By Faye Flam
If what you’re doing isn’t working, you need to correct course — not double down on the same losing tactic. That’s been the case for some time with the US efforts to contain Covid-19.
In the last couple of weeks, I’ve asked a number of experts what they know now that they wish they’d known in the spring, and where they think public health got things wrong. Two big trends emerged: lockdowns (too blunt) and testing (too slow). With months left to go before vaccination can curtail the pandemic, 2020’s regrets should be 2021’s lessons.
University of Minnesota epidemiologist Michael Osterholm, a member of Biden’s advisory board, said one March mistake was closing businesses in places in the middle of the country that had seen almost no cases. “Was it appropriate to shut down so many things back then when there was so little, if any transmission? I think you can argue now that probably was not the best use of resources … it clearly alienated the very populations that we needed to have work with us,” he says.
The time was squandered and so was public trust. He compares the situation to hurricane warnings. People take them seriously because they are usually right. In many Midwest states, people went into emergency mode at the wrong time.
Last spring’s approach left the public full of rancor and deeply divided, with some seeing the restrictions as tyrannical and others convinced, just as wrongly, that if people weren’t “selfish” the control measures would have eradicated the virus. That’s never been feasible in a country where so many people live in crowded housing and can’t afford to stay home.
Risk communication consultant Peter Sandman had it right last summer when he said any policy people don’t follow is a bad policy. Although containment strategies matter as much as ever, because it could take months before a vaccine relegates this crisis to history, politicians and public health officials have squandered people’s willingness and ability to stay home.
Last April, public health experts recognized that lockdowns were never going to eradicate the virus from the US. Once hospitals were no longer in danger of being overwhelmed, they argued that the purpose of continuing to restrict businesses and schools was to buy time to get a good testing strategy in place. But that didn’t happen.
Harvard epidemiologist Michael Mina’s assessment of our testing program is damning. “We’re getting almost no effectiveness from a public health standpoint,” he says. “Our contact tracing and testing program is failing before our eyes.”
Testing is his expertise — he’s trained as a pathologist and oversees diagnostics at Brigham and Women’s Hospital in Boston. Covid-19 tests work for diagnosing people who get extremely ill, but they aren’t well suited to finding infected people before they transmit the virus.
“This virus has a very acute window — a very short window when people are able to spread,” he says. Those who get a positive result back are probably past their most contagious period, and those with a negative result may not still be negative if they don’t get the results back for days.
The more politicians and the media encourage testing, the more people line up for them, the longer the results take and the less useful they become. Labs are overwhelmed with swabs, Mina says, and so they sit for days. He says it would be better for labs to refuse to take swabs if they can’t process them in 24 hours. Better to process half the samples in an actionable time window than none of them.
“There’s no reason to stick a swab in someone’s nose if what we’re doing with the results isn’t useful anymore,” he says. Cheap home tests that take minutes would help, and they are actually being manufactured faster than people are using them, he says, because public health hasn’t laid out a strategy for them.
Mina worries that we’re not getting a usable testing strategy because there’s a history of paternalism in public health. There’s an attitude that if we empowered people to find out their status, they would go out and party. The same thing happened with at-home pregnancy tests, he said, with public health officials initially not trusting women to use them correctly.
He has advocated regular testing — at least once and preferably twice a week with easy, rapid tests, as some colleges have done to keep cases low. Moreover, testing is something people want, he says. They want to know their status much more than they want to wear masks or avoid other people.
A smarter approach to testing and lockdowns would go a long way toward saving lives — and making 2021 more bearable than 2020.
After spending hundreds of hours in 2020 talking to experts, I’ve come away recognizing that they don’t know how to control a coronavirus pandemic — that they’re making recommendations as they go along. That’s the best anyone can do, as long as they stop repeating the same mistakes.