Lessons Learned from CDC's Global COVID-19 Early Warning and Response Surveillance System

Emerg Infect Dis. 2022 Dec;28(13):S8-S16. doi: 10.3201/eid2813.212544.


Early warning and response surveillance (EWARS) systems were widely used during the early COVID-19 response. Evaluating the effectiveness of EWARS systems is critical to ensuring global health security. We describe the Centers for Disease Control and Prevention (CDC) global COVID-19 EWARS (CDC EWARS) system and the resources CDC used to gather, manage, and analyze publicly available data during the prepandemic period. We evaluated data quality and validity by measuring reporting completeness and compared these with data from Johns Hopkins University, the European Centre for Disease Prevention and Control, and indicator-based data from the World Health Organization. CDC EWARS was integral in guiding CDC's early COVID-19 response but was labor-intensive and became less informative as case-level data decreased and the pandemic evolved. However, CDC EWARS data were similar to those reported by other organizations, confirming the validity of each system and suggesting collaboration could improve EWARS systems during future pandemics.

Keywords: COVID-19; Centers for Disease Control and Prevention; Early Warning and Response Surveillance; SARS; SARS-CoV-2; United States; World Health Organization; coronavirus; coronavirus disease; public health surveillance; respiratory infections; severe acute respiratory syndrome coronavirus 2; validation study; viruses; zoonoses.

Publication types

  • Review

MeSH terms

  • COVID-19* / epidemiology
  • COVID-19* / prevention & control
  • Centers for Disease Control and Prevention, U.S.
  • Global Health
  • Humans
  • Pandemics / prevention & control
  • United States / epidemiology
  • World Health Organization