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Why a national COVID-19 strategy is a necessary 'October surprise'

Why a national COVID-19 strategy is a necessary 'October surprise'
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An “October surprise” is a revelation that rocks the nation’s perceptions of the upcoming election. Given the devastating impact of COVID-19 in the U.S. and the seemingly worsening trajectory, the country desperately needs a comprehensive national COVID-19 strategy right now; the development and unveiling of such a strategy would be a welcome October surprise.

The U.S. has now seen over 216,000 COVID-19 deaths, out of over 7.7 million diagnosed cases. While most media attention of late has focused on the president’s COVID-19 diagnosis, the epidemic has disproportionately impacted Black, Latinx and Indigenous communities. Approximately 28 states have high levels of COVID-19 cases and are staying at that high level or increasing, and some areas with a previously well-controlled virus (such as New York) are seeing upticks in cases in localized communities. Parts of the U.S. (such as Florida) with sustained community transmission have removed essentially all preventive policies and residents are left on their own to protect themselves as best they can.

Given such devastation, we need a comprehensive strategy immediately. There are already the starting points of one available. Using the National HIV/AIDS Strategies of 2010 and 2015 as guides, we have elsewhere proposed a vision statement and general structure of a national COVID-19 strategy.

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We argued that the following elements (among others) need to be addressed: a review and forecast of SARS-CoV-2 epidemiology; a mourning of persons lost to COVID-19; evidence-based prevention and treatment services; social factors that lead to health disparities in COVID-19 and policies to address those factors; behavioral and mental health services; modernizing the public health infrastructure; improving health and risk communication; techniques for reopening organizations safely; pathways for participatory community input; as well as aggressive goals, time-specific metrics, and pivot points for midcourse policy and programmatic corrections as indicated by the data.  

The beginnings of the metric set can be found in the proposed dashboard, including the following: new cases per capita, linkage of cases to each other, screening services delivered, deaths, influenza-like illnesses, among others (all stratified by age, sex, race and ethnicity so as to identified and address health disparities). This is synergistic with a proposal from Dr. Peter Hotez to achieve a benchmark of one COVID-19 cases per million residents per day (or other related metrics) by Oct. 1. We argue these indicators should be augmented by measures focused on co-morbid health conditions and on key social factors such as housing instability, food insecurity, racism, income inequality, and employment patterns in essential front-line service occupations. One does not need to start with a blank page to develop a national strategy, but one must have the will to develop a strategy.

We hold great hope for the development of a safe and effective vaccine. But, effective vaccines, by themselves do not end epidemics of infectious disease. Hepatitis B, hepatitis A, and human papillomavirus all continue as significant health problems — with pronounced disparities in certain demographic groups — despite the availability of effective vaccines. Vaccines, like accurate tests, are a critical tool but they must be employed in the context of a comprehensive, national plan.

We don't know why the administration has not yet developed a national strategy for COVID-19 but given our experience with other infectious disease pandemics, we assert that in the absence of a coordinated, comprehensive national strategy, the response to SARS-CoV-2 will be profoundly uneven. Some states will mount effective, science-based strategies to prevent and treat the virus while others will be unable or unwilling to do so, further exacerbating disparities in morbidity and mortality.

If there is no plan there are no goals, and without goals, there is no explicit definition of success. With no accepted definition of success, anything can be claimed as a “success.” Without a plan, there is no yardstick to assess accountability. Further, without goals, there are no time-specific metrics. Without such metrics, one cannot measure progress, estimate the level of needed resources, judge speed of action, address health disparities, or inform mid-course corrections. 

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All Americans are entitled to the best possible support to keep their families healthy during the pandemic. This can only be accomplished with a sound, evidence-based national COVID-19 strategy. 

Although unveiling a national strategy in early spring would have been ideal (thousands of lives would have been saved), the next best time to develop one is right now; with dozens of deaths per hour in the country, there is not a moment to lose to construct the life-saving “October surprise” of a truly comprehensive national COVID-19 strategy.

David Holtgrave, Ph.D., is the dean of the University at Albany School of Public Health and SUNY Distinguished Professor. His three-decade career in public health has included senior positions at CDC, Emory University and Johns Hopkins University, and he served on the Presidential Advisory Council on HIV/AIDS during President Obama’s administration. (The opinions noted here are not to be interpreted as a position of Holtgrave's current or former employers.) 

Ronald O. Valdiserri M.D., MPH is a professor in the Department of Epidemiology, Rollins School of Public Health, Emory University. Valdiserri held senior leadership positions at the Centers for Disease Control and Prevention; the Department of Veterans Affairs; and the Office of the Assistant Secretary for Health, DHHS. As Deputy Assistant Secretary for Health for Infectious Diseases at DHHS, he oversaw the implementation of the National HIV/AIDS Strategy and the National Viral Hepatitis Action Plan.