Precision Public Health as a Key Tool in the COVID-19 Response

Precision Public Health as a Key Tool in the COVID-19 ResponseWith more than 20 million cases of coronavirus disease 2019 (COVID-19) globally and now exceeding 5 million cases in the United States, the COVID-19 pandemic represents one of the greatest public health challenges in more than a century.To succeed against COVID-19, multiple public health tools and interventions will be needed to minimize morbidity and mortality related to COVID-19.Although extreme public health interventions, for example, lockdowns and stay-at-home mandates, were initially critical to flattening the curve, many fundamental questions remain, such as when can employees deemed nonessential return to work, how can children safely return to school, and who should be first to receive a vaccine once it becomes available.Information about who is at highest risk of hospitalization, intensive care unit admission, and death based on age, sex, race/ethnicity, and underlying conditions is now becoming available. 1In addition, the relationship between neighborhood factors (eg, increased neighborhood household crowding rate) and risks for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 disease outcomes are now recognized. 2 These rapidly accruing data suggest that it might be possible to better target interventions for populations, ie, precision public health.Similar to how precision medicine uses genomic and other personalized patient data to provide the right treatment to the right patient at the right time, precision public health is an emerging discipline that uses extensive population-specific data to provide the right intervention to the right population at the right time. 3 Precision public health uses data from traditional and emerging sources to target interventions for populations by person, place, and time, in part with a focus on reducing health disparities.Analogous to the use of genomic information in precision medicine, pathogen genomics has become the leading prototype of precision public health, with numerous applications in tracking and control of infectious disease outbreaks, most notably for foodborne diseases.An example of using pathogenic genomics for the COVID-19 response is the application of a combination of whole-genome sequence analyses and epidemiological data in the Netherlands to provide reliable assessments of SARS-CoV-2 community transmission patterns.These data about transmission patterns were used to better inform decisions regarding cancellation of mass gatherings and recommendations regarding working from home and school closures. 4eyond genomics, granular data from public health surveillance are essential to target public health interventions.For example, when assessing child mortality in Africa, maps that include a high spatial resolution identified significant disparities that would have been missed with a country-level analysis. 3Another example is the na-