Enhancing Situational Awareness to Prevent Infectious Disease Outbreaks from Becoming Catastrophic.

Catastrophic epidemics, if they occur, will very likely start from localized and far smaller (non-catastrophic) outbreaks that grow into much greater threats. One key bulwark against this outcome is the ability of governments and the health sector more generally to make informed decisions about control measures based on accurate understanding of the current and future extent of the outbreak. Situation reporting is the activity of periodically summarizing the state of the outbreak in a (usually) public way. We delineate key classes of decisions whose quality depends on high-quality situation reporting, key quantities for which estimates are needed to inform these decisions, and the traditional and novel sources of data that can aid in estimating these quantities. We emphasize the important role of situation reports as providing public, shared planning assumptions that allow decision makers to harmonize the response while making explicit the uncertainties that underlie the scenarios outlined for planning. In this era of multiple data sources and complex factors informing the interpretation of these data sources, we describe four principles for situation reporting: (1) Situation reporting should be thematic, concentrating on essential areas of evidence needed for decisions. (2) Situation reports should adduce evidence from multiple sources to address each area of evidence, along with expert assessments of key parameters. (3) Situation reports should acknowledge uncertainty and attempt to estimate its magnitude for each assessment. (4) Situation reports should contain carefully curated visualizations along with text and tables.