A COVID-19 Community Vulnerability Index to drive precision policy in the US

Background In April 2020 we released the US COVID-19 Community Vulnerability Index (CCVI) to bring to life vulnerability to health, economic, and social impact of COVID-19 at the state, county, and census tract level. Here we describe the methodology, how vulnerability is distributed across the U.S., and assess the impact on vulnerable communities over the first year of the pandemic. Methods The index combines 40 indicators into seven themes, drawing on both public and proprietary data. We associate timeseries of COVID-19 cases, deaths, test site access, and rental arrears with vulnerability. Results Although overall COVID-19 vulnerability is concentrated in the South, the seven underlying themes show substantial spatial variability. As of May 13, 2021, the top-third of vulnerable counties have seen 21% more cases and 47% more deaths than the bottom-third of vulnerable counties, despite receiving 27% fewer tests (adjusted for population). Individual vulnerability themes vary over time in their relationship with mortality as the virus swept across the country. Over 20% of households in the top vulnerability tercile have fallen behind on rent. Poorer test site access for rural vulnerable populations early in the pandemic has since been alleviated. Conclusion The CCVI captures greater risk of health and economic impact. It has enjoyed widespread use in response planning, and we share lessons learned about developing a data-driven tool in the midst of a fast-moving pandemic. The CCVI and an interactive data explorer are available at precisionforcovid.org/ccvi. What is already known on this topic Various communities across the United States will experience the adverse effects of public health crises to different degrees of severity. Composite indicators, such as the CDC Social Vulnerability Index, have proven to be valuable to policymakers by turning complex data sets into easily digestible and actionable information. However, the indicators within the Social Vulnerability Index do not fully contextualize the negative impacts spurred by the current pandemic. What this study adds The U.S. COVID-19 Community Vulnerability Index captures vulnerabilities spanning health, social, and economic dimensions that have been felt by every community in the US differently. Vulnerable populations have experienced more cases and deaths, higher unemployment, and a lack of access to critical support such as testing sites. Precision policies targeting vulnerable populations need to be designed and enacted to decrease the gap in negative consequences experienced in this and future pandemics, and the COVID-19 Community Vulnerability Index is a tool to highlight where and why these inequities occur.