Before revision:  Without such direct epidemiological measurement, other approaches are required to infer whether the number of new cases is likely to be increasing or decreasing: for example, estimating the pathogen reproductive rate , R, using data gathered from the clinical response to the disease.
After revision:  Without such direct epidemiological measurement, other approaches are required to infer whether the number of new cases is likely to be increasing or decreasing: for example, estimating the pathogen effective reproduction number , R, using data gathered from the clinical response to the disease.