Controlling the Pandemic: Keep It Simple
By Henry Miller, M.S., M.D. and John J. Cohrssen
Presumptive President-Elect Joe Biden’s transition organization has published an initial plan to “beat” the rapidly worsening Covid-19 pandemic. Though it is essential and not wholly unreasonable, some parts seem to have been highjacked by a political agenda that contains tangentially related issues. The plan’s sole focus should be on the difficult and complex problem of interrupting the runaway pandemic while maintaining a viable economy. It needs a sensible organizational structure to use the available and prodigious federal, state, local, and private resources efficiently.
Some of the plan’s proposals seek to address non-pandemic-specific problems, using Covid-19 as an action-forcing and funding device—for example, the formation of a “Covid-19 Racial and Ethnic Disparities Task Force,” which, post-pandemic, would become “a permanent Infectious Disease Racial Disparities Task Force.” This issue is already on the agenda of various federal agencies and need not be recapitulated in the context of the pandemic.
In other respects, as well, the plan reinvents the proverbial wheel (at significant expense). For example, it proposes a new U.S. Public Health Jobs Corps that would hire 100,000 new employees (nine times the number currently at the Centers for Disease Control and Prevention) to trace contacts of infected persons, so that they could be quarantined. With numbers of infections currently out of control in much of the United States—on November 16, the seven-day moving average of cases was more than 157,000—track, trace, and quarantine is not now feasible. There are already too many cases, too many possible contacts, too little public cooperation, and insufficient numbers of tests with the necessary accuracy and speed. Moreover, with widespread vaccination expected to be in progress by about the middle of 2021, the need for active contact tracing will eventually be substantially reduced.
Instead of this new, massive bureaucracy, we should rely on existing federal, state, and local resources. In this large and diverse country, public health is primarily addressed at the state and local levels, where enhanced capacity to track and trace would build competence for this pandemic and other future needs. This does not mean that there should be no federal role; Department of Health and Human Services agencies, including the CDC, can offer guidance and, perhaps, coordination. In addition, the Biden administration will need to develop a coherent organizational structure that includes the White House and all involved federal departments and agencies and designate qualified personnel to implement the plan.
Biden has announced an ambiguous coronavirus advisory board, with 13 members, including three co-chairs. Its members’ expertise suggests that the group will be focused primarily on public-health issues. It’s unclear to whom it will report, and whether it is advisory or operational; and if operational, which programs and agencies it would oversee. According to the president-elect, “The advisory board will help shape my approach to managing the surge in reported infections; ensuring vaccines are safe, effective, and distributed efficiently, equitably, and free; and protecting at-risk populations.” However, an article in the Washington Post suggests a possible operational role: “The task force will have subgroups that focus on issues related to the response, including testing, vaccine distribution and personal protective equipment.”
Biden also needs to determine whether the interagency Operation Warp Speed initiative, primarily concerned with accelerating the development and distribution of Covid-19 vaccines, will continue, and whether its remit will expand to address more than vaccine development and logistics. Testing to diagnose active infections in individuals and to ascertain the penetrance of Covid-19 in the population has been a significant failure in U.S. prevention and suppression efforts. In order to slow the spread, OWS should refine the various kinds of tests, make them widely available and accurate with results reported rapidly, and establish paradigms for their optimal use. Likewise, OWS or an equivalent should oversee the development and stockpiling of important materiel such as personal protective equipment (PPE), which is inexpensive and highly effective at preventing Covid-19 infection, and which remains in short supply in many places. Even this far into the pandemic, we have not had clear, useful guidance and standards from federal officials or other sources about which masks and other PPE work best.
Now that the distribution of two vaccines appears near, the plan should include an urgent, aggressive public education campaign to promote vaccine use and also to reinforce the continuing need for the basic, low-tech pillars of Covid-19 prevention: masks; physical distancing; frequent hand-washing; and avoidance of crowded venues, especially indoors. Without success on both those fronts, the plague will continue.
Suppressing the pandemic is complicated and will require a multifaceted effort. But at the same time, we would urge the KISS—Keep It Simple, Stupid—approach to implementing the plan, lest the effort become so complex and ponderous that constructing it, rather than controlling the pandemic, becomes the goal.