizes the despair suggested by an "alert" and/or "threat"

Stage 2, the rating at the time of this writing, is considered the second worse set of conditions. My biggest criticism is that Stage 1, the most severe situation, is undefined. Part of the reason is that the screen is full of text and there is no more room to fit it in. However, there are ways this column could be included.

For best viewing, use Chrome rather than Safari. With Safari, the text is small and the graphs are crammed together. Some of the material even gets cut off the screen. All of this is corrected under the Chrome browser.

San Antonio/Bexar County has an Risk Level Rating accompanied by whether the "Progress and Warnings" indicators (Cases, Hospital Trends, Average Case Rate, Positivity, and Hospital Stress) are going up or down. The directional trend provides a better picture of the alert than simply a snapshot. When there is a trend rather than data which jumps around in an uncertain fashion, it makes more sense to report "worsening" or "improving" than simply giving a number without a context.

The various Indicators are have their own dashboard with easy-to-read tables with data separated into three columns: cumulative, daily change, and 7-day average. Every table has the date corresponding to the latest posting.

Brownsville has an alert dial similar to Harris County. However, there are two problems:

1) The post is over 6 weeks old and a lot has happened since December 5; and 2) The hot-link "Additional Info" does not lead to any additional information. Elsewhere on the page, one can check out Cameron County's Public Health Covid-19 Dashboard. This information is first rate - no part of the state has a better example of best practices when it comes to Vaccination Information. https://www.cameroncountytx.gov/publichealth/coronavirus/

Austin, Texas has a Threat Level set of links that is layered like an artisan pastry. Austin's main Covid-19 page https://www.austintexas.gov/covid19-orders-rules shows the threat level clearly on the right side of the page:

Note that while all the posts under City of Austin/Travis County Orders have dates, the threat level does not. I was left hoping that this information would be included with my search for more detail. I clicked the Stage 5 image and got this:

Certainly with all the details (in small print), the date could have been included. In any case, the top line highlights what Stage 5 is about: "Cases and Hospitalizations in Austin and Travis County are surging". Then, two sets of instructions are provided: one for vaccinated and the other for unvaccinated. These instructions are spelled out in small print text and color charts - again, one set for vaccinated and the other for unvaccinated.

This screen is the first indication that the Level 5 alert was issued just before Christmas. Next, the chart for the Vaccinated appears to be a generic one which covers each and every stage. So, while the publication date is provided in the footer and agrees with the previous

link, it does not provide the information we are looking for: Is today's data consistent with Stage 5 guidelines? Also, one would have to remember which Stage we were at in order to use the chart as designed. For a traveler who hasn't been following the Travis County numbers over the last 4 weeks, they would not necessarily know or remember - especially if a change had been made during the person's stay.

Finally, we have Longview in the Piney Woods part of North Texas. In contrast to other alerts discussed above, this system was put together in December by the Longview School Board and its Trustees just as classes were shutting down for the holidays. After New Year's, the plan was to have in person instruction and all parents received an e-mail with the alert status level set to yellow. https://www.news-journal.com/news/local/longview-isds-new-color-coded-infection-alert-system-in-effect-elevated-to-yellow/article_d3a38e6e-6dbc-11ec-904a-7b24d2ad991c.html . Unfortunately, the latest is that so many students and staff are sick, that schools could not operate. As of January 13, I counted 32 school districts closed in this part of the state. https://www.ketk.com/news/local-news/list-east-texas-schools-closing-due-to-covid-19-illness/ .

So, while I applaud the School Board's efforts to get classes up and running, it is clear how more buy-in is needed from Government Officials to implement mask mandates and promote vaccinations in order to rein-in spread of the virus on a community basis.