The skeptical cardiologist finds much wisdom in a series of opinion pieces written by six former advisors of the Biden administration’s COVID transition team.
The first article, “A National Strategy for the “New Normal” of Life With COVID” recognizes what is becoming increasingly clear: COVID-19 is here to stay.
We are not going to totally defeat SARS-CoV-2, they write:
The goal for the “new normal” with COVID-19 does not include eradication or elimination, eg, the “zero COVID” strategy. Neither COVID-19 vaccination nor infection appear to confer lifelong immunity.
The authors recommend viewing SARS-CoV-2 in the same category as seasonal influenza and other respiratory viruses:
Thus, policy makers should retire previous public health categorizations, including deaths from pneumonia and influenza or pneumonia, influenza, and COVID-19, and focus on a new category: the aggregate risk of all respiratory virus infections.
The new normal would treat SARS-CoV-2 as we have done the other viral respiratory illnesses that have become endemic:
What should be the peak risk level for cumulative viral respiratory illnesses for a “normal” week? Even though seasonal influenza, RSV, and other respiratory viruses circulating before SARS-CoV-2 were harmful, the US has not considered them a sufficient threat to impose emergency measures in over a century. People have lived normally with the threats of these viruses, even though more could have been done to reduce their risks
Better Testing, Surveillance, Masking and Ventilation
The second paper, “A National Strategy for COVID-19: Testing, Surveillance, and Mitigation Strategies” co-authorizd by David Michaels, PhD, MPH; Ezekiel J. Emanuel, MD, PhD and Rick A. Bright, PhD details a proposed public health approach to this new normal.
It appears that SARS-CoV-2 will persist, and the COVID-19 pandemic will continue for some time. Consequently, to achieve a sustainable “new normal” with substantially lower virus transmission and mortality from COVID-19, testing, surveillance, masking, and ventilation all need significant improvement.
Here are their proposals
- The CDC needs to collect and disseminate accurate real-time, population-based incidence data on COVID-19 and all viral respiratory illnesses.
- Every person in the US should have access to low-cost testing to determine if they are infected and infectious.
- when the CDC tracking system receives notification of a positive test result from a health care facility or at home, the system should automatically 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 most effective way to prevent transmission of respiratory diseases, including COVID-19, is to eliminate exposure to potentially infectious individuals, encouraging individuals who may have illness to stay home. This requires systematic access to testing and paid sick and family medical leave for all US workers, especially low-wage, temporary, freelance, contractor, and gig economy workers.
- Upgrades to ventilation and air filtration systems, including increasing the intake of outside air, using efficient filters (rated at minimum efficiency reporting value of 13 or higher) and adding high-efficiency particulate air filtering devices. These systems will need to be implemented in offices, schools, public transportation, and other congregate workplace and social settings, such as restaurants and bars
It has been clear for a while that cloth and surgical masks aren’t particularly effective against this airborne virus, therefore:
- The country needs to encourage use of high-quality filtering facepiece respirators (FFRs), such as N95s or KN95s, rather than cloth or surgical masks, to reduce transmission of respiratory viruses including SARS-CoV-2 in crowded indoor settings where community exposure risk is elevated.7
- To meet demand and prevent reliance on imported products of questionable quality, there needs to be a national initiative to sustainably produce domestic FFRs and ensure they are readily available to all US residents for free or very low cost. The government could mail vouchers to US households to pick up FFRs at pharmacies, grocery stores, schools, and other locations.
The public needs better guidance on what masks to wear, when to wear them and assistance in obtaining effective masks:
- There needs to be a system for clear recommendations from trusted public health authorities, advising local governments and the public about the appropriate use of facial coverings, depending on the setting; an individual’s vaccination, immune, and risk status; and the level of community transmission.
- An easily interpretable risk assessment map that encompasses these variables to provide immediate risk determination at the zip code level for individuals could be developed and updated daily.
- Such a system would help reduce confusion and guesswork that many individuals face today as they make daily decisions on how to protect themselves.
To reduce COVID-19 transmission, achieve and sustain a “new normal,” and preempt future emergencies, the nation needs to build and sustain a greatly improved public health infrastructure, including a comprehensive, permanently funded system for testing, surveillance, and mitigation measures that does not currently exist
This revised viewpoint and these recommendations seem appropriate to me. Let me know your thoughts.