Today, a group of eminent physicians and scientists with global standing have acted decisively and in unison presenting the world with what it badly needs, whether it knows it or not: a comprehensive, cohesive plan which lays out the steps to reverse the course of Covid-19. Presented today as three linked “Viewpoints” in one of the world’s top medical journals, the Journal of the American Medical Association (JAMA), the group of six has outlined a brilliant, multi-layered strategy that the authors say will bring us to a “new normal” – a life where we are no longer captive to constant reaction to the virus, but instead can proactively take decisive measures to control future disease and death.
This could very well be the wake-up call this country, and the world, needs. Giving it further voice, immunologist Dr. Rick Bright, PhD, one of the authors, described the group’s vision in an interview. “We are not there yet,” said Bright, the CEO of the Pandemic Prevention Institute at The Rockefeller Foundation in New York. “But the ‘new normal’ is what we are presenting as where we want to be. We know what it looks like and we now have a very good sense of how to get there.”
Dedication and coordination are going to be needed, according to Bright.
Together, the authors have provided the most lucid, constructive, and hopeful blueprint for us to address the most devastating plague ever to challenge the world. It is written by celebrated thought leaders who have been at the front lines fighting the most widespread pandemic in global history. They’ve clearly taken a step back, assessed, and devised the first logical approach to the containment of Covid-19 in its current and future forms . In addition, the clarity of language used is appealing. Intelligent lay people can read the essays and understand them.
“I learned a long time ago in Iowa that, to succeed in explaining something and to avoid confusion, you need to be able to communicate it as if it were to a hometown coffee club,” said another one of the authors, Dr. Michael Osterholm, PhD, MPH, an epidemiologist who is the director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “That doesn’t mean you omit nuance. Because without nuance, given our natural hunger for certainty, you can only go from extremes of good to bad news and back again.”
The word “humility” is used carefully in the essays. We don’t know everything. We must look to science. “If we have learned anything from COVID, it’s humility,” Osterholm added. “We must remember that as we make decisions, they are based on our understanding of the science at hand.”
The authors advocate for the creation of a national strategy with multiple components that include speeding up the development of vaccines and therapeutics while ensuring they are accessible to all, as well as developing new testing, surveillance, and mitigation approaches. All of this, inevitably, will reinvent the nation’s public health infrastructure, which, the authors argue, is the real way to see ourselves out of this dangerous period.
No disease has ever been eliminated in the absence of lifelong immunity. Our new reality must include best practices for living with Covid-19. And, as SARS-CoV-2 is simply the latest of the coronaviruses to cause illness, we must retire previous categories and focus on the aggregate risk of these types of pathogens.
Historically, we have not paid much attention to seasonal or regional viral outbreaks, much less developed a strategy to mitigate the effects. To correct this deficiency, we must establish thresholds for infections, hospitalizations, and deaths. Each threshold would then trigger policy recommendations for mitigation. In its simplest form, this would allow for strategic planning regarding hospital capacity and staffing.
If we cannot wipe out Covid-19, we must manage the way we can control it. The key is to lower the possibility of transmission and death. That’s where expanded testing, surveillance, and mitigation strategies come in. The U.S. Centers for Disease Control and Prevention (CDC) currently extrapolates cases and outcomes from data collected from “a few, underrepresented sites,” reads another essay, titled “A National Strategy for Covid-19: Testing Surveillance, and Mitigation Strategies.”
The country needs to establish a comprehensive testing and reporting system that would encompass data from “all medical and testing facilities, all emergency department cases, and all hospitalizations, ICU admissions, and deaths need to be reported to the CDC and linked to anonymized sociodemographic, vaccination, and clinical outcomes data.” And those at-home tests, so many people are taking? The reporting system should accommodate those, too.
Testing must be coupled with genomic surveillance if we hope to detect and track Covid-19 variants before they become established. It is unbelievable that a country such as the U.S., with its brilliant minds and great resources, did not identify the existence of Omicron (present here for weeks) while South Africa was able to do so within 36 hours of receiving its first suspected sample.
Tests should be free or low cost, the essay says. And, when a person tests positive, he or she need not be in the dark, as has happened so often, particularly to individuals in underserved communities. “The system should provide clear guidance on self-isolation and treatment options that may include anti-Covid-19 medications or an opportunity to participate in research studies to assess therapeutic interventions,” the authors write.
Covid-19 may be the latest, but it will not be the last, public health threat. To prepare, we need to accumulate, analyze, and disseminate real-time information. As with all successful systems, flexibility and adaptability are essential. We know that collecting good data will yield critical knowledge. Right now, we lack the capability to acquire and coordinate good data. A solid, integrated, data infrastructure can, and must, be built if we hope to respond in a timely and effective manner to this and future, public health challenges.
Equally important is the need to rebuild trust in our public health institutions. A combination of mixed messaging, misinformation, disinformation, fear, frustration, and fatigue have eroded the public’s trust in government and public health leaders, when it is most needed. Restoring it will be difficult, but we know that a trusting public is also one that cooperates.
If we fail to take the recommended actions, we condemn ourselves to living in a perpetual state of emergency action as we react to one variant after another with no end in sight.
No one wants to admit it, much less say it, but our current course of action has done little except buy time. Now, that time is running out. From the beginning, the CDC followed a flawed policy ranging from its handling of messaging regarding testing, surveillance, masking, and ventilation. It insisted on developing its own test kits (instead of accepting those in use in other countries) which proved to be defective. Compounding the problem, with the advent of vaccines, the value of testing was discounted, and the effort marginalized. Now, in our third pandemic year, we lack adequate testing as well as insufficient data collection regarding such basics as sociodemographic data, vaccination status, and clinical outcomes. Rapid diagnostic test kits exist but are neither accessible nor affordable for much of the population.
We have been presented with a strategic outline and a call to action. We must heed this message before this virus represents an unchecked challenge too bitter to contemplate in its devastating but sadly predictable outcome.