|
Experts Call For A National Strategy To Manage Control Of An Endemic
COVID-19
It Requires
Agreeing On An “Acceptable” Number Of Deaths
The SARS-CoV-2
pandemic has yet to end, but several observers have begun to identify
lessons learned or to call for a national strategy for dealing with
the anticipated new realities of living with COVID-19 under endemic
rather than pandemic conditions. Other experts have called this effort
premature in light of the remaining unknowns, and even those calling
for the new strategy acknowledge the uncertainty and call for humility
in making predictions. More than 2,000 COVID deaths in the US are
still occurring each day.
What Endemicity
Requires
Writing in a series of
commentaries in JAMA and in a special JAMA interview, experts who
helped create President Biden’s COVID strategy a year ago are now
seeking to focus attention not so much on what remains to be
accomplished to make COVID endemic, but instead on what endemic
conditions will require if we are to maintain a desired degree of
control over endemic COVID.
All Respiratory
Viruses
In a viewpoint article
entitled “A New National Strategy for the ‘New Normal’ of Life With
COVID”, Ezekiel Emmanuel and colleagues argue that the nation
needs to set a goal which does not include “zero COVID” and instead
includes an acceptable level of national risk caused by all the
endemic respiratory viruses such as Influenza, Respiratory Syncytial
Virus, SARS-CoV-2, and others. This lumping together of respiratory
viruses is justified on the grounds that control measures, such as
masking or ventilation, are similar for this group of viruses.
How Many Deaths We
Can Live With
To judge the
acceptable level of endemic risk, the authors posit that the level
which existed prior to COVID should be used as a benchmark since this
level in the past did not trigger the declaration of a national
emergency with its attendant disruptive control measures. Using this
framework, the acceptable risk threshold the authors calculate is
approximately 35,000 hospitalizations and 3,000 deaths in a week.
The authors
acknowledge tolerance for risk from these events varies among
communities and no appropriate thresholds have yet been agreed to.
Also, they make clear that the US is currently far from dropping below
this possibly acceptable risk threshold. At present, over 14,000
deaths occur each week. In fact, the latest CDC data on excess
deaths from COVID reveals that the number of deaths from all
causes remain above the expected calculated from six previous years
of death information prior to 2020.
Rebuilding Public
Health
Based on their
predictions, Ezekiel and colleagues envision a need to rebuild public
health in four major areas. These are:
1. A public health
data system that can provide comprehensive, real time, information
that can reliably be used to assess a situation and can be trusted to
take action with.
2. A public health
worforce able to meet ongoing as well as surges in demand. It should
include community public health workers and an expanded school nurse
system.
3. Measures should be
taken to make it easier for services to be directed to hard hit areas.
4. There is a need to
rebuild trust in public health institutions and to increase public
belief that collective action is needed for success in public health.
The lives lost and the
losses in gross domestic product because of the pandemic provide more
than adequate justification for the large investments needed to
rebuild public health, according to Ezekiel and colleagues.
Other Biden advisers
led by David Michaels and Luciana Borio writing in
separate commentaries in JAMA have called for additional public health
and medical initiatives in testing, surveillance, mitigation
strategies, vaccines, and therapeutics.
To read these JAMA
commentaries and interview, visit:
https://bit.ly/3rT3x66
https://bit.ly/3rOXaRw
https://bit.ly/3KMmGiI
https://bit.ly/3rRPhuA
■
|