Pandemic update 3: What do we do the next time?

We are in the third month of vaccine administration for the Covid-19 pandemic, and everyone continues to scramble for their spot in the vaccination queue.  Texas ranks 48^th among the states in the per capita vaccination statistic, despite receiving lots of vaccine.  I am over 65, and can’t find anyplace to get a vaccination anywhere nearby.  I know some friends who drove hundreds of miles to get their shots.  I am not interested in doing that twice.  So, I wait and watch.   

The governor of Texas seems to think the pandemic is over.  I believe he is wrong, and is again making political decisions that put health and lives in danger (see previous posts on this topic).  In my opinion, I do not think that we should lift restrictions until the high-risk populations have been vaccinated, AND until community transmission is at a level that we can resume contact tracing and isolation.  Remember contact tracing – it is still a thing.  Travel should be limited, bars should be closed, and restaurants and other retail establishments should continue capacity restrictions.  I predict that we will have yet another surge in Texas, and that will prolong the pandemic.  And as a result, many of us will remain isolated in our homes to stay safe.  Not to mention lives will be lost.

President Biden is not helping either.  In the push to get all children back in school, now all of the teachers, administrators and school staff will be pushed into the vaccination lines with high-risk individuals.  If schools are such low risk, why do we need to do this?  And with less than three months in the school year, what will we be accomplishing?  It will take two months to get school personnel fully vaccinated.  In my opinion, in-person learning should be suspended until the end of May, when all adults in the US should be vaccinated.  Then school should start in June and run through the summer – assuming the pandemic is under control.  The objective for grade school students should be getting them back on track to graduate on time, not just getting them back in class.

But let’s assume we get the pandemic under control by mid-summer.  What do we do better when the next pandemic comes? And it will.

By definition, a pandemic is disease that is spreading throughout a large population, usually globally.  So, the first thing we need is better international vigilance and surveillance to detect potential pandemics sooner.  We can only hope that our federal government can make this happen through organizations like the World Health Organization.  The World Health Organization needs to be able to detect and classify the severity of a pandemic outbreak early (there is a Pandemic Severity Index).  Once a pandemic is determined to have high transmissibility and clinical severity, with potential global impact, international travel should immediately shut down.  This will help to prevent global spread of highly contagious diseases that result in high morbidity and mortality.  If such an outbreak is detected within the United States, interstate travel should be suspended.  This means the halt of all forms of mass transit.  

The key to controlling a pandemic is preventing uncontrolled spread of disease in communities.  When disease is detected in a community, infection control procedures should be put in place at the community level.  This starts with contact tracing which then guides isolation and quarantine restrictions.  In the case of respiratory pathogens like Covid-19, mask wearing and personal hygiene should be implemented.  Public places should institute regular disinfection protocols.  There may need to be other public health restrictions depending on the type of transmission – think Ebola.

If community transmission reaches a point where contact tracing and isolation fails to control spread, economic shutdown should come early at the community level.  You do not need to shut down the economy in Nebraska for a pandemic that is out of control in Texas, assuming that you are restricting interstate travel.  Shutdown should continue until the rate of community transmission is within the numbers where contact tracing can again become effective.  The Department of Health and Human Services of the federal government should define non-essential businesses and activities that should close during an economic shutdown.  This cannot be left up to local politicians.

Which brings us to the point of keeping politics out of decision-making during a pandemic.  In Texas, and most other states, the governor has exclusive and broad authority to manage disasters under the state emergency management statute.  It is probably not a good idea to give a single politician this level of authority in any emergency, but particularly during a public health emergency.   It is obvious that career politicians will make decisions that are political, and not necessarily in the public interest.  The emergency management statute should give the authority for managing public health emergencies to the public health authorities at the state and local level.  Public health officials should be advised by health care experts who are not elected to their positions as advisors.  These officials should have the authority to enforce restrictions and actions at the community level, where they are needed.  Again, if you can keep a pandemic under control within communities, you may not need state and national restrictions.

Finally, if you do have to shut down travel and economic activity, there needs to be a plan for supporting the economy.  The federal government needs to find a better way to do this, rather than just sending 90% of the population a stimulus check.