COVID19 Reporting using GIS Dashboard and Coordination with Public Health Communications Needs

Lincoln-Lancaster County Health Department (LLCHD) is a local health department whose jurisdiction includes the City of Lincoln and Lancaster County in southeastern Nebraska. There are 324,514 residents of Lancaster County as of 2021. Most of the population is White (80.9%) with a significant Hispanic (7.5%), Black or African American (3.9%), American Indian and Alaska Native (0.9%), Asian (3.4%) and multiracial (8.2%) population.  There is a large refugee community served by our health department from Afghanistan, Iraq, Ukraine, Vietnam eastern Europe, Sudan, Burma, Kurdistan, and Myanmar.  This includes the largest group of Yazidis resettled in North America.   The most common languages spoken are English, Spanish, Arabic, Kurdish, Vietnamese, and Karen.

In response to COVID-19, a public health communications methodology was incorporated by LLCHD that used a COVID-19 GIS-based dashboard application as it's centerpiece. Around this COVID-19 dashboard, a public health communications strategy focused on risk communication (COVID-19 risk dial), associated interventions that should be undertaken, press briefings, press releases, mobilization of the Incident Command System and more, was developed and maintained. This system evolved throughout the pandemic, as did the COVID-19 dashboard application. The following submission for a Model Practice highlights the COVID-19 dashboard, primarily highlighting its role in reducing morbidity and mortality and framing the COVID-19 pandemic via public health communication practices.

The public health issue that this submission pertains to is the COVID-19 pandemic and how data about the pandemic was communicated to the public through this highly complex and prolonged emergency response. Specifically, we address how COVID-19 dashboard and risk dial were used in coordination with broader public health messaging efforts to prevent transmission and improve infection prevention behavior adoption within our community, including quarantine, isolation, and vaccination.

The department has been building capacity and resources since 2010 to be able to respond quickly to an emerging problem, assure data is available and accessible to support decision-making and provide data and communications to the public to improve their understanding of public health issues.  The dashboard and risk dial are specific outcomes in the early days of the pandemic and throughout the last three years.

The goal of our COVID-19 dashboard reporting is to present information describing the COVID-19 pandemic. Specific objectives included describing the magnitude of the problem, informing, and educating the community, justifying interventions, maintaining trust & transparency, ensuring a coordinated emergency response and identifying inequities.

Some of the activities that were implemented to accomplish these goals and objectives included:

-         coordination between epidemiology and geospatial information services (GIS) experts

-         generating estimates from available data

-         stratifying estimates to describe disparities

-         engaging with community leadership

-         adjusting dashboard reporting

-         regularly reviewing existing reporting 

The dashboard planning started in February 2020, released in April 2020, the risk dial related to it was released May 2020, vaccinations added December 2020 and an array of public health communications occurred throughout. This timeline of milestones and outcomes are further described in the ‘Local Health Department and Community Collaboration' section of this submission.

Project objectives were met successfully through this model practice. How these were met is further described in the following sections of this submission.

The specific factors that led to the success of this practice include:

-         engagement with other city departments & community partners to identify data needs

-         maximizing situational awareness with community stakeholders & partners

-         reviewing data reported with partners to ensure the reported data meets their needs

-         maintaining and expanding epidemiology capacity at LLCHD

-         strong support & clear communication by government officials

Public health impact examples of this dashboard meeting the objectives are below.

-         Ensuring key stakeholders in the community are well-informed and take action to prevent transmission or reduce the burden of severe disease was a major result of the COVID-19 dashboard.

-         Increasing trust and confidence in public health that contributed to increased engagement with LLCHD on not only COVID-19 response efforts, but other projects related to improving public health efforts, such as community surveys and focus groups to drive the Community Health Assessment process, was clearly communicated by a broad array of partners.

-         Speaking of these partners, strengthening partnerships between LLCHD and key community partners and city and county leadership by keeping them well-informed and adapting our reporting practices to their identified needs led to an increased adoption of public health practices and well-coordinated interventions.

-         Identifying inequities allowed LLCHD and community partners to focus efforts on reducing those inequities. This included increasing testing availability where cases were being identified less and possible under-ascertainment of cases was occurring, increasing prevention recommendations in communities where cases were being identified more and increasing vaccination promotion events in communities with lower traditional vaccination rates.

Community engagement in the COVID19 dashboard included: city/county executive leadership, city/county departments with GIS expertise, public health communication leadership, healthcare system leadership, emergency response team/ICS command staff, and general community feedback.

The steps taken to reduce health inequities were driven by information shared in our reports. Data gathered showed geospatial variation and identified communities with inequities. Some inequities identified geospatially displayed race, ethnicity, age & sex to identify disparities. Data on income, education, employment, and a range of other factors were considered when working to identify interventions reducing disparities. Disparity information allowed community members to develop age, sex, race, ethnicity, and geography-based interventions. For example, the following interventions were undertaken.

-         Testing practices that improved case-ascertainment rates in the community and allowed interventions such as quarantine, isolation and contact tracing/case investigation to prevent the increased transmission.

-         Vaccination campaigns focused on neighborhoods with lower vaccination rates. These ensured that communities with lower vaccination rates had increased access.

-         Vaccination campaigns in coordination with school systems to increase access to youth & families who had barriers to access due to language, location, and other factors.

-         Vaccination campaigns in collaboration with Cultural Centers of Lincoln and leaders of racial/ethnic communities to promote vaccinations and reducing barriers to vaccination.

The COVID19 dashboard can be accessed at covid19.lincoln.ne.gov, or by visiting health.lincoln.ne.gov

This COVID19 dashboard alone is not the innovation, but it is representative of a broader process that was efficient and ensured information needs of our community were met in a professional, effective, and consistent manner. The entire process is most innovative to the field of public health (and not just to LLCHD) as it was the creative use of dashboard reporting with internal software, public GIS software, public health communications practice and emergency response principles in a way that helped identify inequities, creative responsive solutions to a highly dynamic emergency response situation and engaging as many communities as possible in identify needs.

This COVID-19 information campaign centered on dashboard applications designed to impact the entire population of approximately 320,000 Lancaster County residents. Specific interventions implemented based on inequities identified through this reporting system impacted a broad array of populations, many of which do not have reliable estimates for their size. Generally, the demographics of our community are evenly split by sex, 80% White, 8% Hispanic, 8% multiracial, 4% Black, 3% Asian and the other communities represent 1% or less of the community. Determining the precise reach of this intervention is challenging; however, the evaluation section later in this application will describe how social media, dashboard internet traffic and subjective review helped us determine the effectiveness of this resource and approach. That section will explain why we believe the reach of this application was broad enough to effect significant change.

The structural drivers, or root causes, of the information gap are quite complex. For COVID-19, early on very few individuals, if any, truly understood the magnitude of the issue. As it began to grow and the effect was clearly described to the public, information began to grow, and inaccurate information spread. While this novel virus continued to spread, adapt and cause increasingly challenging situations for jurisdictions all throughout the country, one thing was clear. We need to ensure that the public is well-informed with the most up-to-date information and that our interventions are driven by those data. Few individuals practicing in public health remembered a time that a threat as significant as COVID-19 loomed. For many, the last time was the HIV/AIDS pandemic. For most younger public health professionals, there had been nothing to prepare them for this issue. In the past, information could not be shared as easily as it is now. Now, we used the large infrastructure that had been established in Lancaster County to address the problem.

A lack of publicly available information on COVID-19 transmission (cases/testing), hospitalizations, deaths and vaccinations were the main reason why the dashboard application was put together. This helped us begin to understand what inequities existed so that we could be as informed as possible when implementing solutions to those inequities. The information shared in the dashboard application was regularly used to track the effectiveness of our interventions at reducing inequities and serve as a foundation to dive deeper in designing those interventions based on structural drivers, or root causes, of the problem. In the past, the process for evaluation would take a much longer amount of time, but given the emergency, time was of the essence and this dashboard allowed us to accelerate our interventions.

Information from our COVID-19 dashboard combined with regular COVID-19 briefings and the COVID-19 risk dial enabled public health entities and stakeholders in Lancaster County to implement well-adopted interventions by the public. This open communication method and linking that information to our interventions helped justify the interventions to the community and improve adoption. Working to incorporate community wide interventions helped reduce inequities, but a lot of work was done knowing that these alone would not be enough to reduce inequities.

Early in our efforts, the COVID-19 dashboard was used to show how cases and testing varied by age, sex, race, ethnicity, and geography. This information was critical as we implemented community wide solutions to address the inequities presented by COVID-19 testing. With the arrival of the vaccines, vaccination campaigns included all the cultural centers collaborating for improving coverage rates in various racial and ethnic communities, as well as improving accessibility to individuals in the area who may have not received their vaccine because of distance or availability. These vaccination campaigns were conducted along with other efforts to complete the community health assessment safely, while ensuring that participation by communities served by cultural centers was promoted. These partnerships also improved the capacity to serve these communities in an array of other ways, such as helping to advance health literacy and reduce health inequities.

Further efforts to reduce health inequities focused on locations where people were comfortable. Church vaccination events were designed to increase reach into the Hispanic and Black communities with trusted community partners, which resulted in improvements to the vaccination rate for our Hispanic and Black communities alongside improving relations and expanding opportunities in other areas of public health. These vaccination campaigns were conducted along with other efforts to complete the community health assessment safely, while ensuring that participation by the Black and Hispanic communities was promoted.

Inequities in transmission were also common and put the rest of the community at an elevated risk. Testing campaigns with the university and partner entities via saliva testing helped increase case ascertainment in a younger population known to engage in risky behaviors with regards to COVID-19 transmission as well as ensuring continuity in our state legislature as that saliva testing was done to support safe operations in state government. This method of saliva testing was less invasive and helped reduce accessibility barriers. In coordination with the saliva testing programs, the largest university in our community also used the data from our dashboards in coordination with their data systems to better understand transmission in their community. This university focus helped reduce transmission in a population more likely to transmit due to social activities into more susceptible communities.

One major root cause of health inequities is the prevalence of inaccurate beliefs about public health issues. Considering the risk of inaccurate information misleading the public, the dashboard application planning and development process incorporates the public health communications team as an approving group for changes to align public health information being shared with communications at a departmental level. In the past, information would be shared through a similar approval of management to director, but the COVID-19 pandemic presented an opportunity to hire a communications manager who was able to coordinate our public communications more effectively.

The COVID-19 dashboard also addressed health inequities in Lancaster County by providing important details about the risk to the public, the magnitude of the problem and what specific communities could do in consideration of the COVID-19 dashboard data to reduce risk and inequities. Important members of the community were regularly engaged to reduce inequities in COVID-19. The COVID-19 dashboard primarily identifies health inequities in our jurisdiction; however, the previous section addressing the target population also included how those health inequities were addressed in our jurisdiction. Without these data being shared publicly and consistently, clarity in the response and what interventions were improving the situation would have been more difficult.

While all these examples of how the COVID-19 dashboard helped address health inequities, the principles of health equity being incorporated into the planning and implementation process by a review with our epidemiology team and our communications team whenever changes were made to the application was a key component that shouldn't be forgotten. This helped the dashboard application consider health equity principles through departmental leadership who were regularly engaged with the community. Prior to the implementation of this COVID-19 dashboard application, there was not a health equity coordinator position filled at LLCHD. Still, our collaboration with the community, emergency response leadership and other leadership throughout the community, particularly those at the Cultural Centers of Lincoln, helped us to identify where information was lacking so we could expand our reporting in this application. While the dashboard application focuses on age, sex, race, ethnicity and geography to identify inequities, the framework for gathering data, analyzing data and reporting the results that this COVID-19 dashboard showed to be effective can be applied in the future for multiple purposes. One purpose may be to identify inequities in other populations, while another purpose may be to identify inequities in these populations for different public health issues.

The COVID-19 dashboard focused practice for public health communication was better than previous practices of sharing data or risk communication. In the past, data was only shared as it was requested and often shared without considering how those results were framed, leaving it open to a range of conclusions without a unified response. The collaboration of the COVID-19 dashboard and the common data streams with the COIVD-19 risk communication tool (COVID-19 risk dial), social media and press briefings all informed the community stakeholders to ensure an effective response. It truly laid a framework that the community could use as a common resource and was the central component of our entire community's response. With this information, we were able to have the highest vaccination rates in the state and the lowest death rate as well. This coordination of dashboard reporting, public health communications strategies, intervention design and emergency response were innovative, improved the health of the community and prevented morbidity and mortality.

Overall, this COVID-19 dashboard driven public health communications strategy truly helped us reach our community at a level that was unprecedented. It helped us to address information needs in a way that we typically did not in the past and helped us identify and respond to inequities caused by COVID-19 and by a lack of accurate information in some communities.

The goal of our COVID-19 dashboard reporting is to present information describing the COVID-19 pandemic throughout Lancaster County and identify inequities. Specific objectives included: describing the volume of transmission and new cases identified, promoting vaccination, informing the community of healthcare capacity limitations and strains, educating the public on the risk of infection based on current data, describing inequities by race, ethnicity, age, sex, and geography, and to ensure a coordinated emergency response by keeping the public and primary partners well-informed.

To achieve our goals and objectives, each objective was reviewed regularly and, depending on the circumstance and the stage of the pandemic, action was taken accordingly.

-         We described the volume of transmission and new cases identified effectively using the COVID-19 dashboard. This objective was met as maps were made available showing variation by zip code for cases that were identified and showing how the cases were occurring by race/ethnicity and age. Variations by sex were not significant and other factors were more predictive of risk so that information was not presented in the dashboard to maintain as concise a message as possible.

-         Promoting vaccination as an objective was met as indicated by regular communications using the information presented in the COVID-19 dashboard application aligning with significant improvements in vaccination rates. The community used this dashboard to communicate the need for vaccinations with their partners. Regularly, stakeholders would return to the dashboard as a point of information for evaluating equity in specific communities.

-         Informing the community of healthcare capacity limitations and strains was critical. Hospitalization data was incorporated into the dashboard application showing the significant increase and the strain on the healthcare system. These data were regularly referred to by emergency response personnel and other stakeholders to evaluate whether specific interventions were necessary.

-         Educating the public on the risk of infection based on current data was a key component of the COVID-19 dashboard and risk communication. LLCHD uses a COVID-19 risk dial (green, yellow, orange, and red) to communicate the risk of COVID-19 to the community. This is a multi-factorial risk dial including risk of infection, hospitalization, and death as well as the benefit of vaccination rates. This risk dial aligned with data from this dashboard and was critical to press briefings and keeping the community updated through that avenue. Generally, the community was well-known to be accessing the dashboard application for their own situational awareness, while emergency response partners regularly used the application as well for their own situation awareness. Many who engaged in planning and response efforts used both the risk dial and dashboard together.

-         A key feature of the COVID-19 dashboard is to identify inequities by race, ethnicity, age, and geography. The dashboard application, where data was available, was stratified by race/ethnicity, age, and geography. Maps have been available since the beginning showing cases counts, testing counts, and vaccination counts throughout the community. Vaccinations, cases, and deaths were all stratified by age group, race/ethnicity and gender were all presented to describe inequities in the community.

-         To ensure a coordinated emergency response keeping the public and primary partners well-informed, emergency response partners and the Incident Command System used this COVID-19 dashboard for situational awareness. This helped to ensure that consistent, reliable information was being shared with the public while also informing emergency response operations.

The previous narrative helps highlight how the goals and objectives were met. The following helps to frame the COVID-19 dashboard and public health communication strategy relative to dates.

-         First, data needs were identified in February 2020, early in the pandemic based on available data. Partnerships were developed with community members to ensure necessary data was available, including situational summaries prepared for city leadership, emergency response and community partners starting February 29^th, 2020.

-         The dashboard application was drafted during March 2020. This framework was reviewed with community partners and public health leadership to confirm data was adequate. This ensured that GIS experts in our community were engaged to assist with developing a robust geospatial reporting system. These data were also distributed in a daily situational summary to community partners, including the healthcare community, ensuring a coordinated message.

-         Dashboard application was launched in April 2020. This outcome meant that we were able to report to the community the data that was available. This system would be updated daily throughout the pandemic, but this milestone had the impact of informing the community. Our engagement with the dashboard application was consistently high throughout the pandemic and community partners regularly used it to inform their practices, while we also used these data to inform risk communication with regards to COVID-19 to the public.

-         The COVID-19 Risk Dial was launched in May 2020. This risk dial presented a simplified depiction of risk to the community so that interventions could be adopted based on current recommendations. The risk dial categorization is based on the same measures presented in the dashboard.

-         Between May 2020 and the rollout of vaccinations in December 2020, regular press briefings (daily to weekly) summarizing the current situation in the lens of this dashboard and the risk dial helped to increase the community's situational awareness and guide interventions.

-         Vaccination data was incorporated December 2020. Incorporating the vaccination data was a critical component of communicating the need for vaccination to the public and for people to be able to see the relationship between vaccinations and the improving case situation. With the arrival of Delta, it became clear that vaccination practices would need to be adapted as well, which was able to be clearly communicated using this system.

-         All throughout the pandemic, regular press briefings were used to inform the public. This dashboard application was aligned with public health messaging to ensure that consistent and reliable information was shared with the public, preventing confusion, and increasing trust in the public health community at a critical time.

This timeline generally describes the evolution of the dashboard, but who we engaged with throughout the process must also be described to understand how our public health communications strategy centered on the COVID-19 dashboard was a result of collaboration between LLCHD and the community. Today, the dashboard is being revised to incorporate more information about ‘up-to-date' vaccinations, while also being planned to expand reporting into other areas potentially, based on feedback from public health stakeholders in our community. All throughout this response, LLCHD engaged a wide array of partners in the healthcare system, government, cultural centers, community leaders and other community members to not only evaluate the COVID-19 information being shared, but to also ensure that any information being shared was helpful. Regularly, information in the COVID-19 dashboard would be adjusted based on community needs and feedback, as was also the case with all COVID-19 public health communications.

The primary stakeholders and collaborators involved were:

-         Executive leadership in city and county: Mayor's office, public information officer at City of Lincoln and Lincoln-Lancaster County Health Department, Health Director

-         Information Services & Finance Department in City of Lincoln: GIS team

-         Health department COVID-19 planning team

-         Community-wide COVID-19 incident command system

-         Community feedback regularly obtained through reporting channels (email, calls)

-         Educational setting partners identifying information needs

-         Healthcare system partners describing the issues and information needs

-         Press regularly requested information and identified information needs

It's been previously described, but to be clear, each of these partners had a voice in the planning and development of the COVID-19 dashboard. They also were regular participants in meetings that helped to identify data needs and where public health communications needed to focus. These relationships, while frequently strong leading into the pandemic, were further strengthened through this difficult time. Future public health endeavors in Lancaster County have a great deal of growth potential thanks to the partnerships that were reinforced in responding to the pandemic. This obviously had a huge impact on our ability to expand the reach of the COVID-19 dashboard and public health risk communication, while also helping us reach specific objectives outlined previously.

Through our partnerships, LLCHD regularly presented the dashboard application in public communications via social media, press releases and video briefings. These communications frequently included COVID-19 dashboard updates and members of the groups mentioned above as collaborators. In these communications it was regularly requested that if more information is needed, people submit these requests for information. The press was also able to ask questions. Whenever possible, common information requests identified were incorporated into the information presented in this dashboard application. This engagement helped to adapt the reporting to community information needs, and not only what public health professionals in our health department found to be valuable. This also helped contribute to community members feeling heard and feeling better served by LLCHD. Overall, trust was increased through this standardized, reliable COVID-19 information reporting process.

Equity is critical, always. Steps were taken to ensure equitable, meaningful, and representative collaboration with target populations. Academic partners were regularly engaged to discuss the COVID-19 pandemic and the dashboard we used was a central tool in public health communications with these partners. This ensured that academic partners were able to communicate information needs and design interventions to address inequities and other issues in a timely manner. They aligned their responses frequently with the COVID-19 dashboard and the related risk dial communications. Other community partners, such as Cultural Centers of Lincoln and other key stakeholders for different racial, ethnic, age-specific, and geography-specific groups, were able to communicate information needs and this contributed to what information was incorporated into the dashboard application. This helped ensure that inequities were identified, and our designed interventions addressed these inequities. This was not the only outreach to ensure equity, and equity was always central to conversations around the COVID-19 dashboard and our public health communication strategy, but these were two of the most critical.

As a final note, the start-up or in-kind costs and funding services associated with this practice are difficult to reproduce. The GIS software can be obtained from ESRI, or from open-source resources. The epidemiological expertise required to gather, manage, analyze, and report these data is critical. The expertise to incorporate public health professionals from an array of backgrounds and to mobilize the community is particularly challenging and varies by local health jurisdiction. In general, while Lancaster County has a great array of resources available, the baseline technology and data accessed is available for all jurisdictions in Nebraska and the framework designed can easily be duplicated elsewhere. This is clear by the adoption of COVID-19 dashboard reporting and the risk dial communications that Lancaster County was the first to establish in Nebraska.

In summary, our local health department can utilize other city and county agencies, the healthcare system, cultural centers, the educational system, the press, emergency respondents and so many other individuals representing our community. This great system of collaboration and relationships that have been established, fostered, and grown throughout the pandemic helped us reach our goals and objectives. Without those partnerships, much of what was accomplished by our public health system likely would have been less effective

The evaluation of the COVID-19 dashboard was an ongoing process for LLCHD and varied depending on the situation, which was constantly evolving throughout the pandemic, until the situation stabilized (relatively speaking) after the hospital capacity issues subsided following the initial Delta & Omicron driven surge in late 2021 and early 2022. One key message was that reporting practices must be flexible and change alongside community information needs. An example of this is how many health departments have adapted to the return of common respiratory pathogen surges, such as influenza and RSV, by presenting their COVID-19 dashboard as a respiratory pathogen dashboard instead. While LLCHD has not yet undertaken this, it is a likely outcome for our department to expand on this COVID-19 reporting framework to include influenza and other pathogens in the future. Regarding the COVID-19 dashboard and how it was evaluated, we evaluated its effectiveness at presenting the information with internal review, regular discussions with our response partners and a range of metrics suggesting utilization by the public.

Our internal review of the objectives was conducted in planning meetings at least weekly, which frequently resulted in changes to the dashboard. These changes were typically clustered to reduce confusion to the public and align with any changes in our COVID-19 risk dial communications. This was critical given the risk dial's role in communicating risk and differential interventions based on that risk level. Generally, we ensured that we reached all our objectives. See the points below for an objective-specific description of how we met our objectives.

-         Our COVID-19 dashboard was describing the volume of transmission & new cases identified in these regular internal reviews. Discussions frequently highlighted limitations to these data, which were then shared with the press in weekly, sometimes daily, press briefings.

-         Our COVID-19 dashboard described how vaccinations were being taken up overall and among different parts of our community, whether that's by age, sex, race, ethnicity, or geography. This information was then communicated to the public to help us reach our objectives.

-         Our COVID-19 dashboard was informing the community of healthcare capacity limitations and strains. This was particularly important throughout the pandemic and helped explain in multiple instances why an array of interventions was necessary. This along with our risk dial helped the community plan and take actions accordingly.

-         Our COVID-19 dashboard educated the public on the risk of infection using current data. This was highlighted by the way our dashboard evolved with changing data availability, such as when the dashboard application incorporated saliva testing results or vaccine uptake. It was also clearly achieved in the alignment of the COVID-19 dashboard metrics with the COVID-19 risk dial and related communications.

-         Our COVID-19 dashboard maintained public trust and increased LLCHD transparency. This was accomplished by presenting data in a uniform way, regularly answering questions about the data, and presenting in press briefings any changes to the dashboard application while opening up the application and its development to press inquiries. It was important that any changes to the dashboard application were explained, and their significance communicated to the public. This is one reason why each change was communicated in that daily/weekly press briefing.

-         Our COVID-19 dashboard described inequities by age, sex, race, ethnicity, and geography. This was important to ensure that inequities were being described whenever possible and the community could act accordingly. One way we consider this successful is how we could see inequities being reduced in the COVID-19 dashboard when these results were presented, and interventions were undertaken in response to those inequities.

-         Our COVID-19 dashboard ultimately helped ensure a coordinated emergency response by serving as the foundation for information related to the pandemic. Without this data approach, it's possible that the response may have relied on data from other sources, which proved to be unreliable and inconsistent, while other sources lacked the situational awareness for Lancaster County and its residents. Not all communities are the same, which is why our dashboard approach was so important in helping maintain situational awareness for our respondents.

Evaluation of this COVID-19 dashboard application occurred in a collaborative fashion and was primarily subjective. No formal quantifiable evaluation was prepared for this reporting data flow and communications process. Data was not gathered prior to the implementation of the COVID-19 dashboard application on metrics associated with reporting and public health interventions being implemented; however, we are able to draw an array of inferences about the effectiveness of our communications based on cases, hospitalizations, deaths, and vaccinations that occurred in our county through the collaborative, multi-method emergency response to the pandemic in Lancaster County. There is, however, some information that can be shared that highlights the significance of our COVID-19 dashboard as a public health communications tool.

-         Social media data. The primary social media avenues were Facebook and Twitter, while press briefings that were recorded were shared to the City of Lincoln YouTube page. On Facebook, there were 7,800 followers ranging from 18 years to 65 and up. The core audience was 35-54 years and 75% female. On Twitter, there were 2,300 followers, with a core audience 18-29 years old and 38% female. Overall, social media had a reach of at least 10,000 people, but this does not include all the information linked to the dashboard by the City of Lincoln and other partners.

-         COVID-19 dashboard engagement. We've had multiple versions of the dashboard. The first version of the dashboard had 14,286,690 views. This averaged out to over 16,000 views per day. The second version of the dashboard has had 93,496 views averaging out to significantly less views at about 300 views per day. This coincided with a reduced interest in COVID-19 post-Omicron as the community began to normalize its transmission and adjust practices to the endemicity of COVID-19 today. Still, the criticality of sharing this information was met with astounding success given nearly 16,000 interactions per day. This high level of interaction is a major indicator of the adoption of this dashboard as a resource to the community and a guide for interventions.

Overall, the COVID-19 dashboard alone was not responsible for the improved health and well-being of our community throughout the pandemic compared to many other similar communities, but the coordination of the COVID-19 dashboard with the risk dial, press briefings, press releases and other public health communications helped. The information that was presented in this section helps show that. The information below highlights how our community had better health outcomes.

-         The vaccination rates in Lancaster County were significantly better than Nebraska overall and better than any other county in the state. Early in the vaccination campaign, this dashboard was used to track uptake of the vaccinations and describe the need to go out into the community for different groups by age, race, ethnicity, and geography. It continues to be a resource as it highlighted the differences in booster uptake and staying up to date.

-         Deaths due to COVID-19 in Lancaster County occurred at a lower rate than Douglas County (the most comparable large city in Nebraska to Lincoln and Lancaster County) and the state of Nebraska. This was presented in multiple areas to justify the interventions that were undertaken. In this case, it also helps to show how the communications campaign centered on the COVID-19 dashboard helped to communicate risk, so the public took appropriate action and mitigated risk more than others. John Hopkins University analyzed over 700 counties with similar demographics to ours and found that Lancaster County was in the lowest 10% for death rate in the nation.

Overall, the pandemic was an enormous challenge and led to levels of morbidity and mortality that haven't been seen in a long time; however, the presence of our COVID-19 dashboard and the rest of our tools related to these data is part of a public health communications campaign that was successful in mitigating the risk. As we continue to grow and respond to public health issues, this COVID-19 dashboard and public health risk communication strategy will serve as a framework for LLCHD and our community. Hopefully, it will also serve as a resource for NACCHO and other local public health jurisdictions nationwide

This approach is highly sustainable for LLCHD. We are a mid-sized health department serving the City of Lincoln and Lancaster County with a strong centralized government that pools resources. One of the benefits of this approach is accessibility to experts in mapping. This was of particular importance with the GIS support and the communications framework.

Geospatial information systems (GIS) services at Lancaster County are robust. A committed team of GIS technicians supported the implementation of our COVID-19 dashboard. Changes were able to be incorporated very quickly and enabled us to adapt to the changing circumstances. Change is common in public health, so this resource will continue to be sustained in Lancaster County and support our communications and reporting needs.

Communications infrastructure at the City of Lincoln and within Lancaster County is also well developed. This enabled us to put together a cohesive and consistent messaging approach. This consisted of great relationships with our local press and the ability to deliver messages to the community efficiently. Through the pandemic, LLCHD hired a Communications specialist who focused on the messaging for an array of projects, including COVID-19.

The coordinated messaging between the website (maintained by the City of Lincoln), the dashboard maintained by the GIS team, the risk dial posted on our website and regular information shared elsewhere, such as the daily (now weekly) situational summary or press briefings, was the result of a robust communications network and expertise in data management, analysis & reporting. Maintaining a strong communications team and technical expertise in data management, analysis, reporting, and GIS are critical to ensuring a robust communications approach in public health emergencies.

The truest test of sustainability is this was all developed using tools, processes, expertise, and skills which have been developed and maintained over the decade preceding the pandemic. The ongoing investment in technology, tools, training, and practice were already embedded in the information infrastructure and ongoing budget for LLCHD. Organizations attempting to duplicate this process would benefit from duplicating these sustained investments.