How to open a country in 90 days — a six-step plan to Fourth of July cookouts

How to open a country in 90 days — a six-step plan to Fourth of July cookouts
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President BidenJoe BidenMan sentenced to nearly four years for running scam Trump, Biden PACs Dole in final column: 'Too many of us have sacrificed too much' Meadows says Trump's blood oxygen level was dangerously low when he had COVID-19 MORE’s administration has established a National Strategy for the COVID-19 Response and Pandemic and he has called for sufficient progress to be made such that small gatherings of family and friends at homes would be possible by the Fourth of July. What remains to be spelled-out is a set of interim goals that, if achieved, would likely make the president’s mid-summer goal a reality. 

A set of interim COVID goals for April, May and June should be realistic, measurable, easy to communicate and set at a level that if reached, would signal the feasibility of safely returning to certain social activities —for example, small gatherings — that have eluded the U.S. public for over a year.  Given that COVID-19 control is highly complex and influenced by a number of individual and societal-level variables, one could easily generate a large number of potential goals for the coming months. However, to ensure that these goals are readily implemented and easily monitored, it will be important to select a small set of the truly most important time-sensitive, interim goals. 

Here, we propose a set of six interim goals for reducing the burden of COVID-19 in the U.S. over the next 90 days.  

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The first interim goal we propose is that 90 percent of people in the U.S. will  consistently and correctly use masks when in public. This would reflect an increase from the roughly 70 percent of Americans who report mask use when in public. The 90 percent level should be achieved by May 1 and persist at least until the end of this interim period on June 30. Certainly, a widely expanded communications and behavior change campaign would be needed to reach this interim goal.

Second, 100 percent of states should keep in place or strengthen their policies requiring (or at least strongly recommending and facilitating) mask use, physical distancing, hand sanitizing and related non-pharmaceutical interventions. This interim goal should be achieved immediately and kept in place until at least June 30. We recognize that a number of States and localities are now rolling back all or some of these preventive measures, but we believe this is premature, especially in the near term, based on current epidemiology.

Third, 90 percent of persons 18 years old or older in the U.S. should be fully vaccinated by June 30, up from 17.9 percent as of March 24. We recognize that some currently unvaccinated persons may have some immunity achieved due to prior COVID infection but the level and durability of this immunity is a subject of current, urgent study; this is why vaccination is recommended even if an individual has had previous COVID infection. At the current rate of approximately 2.5 million vaccinations per day, this goal appears achievable, but as vaccination levels increase, challenges of vaccine access in some communities and vaccine distrust among some persons will continue to pose challenges. Indeed, to achieve this high level of vaccine coverage in the next 90 days will require tremendous financial and logistical resources, coordination among public and private sector partners, additional communications campaigns featuring trusted community spokespersons as well as other key strategies, like targeted outreach to “pharmacy deserts” and rural communities.

Fourth, at least 90 percent of symptomatic persons diagnosed as having COVID-19 should be successfully engaged in care so that all potential medical remedies are available for use. For instance, some treatments such as monoclonal antibody treatments must be administered as early as possible during the course of illness. Late (or failed) diagnosis of a person infected with SARS-CoV-2 renders such access impossible, as does a medical system that does not readily provide evidence-based treatments for all who need them. 

Because it is a preventable disease, ideally, deaths from COVID-19 should be eliminated completely. However, as a realistic interim goal, we propose that COVID-19 deaths should be reduced to no more than 50 per day by June 30, 2021. This level was chosen because it is similar to average daily deaths due to influenza during a relatively typical year (though the number of influenza deaths per year varies, of course). Reducing deaths to this level in the next 90 days will require progress in meeting all of the previously stated four interim goals. 

Sixth, there should be an explicit interim goal that seeks to eliminate all health disparities in the five metrics described above. The COVID-19 pandemic has been marked by racial and ethnic minority communities bearing a highly disproportionate burden of the epidemic and having relatively less access to key public health services (very clearly seen in terms of disproportionate access to vaccine delivery). All of the previous five interim goals should include data collection and analytic strategies to monitor disparities by race, ethnicity, age and gender. Further, client and community centered service programs that directly address disparities will be needed to achieve this goal.

There are many additional interim goals that could be added to this list (e.g., related to testing, contact tracing and the mental health consequences of the epidemic, among many others). However, we believe that basic principles of public health would suggest that if we can address primary prevention with vaccines and non-pharmaceutical interventions and address treatment needs with good access to comprehensive, quality, client-centered services, we should be in a good position to improve health outcomes. Further, if prevention and treatment services for COVID-19 are developed and delivered by and in close partnership with communities most heavily and disproportionately affected, it will provide a solid platform for improving health equity. 

Certainly, this is a tall order in a short time. But if we can make substantial progress in achieving these interim goals, we will come closer to the president’s midsummer goal of celebrating a degree of independence from this viral pandemic which has held us in thrall for the past year. There is no time to lose. 

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.