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Former Head Of The IOM And Harvard Dean Calls For A War-Like Fight To
Eradicate SARS-CoV-2 In Ten Weeks
The Association of
State and Territorial Health Officers, Johns Hopkins and Duke
University are not alone in calling for a change in strategy to combat
the coronavirus outbreak. In a stunning editorial in the New England
Journal of Medicine published on April 1, 2020 entitled “Ten Weeks To
Crush the Curve”, Harvey Fineberg, former head of the Institute
of Medicine and former Dean of the Harvard School of Public Health,
invokes President Trump to say if we are at war with coronavirus, then
“It’s a war we should fight to win.”
Crush The Curve
Fineberg
calls for “a forceful, focused campaign to eradicate COVID-19 in the
United States. The aim is not to flatten the curve; the goal is to
crush the curve.” This goal is based on the reported success in Wuhan
China and echoes New Zealand’s approach which is also reportedly
succeeding in eliminating COVID-19 from the country. Fineberg’s plan
has 6 key components to carry out over just 10 weeks.
1. Establish a
unified command.
Fineberg wants a
commander appointed by the President with full power to target
responses to specific places and times because different regions of
the country are at different phases of the epidemic in the US.
2. Make millions of
diagnostic tests available.
In this regard,
Fineberg’s strategy is similar to that of the state health officers
reported elsewhere in this issue. He suggests multiple ways of
achieving this such as mobilizing the nation’s research laboratories
and organizing dedicated clinical test sites. We can’t track if we
can’t test is the idea.
3. Supply health
workers with personal protective equipment and equip hospitals to care
for a surge in severely ill patients.
Says Fineberg: “We
wouldn’t send soldiers into battle without ballistic vests; health
workers on the front lines of this war deserve no less.” He suggests
that regional distribution centers could deploy materials to the
hospitals in greatest need.
4. Differentiate the
population into five groups and treat accordingly.
These five groups are:
I. infected persons
who test positive
II. suspect cases who
have typical symptoms but test negative
III. exposed persons
IV. persons presumed
unexposed or uninfected
V. recovered persons
Once identified, there
are different means of treating each of these categories of persons,
according to Fineberg.
5. Inspire and
mobilize the public.
Fineberg believes
there is a role for everyone and that most are willing to do their
part.
6. Learn while doing
through real-time, fundamental research.
Fineberg concludes his
editorial with an exhortation and a bold prediction. “Rather than
stumble through a series of starts and stops and half-measures
on
both the health and economic fronts,
we
should forge a
strategy to defeat the coronavirus and open the way to economic
revival. If we act immediately, we can make the anniversary of D-Day
on June 6, 2020, the day America declares victory over the coronavirus.”
Realistic?
Several objections to
Fineberg’s proposal can be raised, perhaps the major one being how
realistic it is to make millions of tests available in a very short
period of time, and whether or not it is possible to effectively
categorize the entire population into the five groups described.
Interviewed on television by MSNBC’s Brian Williams, Fineberg
expanded on his plan by emphasizing that social distancing will only
be good enough to reduce the spread of coronavirus and not stop it.
For getting ahead of the curve and eliminating COVID-19, aggressive
testing, categorizing people into the five groups he described, and
acting on that information will be key, he said.
Fineberg told Williams
that the person to be appointed as commander of the effort needs to
have the full confidence of the President, to understand government,
the health scene, and federal/state relations, to be decisive and
respected. Potential candidates he named included former Department of
Health and Human Services Secretary Secretary Mike Leavitt and
former Defense Department head Ash Carter. Fineberg added that
the country needs to prevent the miscommunications, misunderstandings,
and lack of coherence in the attack on coronavirus. “We need the A
team,” he said.
To read the editorial and plan, visit:
https://bit.ly/2VjW6WP
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