A comparison of prospective space-time scan statistics and spatiotemporal event sequence based clustering for COVID-19 surveillance.

The outbreak of the COVID-19 disease was first reported in Wuhan, China, in December 2019. Cases in the United States began appearing in late January. On March 11, the World Health Organization (WHO) declared a pandemic. By mid-March COVID-19 cases were spreading across the US with several hotspots appearing by April. Health officials point to the importance of surveillance of COVID-19 to better inform decision makers at various levels and efficiently manage distribution of human and technical resources to areas of need. The prospective space-time scan statistic has been used to help identify emerging COVID-19 disease clusters, but results from this approach can encounter strategic limitations imposed by constraints of the scanning window. This paper presents a different approach to COVID-19 surveillance based on a spatiotemporal event sequence (STES) similarity. In this STES based approach, adapted for this pandemic context we compute the similarity of evolving daily COVID-19 incidence rates by county and then cluster these sequences to identify counties with similarly trending COVID-19 case loads. We analyze four study periods and compare the sequence similarity-based clusters to prospective space-time scan statistic-based clusters. The sequence similarity-based clusters provide an alternate surveillance perspective by identifying locations that may not be spatially proximate but share a similar disease progression pattern. Results of the two approaches taken together can aid in tracking the progression of the pandemic to aid local or regional public health responses and policy actions taken to control or moderate the disease spread.