We are in a precarious moment in the COVID-19 pandemic. It is critical we understand this moment, how we got here, and the action it demands.
The moment
These factors are creating uncertainty and anxiety:
- The Delta variant is spreading aggressively across much of the country, leaving a trail of infections, hospitalizations, and death.
- After 18 months of this pandemic, people are tired of social restrictions, and less willing to act in ways that prevent virus transmission.
- The expectation that vaccines would be the way out of this pandemic has been clouded by uncertainty about how many people will get vaccinated and the effectiveness of the vaccines.
- Key actions that can help control spread, such as wearing a mask, have been deeply politicized, undermining our ability to reduce infections.
- Schools have opened, often with fewer mitigation measures in place than last fall, resulting in outbreaks and new school closures. Communities are concerned about the potential for more children and educators to be infected and further drive community spread.
- Fall and winter in the northern parts of our country are the seasons of respiratory viruses, such as influenza and now, COVID-19. So we should expect that infection numbers may rise.
- An escalating campaign of mis/disinformation is causing confusion and breeding mistrust of science and medicine, making it even harder to manage this pandemic and keep people safe. This campaign of lies is polluting the environment in which we implement policies to take on this pandemic.
The action
Now, in 2021, we have had 18 months to learn a lot about this virus and the tools needed to get the pandemic under control. We can get through the fall and winter without more spikes in cases, without pushing hospitals to the brink, and without more illness and death. These are the policies that will put the pandemic behind us:
- VACCINATIONS The Biden Administration’s move to mandate vaccination for anyone, anywhere engaged with the federal government, is the right next step. Including government employees, contractors, anyone taking federal money, will increase vaccination rates, and bring down the spread of Delta. Including hospitals that receive Medicare and Medicaid dollars is particularly important – this will keep our patients safe when they seek care at their most vulnerable moments. Mandating vaccinations (or testing) in companies with 100 or more employees is equally essential to keeping workers safe. We have to invest time and resources, however, in engaging directly with Americans and make transparent and tangible why this policy is necessary. BOOSTERS: Elderly and at-risk people should get a third shot, a booster. The science is increasingly clear on that. States such as Maryland are leading the way by authorizing 3rd shots for older adults living in group settings. The Food and Drug Administration (FDA) and the Centers for Disease Prevention and Control (CDC) must review the data and verify the effectiveness of boosters for younger people but there is no reason to think a third shot will not help everyone. And, there is no precise moment for this third shot, but somewhere between six and 12 months after a second shot (or one shot, for those who received a J&J vaccine). And if you miss the window for that third shot, just get the shot when you can.
- VENTILATION The Department of Labor (DOL) and the Occupational Safety and Health Administration (OSHA) should be setting ventilation standards for workplaces as part of their responsibility to keep people safe on the job. Ventilation is a worker safety issue. There is money from Congress that went to schools and states. Loans should be considered to small businesses to upgrade ventilation and improve indoor air quality.
- TESTING Widespread availability of free tests is essential to controlling this virus. The Biden Administration’s action to boost production of tests to overcome the current testing shortage, and make low-cost antigen tests available everywhere, is an important first step.This must be a longer-term strategy. The FDA should expedite approval of antigen tests that have been waiting in the approval cue for almost a year. While market forces can create powerful incentives for innovation, it is clear that relying on the markets alone is not enough. Congress, the President, HHS, CDC and private companies must work together to produce and distribute more tests, and to equip schools, workplaces and community centers with the technical skills to implement testing strategies.
- MASKS Mask mandates for federal employees and in public transportation should continue. Given clear evidence that mask mandates can prevent infections and the spread of the virus, states and the federal government should leave decisions about local ordinances to local authorities who understand their community characteristics and outbreaks best. State policies that block local decision-making are deeply unhelpful.
- SAFE RETURN TO SCHOOL These same policies are essential to getting kids and educators back to school safely. Schools should have indoor mask mandates when community transmission is high and offer higher quality masks (surgical masks, KF94s or KN95s) to those who can’t readily purchase them. Schools should do weekly testing of all their students and staff. Vaccine mandates for adults in schools are essential and while the Biden Administration did not mandate vaccinations in schools, it encourages local school districts to enact such mandates. Finally, the large sums of money allocated for schools can pay not only for the above but also for improvements in ventilation and filtration. Schools have had months to make these upgrades and if they have not done so, they should get going immediately.
If we implement these policies – now and into the next few years – we can dramatically reduce infection rates, unburden our hospitals, prevent future surges, and get through fall and winter when influenza is likely to make a comeback, with a lot less loss of life and damage to our economy.
Dr. Ashish K. Jha
Dean, Brown University School of Public Health