To End the Pandemic Faster, Don’t Give Up on State Mask Policies | Governing

Authored by Amy Lauren Fairchild, Cheryl Healton, Sandro Galea, David Holtgrave And James W. Curran.

Pandemics demand responsible public health policy. Even as we — hopefully — see the end of the COVID-19 pandemic in sight, the pathway that Texas and some other states have laid out as we enter the endgame stage of the pandemic puts us on a dangerous path to resurgence.

The Centers for Disease Control and Prevention (CDC) has confirmed an association between lifting mask requirements — including reopening restaurants for indoor dining, which is a type of mask requirement relaxation — with an increase in both coronavirus cases and deaths.

Yet Texas planned to lift its mask mandates and allow a full return to business as usual as of yesterday. In announcing the move, Gov. Greg Abbott urged individual responsibility and adherence to medical advice, but a mask is now optional rather than an urgently needed mandate to save lives. Mississippi followed in short order, and other states plan to follow suit, including Alabama on April 9.

Next time, Testing First | The Turning Point

Biomedical science had an astounding, unprecedented year. Two vaccines were developed for a new coronavirus in under 12 months. An entirely new mRNA technology proved sound. Clinicals trials of several therapeutics completed trials and were approved for use with patients. Less impressively, the centerpiece of coronavirus disease control, Covid-19 testing that can be available where people work and live and go to school, an at-home test with no delay in results, became available only in the final weeks of 2020. That it arrived so late in the year, after the US had experienced a per capita rate of testing far lower than most other high-income countries, has been one of the great public health disappointments of the pandemic.

Also lacking a rapid home test, other countries were able to make better use of the medically-supervised, slower, “gold standard” Covid-19 tests than the US. Asian countries had testing machines spread across their nations, and systems to evaluate which locations had excess capacity. With their smaller numbers of infections, contact tracing, isolation, and quarantine were successful for disease control, and were culturally acceptable.

Reason + health | The Healthiest Goldfish

When the Black Death struck Europe, it turned society upside down. The scale of the mortality—possibly up to a quarter of the population died from the plague—transformed economic systems, inflected religious thought, upended old institutions, and created space for new ones to emerge. It struck at the heart of the feudal system, which had long been the defining economic feature of the Middle Ages. For the first time, peasants no longer had to accept the terms dictated to them by the lords for whom they labored. With the population decimated, there were fewer people to work; those who remained were able to use their new leverage to demand better pay and conditions. Meanwhile, with the established authorities powerless to stop the spread of the disease, people began to imagine new approaches to scientific, political, and spiritual questions, paving the way for the currents of thought which would inform the Renaissance, a period which would, in turn, provide much of the intellectual grounding for the Age of Enlightenment.

It is significant that a pandemic would play a role in birthing these intellectual movements. The philosophies which emerged and were refined after the Middle Ages provided many of the values we now use to support health, and which have helped us to address the current pandemic, COVID-19. Centrally, these values are reason, the scientific method, and the pursuit of progress as a common goal worth striving toward. It was during the Enlightenment that our means of understanding the world shifted towards the collection of empirical data, and away from uncritical acceptance of revealed truths or articles of faith. This still serves as the template for scientific inquiry, shaping everything from our understanding of the socioeconomic determinants of health, to the research which has delivered a COVID vaccine.

From Theory to Practice | The Turning Point

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

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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.

This is the personal website of Sandro Galea. All photos are taken by Sandro Galea.