Breaking: Leading Experts Release Comprehensive Covid-19 Roadmap.
The new document expands on the White House's recent plan, and envisions a safe “next normal.”
Today, I am writing with some good news. For the first time, I feel like our country's leaders finally have the makings of a coherent plan for the future of the Covid-19 pandemic.
Until now, both the Trump and Biden administrations have been reactive, not proactive, always trying to keep up with the twists and turns of this unpredictable emergency.
When President Biden was elected, I was hopeful that an administration that, unlike the Trump administration, promised to follow the science, would be significantly more successful in handling Covid-19. To some extent, they have been successful. Gone are the daily doses of misinformation from the White House, replaced by good-faith efforts to use the resources of the federal government to help people.
What the Biden administration was unable to do, however, was keep up with a virus that had plenty of surprises in store: Believing that vaccines would provide lasting immunity and effectively end the pandemic, the administration did not prepare for new variants and future surges, leaving the country critically short of tests and infrastructure to distribute masks and treatments when the Delta and Omicron variants arrived.
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By December, there was a growing sense from experts that the White House's strategy was significantly off track and its approach woefully insular.
As cases surged and hospitals overflowed, a small group of former scientific advisors to the Biden-Harris transition team went public with a trio of essays published in the Journal of the American Medical Association. Together, they were both substantive critiques of the administration's approach and fulsome calls for a comprehensive plan for the future. At the time, members of the group said they were airing their criticisms and their proposals because they had been unable to get the White House to listen to them. I was heartened to see their thoughtful ideas getting media attention but frankly uncertain if they would succeed in convincing the administration.
The good news is, they have.
Over the past couple of months, as these former Biden officials worked with a larger group of experts on creating what it called a "roadmap" for the future, the White House engaged with them and were extensively briefed on their proposals.
“It appears to me that since the JAMA articles, the White House has realized the importance of having a strategic roadmap,” Dr. Ezekiel Emanuel, a former member of the Biden-Harris Covid-19 Advisory Board transition, who led the team that created the roadmap, told Inside Medicine.
I was asked to contribute ideas to the roadmap relatively late in the process, and until recently, I did not know about the group's meetings with the White House. But when I watched Biden's State of the Union address last Tuesday, and then the administration's announcement of its new National Covid-19 Preparedness Plan the next day, it was clear that the administration had in fact been listening to Dr. Emanuel's team.
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Today, Dr. Emanuel's team, comprised of 53 leading experts, released its plan, entitled, "Getting to and Sustaining the Next Normal. A Roadmap for Living with COVID." Along with the White House’s plan, these two documents comprise the first comprehensive rendering of how we can apply what we have learned during the pandemic to live sustainably with SARS-CoV-2 and other respiratory viruses going forward—saving lives, without sacrificing what makes life worth living.
Here's a rundown of the major highlights in the two documents.
•The White House’s National Covid-19 Preparedness Plan has 4 sections:
Protect Against and Treat COVID-19: Create a stable vaccine supply and implementing a “Test to Treat” initiative that would provide immediate treatments after a positive test result at the same place.
Prepare for New Variants: Increase monitoring and test vaccines and therapeutics on new variants quickly to determine whether modifications need to be made, with a goal of updated vaccines within 100 days.
Prevent Economic and Educational Shutdowns: Provide safe environments, access to tests, increased sick leave, funding to keep schools safely open, expand access to federal programs.
Continue to Lead the Effort to Vaccinate the World and Save Lives: Increase not just vaccine doses, but other global needs like oxygen and PPE.
•Getting to and Sustaining the Next Normal. A Roadmap for Living with COVID has 12 key points spread across 14 chapters:
Track all major respiratory viral illnesses: In addition to Covid-19, increase surveillance of other threats like influenza and respiratory syncytial virus.
Create an infectious diseases dashboard to guide both public and policymakers at the national, state, and local levels: Track a variety of metrics, including hospital capacity, that can guide local policy (on-ramps and off-ramps) for a variety of public health actions.
Increase testing, surveillance, and data infrastructure: Manufacture enough tests so that when surges occur, 1 billion tests are already ready. Standardize timely public data reporting.
Improve indoor air quality: With schools and workplaces being the priority, upgrade filtration systems.
Make better vaccines and therapeutics: Prioritize oral multi-drug antivirals (which have worked for HIV/AIDS, and already for Covid-19). “Mucosal” vaccines that are designed to protect against infection should be prioritized to augment existing effective options that protect against severe disease and long-term consequences.
Invest in global vaccine and therapeutic infrastructure: There should be a paradigm shift from a focus on the US providing actual vaccines and therapeutics and instead supporting sustainable infrastructure so that vaccines and treatments are manufactured and delivered locally where and when they are needed.
Research and treat Long Covid: Standardize research on Long Covid, with the goal of assessing therapies with special attention on the role of vaccination in improving outcomes within a year.
Create needed public health infrastructure and address equity: Build a permanent workforce dedicated to reaching vulnerable populations, both in terms of messaging and delivering medicine.
Bolster the healthcare workforce and improve work conditions: Ease financial and mental health burdens on healthcare workers. Plan for surges by creating the equivalent of a volunteer National Guard for emergencies (e.g. retired respiratory therapists).
Monitor and communicate biosecurity threats, including misinformation: Address the health implications that a partisan divide has created. Streamline public health communications so that major agencies send consistent and tested messages.
Improve scientific communications to increase access to vaccines, tests, and treatments: Educate the community and implement scientifically validated strategies to increase dissemination and uptake of critical health information.
Keep schools open safely: During surges, schools and childcare programs must be the last to close and the first to open, with adequate support to reach the most at-risk communities.
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The strength of these documents is that they cover a lot of territory. Before we had nothing. Now we have a lot.
But like all plans, the weaknesses are that without the right people and the right provisions (i.e. money and political will), these ideas will remain only as unrealized potential, mere ink and pixels on pages. Getting buy-in from hard-to-convince stakeholders will be the real challenge.
In fact, when I discussed the notion of a plan like this with my friend Dr. Carter Mecher (who was the principal author of the National Strategy for Pandemic Influenza Implementation Plan) last fall, I asked him whether we needed at least 4 different plans, one for each political configuration (i.e. Democrat president, Democrat-controlled Congress; Democrat president, Republican-controlled Congress, etc.), or even different plans for different kinds of states. Carter told me that back when he wrote the influenza plan (during the George W. Bush administration), he and his colleagues never imagined things would be so political during a pandemic. If anything, he thought that a pandemic might bring people together. "We were so naive," he told me. He agrees that given the politics now, distinct plans for different political landscapes are probably necessary.
But today is a day for optimism. Some of the best minds in public health and medicine finally came together to create a modern plan that reflects what we can already do now and what we will reasonably soon be able to do, if we just decide to try. We’re no longer consigned to wandering aimlessly through this or the next pandemic. Now, at least, we finally have the makings of a real plan and a usable roadmap.
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