We enter 2021 buoyed by the end of the Covid-19 pandemic in sight. The reason for the optimism: vaccines. In a remarkable feat of twenty-first century medical achievement, effective vaccines for Covid-19 were developed around the world in 9 months, substantially faster than we had ever developed a vaccine; the previous record for vaccine development was for mumps—and that took three years. Signals from vaccine makers—both those using the novel mRNA technology, and those using more traditional adenovirus technology—had us anticipating the end of the Covid-19 pandemic as soon as the vaccines were available.
After a year that upended our entire economy, our collective incentives were aligned to vaccinate as many as possible, as quickly as possible. We knew the vaccine was coming months in advance and several professional organizations proposed guidelines for vaccine prioritization. The President set a target of 20 million people vaccinated by the end of 2020.
Science and Society Are Failing Children in the COVID Era | Scientific American
Authored by Nason Maani and Sandro Galea.
The long-anticipated CDC guidance on schools was released on February 12. This is the latest event in what has been, up to this point, among the most politically charged and scientifically contested aspects of the COVID-19 response. In its guidance, the agency calls for K–12 schools in particular to reopen as soon as possible, noting that with safety precautions in place such as physical distancing, contact tracing and mask-wearing, many have been able to open safely, and stay open. The report also cites evidence, also referenced in a recent article in the Journal of the American Medical Association authored by CDC staff, that school attendance in this age range is not a primary driver of community transmission, and that declining infection rates are possible while keeping schools open.
However, the levels of community transmission used as benchmarks have drawn criticism, not least because they seem to not reflect the latest evidence on what is achievable with safeguards, and by implication suggest almost all schools in the U.S. should remain in remote or hybrid forms for the immediate future, in spite of the evidence.
The spherical cow problem | The Healthiest Goldfish
There is an old joke, variations of which have long circulated. It goes like this: there once was a farmer whose cows had stopped producing milk. The farmer tried everything but could not manage to solve the problem. She tried altering the cows’ diet, she tried putting them in a new pasture, she tried enlisting the help of the local vet—all with no success. Finally, she took one of the cows to a world-renowned university located in her state. The university was home to some of the brightest contemporary minds; surely, they could help fix her malfunctioning livestock? The professors were indeed willing to help, leaping at the chance to tackle a difficult challenge. They agreed to examine the cows and apply their know-how to finding a way to return the herd to milk production. They spent weeks on the problem, making calculations, running various milk-production models, and consulting with researchers at other universities. When they had finished, the farmer returned to hear what they had come up with. Had they solved the problem? “Yes,” said the lead researcher. “We have found a surefire way to increase milk production. First let us assume we have spherical cows in a vacuum.”
Achieving Health Equity, Efficiently | The Turning Point
We have previously written about the challenge public health faces in balancing the — sometimes — competing demands of equity and efficiency. Health equity, one of the core principles that animates public health, suggests that we should implement any health-related effort such that those who are most vulnerable are protected first. Efficiency refers to the success of our efforts in promoting the health of populations. These two goals can be aligned much, if not most of the time. We can promote population health while leading, first, with promoting the health of those who are most vulnerable. And when the two principles are in conflict, it is probably generally right to privilege health equity, to help push against injustice that has left some groups lagging on health.
With that in mind, we applaud the principles that have been widely articulated and that have been informing the rollout of the Covid-19 vaccine in the United States. Broadly speaking, these guidelines prioritize vaccination of health care providers and persons who are at high risk of contracting Covid-19, ensuring that those groups are vaccinated before others. This approach correctly recognizes that those at higher risk need to be protected first, and, reassuringly, most states have embraced these principles and have been implementing their vaccination plans accordingly, even establishing fines for any vaccine providers who do not comply with these guidelines.
Decision-making in an age of Covid and social media | The Healthiest Goldfish
Lately, I have been thinking a fair bit about decision-making. Covid-19 has confronted us with a range of significant choices: about whether, and to what degree, to embrace lockdowns, about closing and reopening elementary schools, about who should get the vaccine first, and so on. As we have engaged with these choices, there have been people on both sides making good-faith cases for their point of view. There are some who passionately think we should reopen elementary schools, and there are some who passionately wish to keep them remote-only. There are some who feel lockdowns should remain in place until vaccines are widely distributed, there are others who feel a phased reopening is both feasible and necessary for countering the economic consequences of the pandemic. There are some who think vaccine priority should be guided exclusively by who is likeliest to die from the virus and there are some who favor an equity-based approach which accounts for the historic disadvantage that creates health gaps.
These choices have in common their deep ramifications for health, and the quality of being difficult to get completely right. Indeed, I have yet to see anyone suggest a resolution to any of the issues I have just mentioned that both elides costly health and economic tradeoffs and manages to satisfy everyone. (If you, the reader, can name an instance where this needle has been successfully threaded, please do let me know in the comments section below. I am interested to hear about it.)
Read the full article on The Healthiest Goldfish.
Should We Be More Upset by This? | The Turning Point
The world was upended during 2020 by Covid-19. As we struggled with the pandemic, much of life as we knew it ground to a halt. We watched case numbers, anguished over severe cases, and waited for a vaccine. We started talking about the potential for a vaccine as early as March, giving us what turned out to be more than eight months of lead time to be ready for the rollout once we had vaccines approved.
Vaccines finally arrived in December, and the rapid distribution that could save lives, more or less, did not happen. And we all fretted again and wrung our hands in frustration. But have we been upset enough that a vaccine rollout that we knew was going to be needed, and we knew would be happening soon enough, has essentially been sub-par at best, botched at worst? Has there been enough vaccine activism to try to fix this?
We suggest that this has not upset us as much as it should have, and we have not seen outraged calls for fixing the problems, for a number of reasons.
Read the full piece here.
A case against moralism in public health | The Healthiest Goldfish
Covid-19 has been, in many ways, a high watermark moment for public health. Over the last year, health authorities have engaged with the public, with the goal of influencing behavior in order to save lives. And the public has largely listened, making drastic changes to their lives in the name of health.
A key reason, perhaps, that public health advice has so resonated is that it has tried to offer clarity in the midst of a disorienting moment. This clarity comes largely from our data. Throughout Covid-19, public health recommendations have largely been supported by our growing knowledge of the disease. For example, the data reliably show that the virus spreads through the air, via person-to-person contact. This allows us to clearly say that masks and physical distancing are an effective means of slowing the disease’s spread. This clarity has led to the widespread embrace of these measures, which have come to define our response to Covid-19.
How Federal Dollars Can Incentivize a Stronger Response to Covid-19 | Barron's
Authored by: Efthimios Parasidis, Amy Lauren Fairchild, Sandro Galea, Cheryl Healton, and James W. Curran
A year into the pandemic, Covid-19 continues to spread. In large part this is due to widespread failure to institute and enforce evidence-based public health measures, including protocols for testing, universal masking, distancing, and isolation and quarantine. The Biden administration issued an order requiring masking in all federal buildings, a testing program for federal employees, and masking on all forms of transportation. While these are smart, swift moves, more is required for the United States to be a world leader in pandemic response and prevention.
The spread of new variants of concern—that are more transmissible, possibly more lethal, and potentially reduce the efficacy of our current menu of vaccines—makes it important to shore up layers of prevention that we know work. While vaccinations are safe and effective in preventing symptomatic Covid-19, strong efforts will be required to maintain additional public health policies as vaccine roll-out picks up speed. Vaccination, at this stage, is another protective layer in a comprehensive strategy, not a panacea that will end the pandemic.