Physicians: Let's build on-ramps for next COVID-19 surges, too

As public health experts and political leaders construct off-ramps from the highly regulated highway of COVID-19 safety measures, many physicians are encouraging just as much effort toward on-ramps to guide public health measures when the virus picks up again.

At the time of publication, seven states have introduced changes to ease their mask rules in schools and public places: California, Connecticut, Delaware, Illinois, New Jersey, New York and Oregon. The move is hardly unanimous, as the CDC stands firm in its recommendation for masking in areas of high and substantial transmission, which accounts for 99.41 percent of the U.S. at the time of publication. 

Hospitals in 46 states are seeing fewer COVID-19 hospitalizations as of Feb. 10 compared with 14 days earlier, and physicians encourage cautious optimism, spectrum thinking and productive planning in this reprieve.  

"Now, I am not angry at the virus itself," Megan Ranney, MD, a practicing emergency medicine physician and associate dean for strategy and innovation with Brown University School of Public Health in Providence, R.I., wrote in an op-ed for NBC News. "Viruses will mutate, and variants are inevitable. Rather, I'm angry at our inability to think beyond an all-or-nothing response to SARS-CoV-2. Our country keeps seesawing between a desire for 'zero COVID' and a desire to 'let it rip.' Neither option works." 

Dr. Ranney suggests the alternative is to stop celebrating prematurely and instead prepare for the almost-inevitable next surges. 

It is worth remembering that omicron was first identified in Botswana in November. "It's not been around very long, and it's taken over the world," Robert Murphy, MD, professor of infectious diseases and executive director of the Institute for Global Health at Northwestern Medicine's Feinberg School of Medicine in Chicago, said in a Feb. 9 interview with WTTW's "Chicago Tonight." "The BA.2 variant is only a couple weeks old, and it's already up to 20 percent in some places. It's going to take over also."

The BA.2 subvariant is spreading rapidly in parts of Asia and Europe. It has gained dominance in Denmark, where nearly all restrictions were lifted Feb. 1, with the government stating it would no longer consider COVID-19 a "socially critical disease."

Dr. Ranney called for several proactive steps in her op-ed, including investments in better data systems to obtain insights on when a surge is on its way and to provide clear metrics of when to increase protections. "We also need more easily available tests, more affordable and equitable treatments, more consistent high-quality ventilation, better community engagement — and we need it all set up in a way in which it can be called on if and when needed," she wrote. 

In the calls for stronger on-ramps, or guidelines for when public health measures will be re-enacted upon the coronavirus' next surge, at least one voice is saying it's not as straightforward as it may seem. 

Epidemiologist Jay Varma, MD, says no one metric or even combination of them are sufficient to trigger decisions about restrictions. "No COVID-related number can speak for itself and work at all times, because critical factors keep changing," Dr. Varma, a professor at Weill Cornell Medical School who worked for the CDC in New York, Bangkok, Beijing and Addis Ababa, wrote in an op-ed for The New York Times.

"The truth is that science doesn't have an answer for what level of COVID-19 transmission is acceptable in schools before and after masks are removed or what level is acceptable in communities before and after vaccine verification," he writes. "Someone has to decide, and that decision will involve subjective assessments of the risks people will tolerate."

Elected officials should consider data when making these decisions and begin their evaluations by asking public health leaders if the overall burden of disease is rising and if it could overwhelm the healthcare system, Dr. Varma wrote. "Even if it's not rising, are there gross inequities in disease burden by place or race that can be addressed, such as specific communities or facilities that require a targeted response?" He posits that public health officials could answer these questions using a similar approach to how they measure flu.

"For the flu, public health officials acknowledge they cannot accurately count all community and hospitalized cases, so they monitor samples of the population for flulike symptoms, flu strains circulating and vaccine effectiveness," he wrote. "They make a composite estimate of flu activity and compare it with historical data. We can shift to this approach for Covid-19 and complement it with other promising approaches, such as wastewater monitoring."

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