Woman wearing a mask sitting behind a computer monitor at the UW Belltown COVID-19 Clinic. Credit: University of Washington
Photo of a staff member at the UW Belltown COVID-19 Clinic. Credit: University of Washington
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For nearly seventeen months, the COVID-19 Literature Situation Report provided up-to-date information to the public health community about scientific evidence relevant to the COVID-19 pandemic. After more than 330 daily summaries, the project – a partnership between the Washington Department of Health (WA DOH) and University of Washington Department of Global Health (DGH) – ended on June 15, 2021.

Jennifer Ross, an acting assistant professor of global health and medicine at UW who served as co-editor of the COVID-19 Literature Situation Report (Lit Rep) along with assistant professor of global health and epidemiology Brandon Guthrie, said the end of the project reflects the progress that’s been made in the United States to both understand and contain the COVID-19 pandemic.

“Cases are declining locally, both here in King county and across the country, and we've heard from our stakeholders and our partners at the Department of Health that the sources of trusted information have grown and expanded,” said Ross, though she noted that globally cases are still at unprecedented and devastating levels.

Filling a Critical Knowledge Gap

The Lit Rep started in January 2020, when information about COVID-19 was limited and rapidly changing. With Washington state the site of the first confirmed COVID-19 case in the United States, the WA DOH and COVID-19 Incident Management Team recognized the importance of helping state and local leadership stay on top of the evolving literature about the virus, including emerging research on transmission, mitigation strategies, and health effects. To meet this need, the COVID-19 Literature Situation Report was created by Cathy Wasserman, the WA state epidemiologist for non-infectious conditions, and Maayan Simckes, a behavioral health epidemiologist who earned her PhD in Epidemiology from UW in 2019.

The first Lit Rep was developed and circulated on January 28, 2020 to a small group of WA DOH leadership, including the Secretary of Health, State Health Officer, and Incident Commander. It was so well received that a decision was made to release a report daily Monday through Friday.

“From the outset, we knew that the Lit Rep was filling a critical knowledge gap. State and public health leaders could not keep up with the tsunami of scientific information. The Lit Rep helped inform state level decisions around masking, physical distancing guidance, school closures and reopening, and other aspects of the response,” said Dr. Scott Lindquist, state epidemiologist for communicable diseases at the WA DOH.

The audience for the Lit Rep quickly expanded to include more than 5,600 public health partners, hospital professionals, and members of the public both in Washington and around the country. Sarah Murray, a public health nurse with the Walla Walla County Department of Community Health, said her department used the Lit Rep to inform and update local policies related to everything from mandatory quarantines to music groups, diagnostic tests to Long Term Care visitation.

“Citizens were so happy we had information and answers for them straight from the literature, even if the government didn’t have guidelines and there was no action to be able to take. It’s like getting a real diagnosis for a chronic debilitating disease that has had no answers for years. Even if there is really no cure and nowhere to go with the diagnosis, just knowing what it is and being able to understand what’s out there about it, brings peace,” said Murray via email.

Balancing Speed and Quality

As the subscriber base and volume of literature grew, responsibility for operations of the Lit Rep transferred to the University of Washington where it was supported by the Department of Global Health, Alliance for Pandemic Preparedness, and START Center. Starting in May 2020, the UW team sent out more than 270 daily reports including summaries of over 3,300 articles, produced 11 in-depth reports, and maintained updated synthesis summaries on four priority topic areas.

The process of creating and delivering the Lit Rep started at six-thirty each morning, when a member of the team from the School of Public Health would begin scanning databases, including PubMed, for both published, peer-reviewed articles and pre-print articles. Next, two additional team members would sort the citations – which ranged in number from 100-1,000 – and select the top 10-15 articles to summarize. A writer would then draft the report, which would be reviewed by two editors including Guthrie, Ross, assistant editors Alison Drake, an assistant professor of global health at UW, or Will Hahn, a protocol team lead at the Fred Hutchinson Cancer Research Center, or senior student team members, before being distributed to subscribers in the evenings via email.

In addition to managing the logistics of a daily operation, Guthrie and Ross also had the difficult task of balancing speed and quality, especially given how quickly the media picked up and circulated new research findings. Even if studies and claims were making a splash in the headlines, the editors only included them if they had scientific grounding or were accompanied by an editorial note that urged readers to be cautious in their interpretations of the results. 

“There is some incorrect information in the realm of scientific research, where there's a lot coming up very quickly and sometimes things that grab headlines and grab attention turn out to later be debunked,” said Ross. “We wanted to make information available because people who read the report in some cases were getting asked to comment on these articles, but we flagged articles that hadn’t been peer reviewed or were potentially problematic.”  

While its normal for the scientific community to debate evidence and policy guidance, Guthrie pointed out that this back and forth typically happens over the course of many years and away from the view of the public. “One of the challenges of this past year and a half, is that everybody got to see how the sausage is made. Science is not always a linear path. I think very few of the public health decisions that, in retrospect, maybe were not the best decisions were made out of malice. They were made while operating from incomplete information but being in a position where you have to do something.”

Editorial notes were just one way the Lit Rep team ensured that the summaries were trustworthy and easy to digest for an audience operating in an environment of extreme uncertainty. They also tried to keep the language as non-technical as possible, and to emphasize the main takeaway of the literature.

Susan Wagner, a public health specialist with Island County Public Health, said the user-friendly format set the Lit Rep apart from other resources available during the height of the pandemic by making complex and highly variable public health information easy to consume, share, and implement.

“I would review the top three at a minimum each day and then forwarded to the staff, COVID-19 Command, or management staff as appropriate,” said Wagner via email. “The two areas of intense and high involvement by our department have been schools and long term care facilities. The ability to have a quick concise literature review once a day was reassuring that we were on the right track or not missing something important.”

Entering the Next Phase of the Pandemic 

While there is still scientific knowledge to be gained from the pandemic, Guthrie says the public health response is shifting towards the optimization and implementation of existing knowledge and solutions.

“There's still lots of new basic science that's coming out, but a lot of what we're focused on now is making systems work better. How do we do it more efficiently or reach the people who are getting left out or make it more sustainable, those are going to be the new questions,” Guthrie said.

As the pandemic enters its next phase, the resources dedicated to supporting the Report will be directed toward other important priorities. The Alliance for Pandemic Preparedness will continue to host all of the materials produced by the COVID-19 Literature Situation Report since its initiation, along with other resources relevant to the pandemic. Additionally, the CDC produces evidence summaries related to COVID-19.

Although the COVID-19 Lit Rep is coming to an end for now, its successes will likely inform the response to future public health crises. 

“The Lit Rep was such a useful tool throughout the response, both for daily and more in-depth reports, that leadership have discussed the potential future of a Lit Rep model within our incident command structure to support effective response to other emerging public health threats,” said Lindquist.

The COVID-19 Literature Situation Report team includes: (Washington Department of Health) Cathy Wasserman, Maayan Simckes, Anar Shah, Kelly Naismith, Brad Klos, James Oloya, Amy Sullivan; (University of Washington) Brandon Guthrie, Jennifer Ross, Lorenzo Tolentino, Jessie Seiler, Rodal Issema, Molly Fischer, Francis Slaughter, Emily Rowlinson, Mark Fajans, Ashley Tseng, Diana Tordoff, Wenwen Jiang, Julianne Meisner, Basia Otto, Caroline Liou, Amy Goldstein, Dylan Green, Tigran Avoundjian, Lauren Stroemel, Ghadah Gadi, Elisabeth Gunningham, Sherrilynne Fuller, Diana Louden, Jodi Greathouse, Arika Johnson, Dana Panteleeff, William Hahn, Alison Drake, Judith Wasserheit, Judd Walson, Stephen Hawes

By Amy Frances Goldstein