Vaccines are coming, and there is no doubt that they are our best hope. But simply waiting for them to arrive puts us on the path to perdition. In the United States, hospitalizations are almost double their spring peak, and daily deaths are at a seven-day average of over 2,000 – a level we haven’t seen since late April – and they continue to rise. ‘increase.
At this rate, at least 200,000 more Americans will die of COVID-19 by spring 2021, adding to the 290,000 deaths to date. Figures like these bring us closer to the losses suffered in the Civil War, our country’s deadliest conflict, when 620,000 American troops died.
It doesn’t have to be that way.
We think the story of the end ofthe COVID-19 pandemicshould take place in three acts. To save the most lives and beat the virus quickly, we need to understand the sequence ahead, even though we will be working on all three acts simultaneously.
We managed to flatten the curve last spring and we know a lot more about COVID-19 now than we did then. But flattening the curve in the dead of winter, when people can’t socialize outside, is another story. And we now know that telling millions of healthy young Americans to stay home indefinitely doesn’t work when they’re no more exposed to COVID-19 than they are to seasonal flu.
These three acts require holistic and reactive strategies that allow us to fight the current crisis while creating a bridge to vaccines that are months away from wide distribution.
Act I: Mastering the “ epinomics ”
The first act concerns the balance between epidemiology and socio-economy (what we call “epinomics”). Aepinomic approachinvolves risk management – and the recognition that we cannot eliminate it entirely. We need targeted public health measures that reduce risk at the lowest socio-economic cost. For example, we know that schools are reasonably safe and extremely important. Most of them should be open. Dining out and traveling, however, carries a much higher risk and is not as vital in the short term. These activities should especially be curbed where the prevalence is higher.
For this act to be successful, Congress must passurgent fiscal stimulussupport to give citizens the food, income and job security necessary to make these measures bearable and their compliance possible. We can also include support measures for the most vulnerable populations in terms of health.
Act II: Testing and tracing
The second act is to scale up a robust screening and tracing surveillance system to contain the virus, in particular by undertaking more proactive testing of populations, rather than relying solely on reactive testing for them. probable cases.
Once health measures flatten the virus and vaccine administration increases, officials will be under tremendous pressure to widely open up society and the economy – and citizens will be more than willing to ease restrictions. But it will still be cold across much of the United States in February, March and April, and vaccines will not yet be readily available to much of the population. To manage this phase, we will need a strong testing capacity, which is still sorely lacking in many regions.
We have made real improvements to diagnostic testing in cases where there are symptoms or suspected exposure, but we still do not have enough rapid tests to randomly and widely screen entire populations, such as nursing homes. , schools and prisons, so that we can find asymptomatic cases and act quickly. And it’s not just a question of the amount of testing. Most of the rapid tests we have available are not precise enough, even less accurate on children, and require additional FDA approvals.
We need national guidance and systemic support to achieve the necessary level of screening in long-term care facilities, schools, businesses, and across society. Our modeling suggests that regular screening tests on about 3% of the US population would allow us to relax the restrictions to the same degree as we could by vaccinating about 40% of the population – which makes broader testing an extremely important while we wait to complete our vaccine rollout.
Act III: the perfect deployment
The third act is to complete the administration of vaccines. We had the best holiday start gift possible with the announcement of 95% effective vaccines. We are now starting the hard work of managing the biggest logistical challenge of our time. We must execute a flawless deployment and provide clear, transparent communications that drive adoption. At the same time, we need to motivate people to continue to observe safety measures and maintain virus surveillance systems until the supply of vaccine doses increases and we can build herd immunity to the virus. spring and summer – and declare victory.
The challenge through these three acts is how to maintain vigilance. Some people may especially worry about when they can get the vaccine and resume their normal lives – one where they can stop wearing a mask, travel fearlessly, and see their colleagues and friends in person. But there are 100 million Americans vulnerable to health and more than 50 million workers vulnerable to exposure. The pandemic has so far been extremely regressive, affecting these populations at disproportionate rates. If, given what we know now, we do not take appropriate action on these three acts to limit this regressive impact and protect this 150 million, shame on us.
So what do we do now?
Going through the three acts will require a coordinated response from the whole of society. As all eyes turn to vaccines, all stakeholders have a critical role to play and must take the following immediate actions:
Federal governmentmust act immediately and adopt a strong fiscal stimulus package to ensure income, food and job security to protect those whose livelihoods are hampered by public health measures. Without it, we risk not only another recession, but the loss of hundreds of thousands of additional lives. The government should also provide support to protect vulnerable health testing and technology capacities, as well as implementation guidelines to support testing and the reopening of schools. Finally, it must continue to evolve at full speed to complete reviews and vaccine deployment.
States and local governmentsshould get people to wear masks and gradually reduce the activities that best allow them to optimize epinomics. They should provide the resources to help reopen schools safely. They need to be extra careful to increase screening and screening capacity – especially in communities of color that have borne a disproportionate burden to date – so that they are ready to contain the virus when community prevalence is lower. at the end of act I. Finally, they must give priority to the vaccination of the most vulnerable populations in terms of health and exposure, while implementing solid strategies for administration, data collection and Communication. The federal government should explicitly devote part of its upcoming stimulus package to supporting states and municipalities in these immunization efforts.
Business leadersmust call on Congress to pass a stimulus bill and advocate for sensible public health measures. They need to take extra steps to protect their employees and customers, in part by scaling up their own virus monitoring systems. They should also provide time off for eligible employees so they can get vaccinated, or sick leave for those who experience side effects afterward. Globally, in regions where their employees may have more difficulty accessing vaccines, they can play a role in securing the vaccine supply for the communities in which they operate.
Nationalsmust wear masks and continue to limit the size, frequency and duration of gatherings. They must manage an “interaction budget” tightly and only expand it when the virus and public health measures recede. They should participate in drug testing and support tracing and quarantine efforts, and they should seek access to vaccines as soon as they are eligible.
We have limped on the road to perdition. This is our last chance to take the exit ramp to the finish line. Let’s not waste it.
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