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CDC Director Almost Admits Failure

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Yesterday the CDC director Rochelle Walensky tweeted that we must protect people at highest risk of bad outcomes from COVID19

The tweet is a subtle shift from prior messaging, and likely reflects her realization that the pipe-dream of ZeroCovid—eradication of the virus—is dead.  Omicron makes it clear, COVID19 will not go away.  Even more, holding society hostage to slow spread is no longer a tenable policy choice.  We will have to return to living life, and balancing important societal priorities while minimizing the harms of COVID19.  Alpha and delta variant thinking won’t help us for Omicron.

Omicron has three characteristics different than prior variants.  First, it spreads very fast. Second, it is less lethal, and, third, vaccines do less to stop symptomatic infection.  These three features mean that in this wave, or in a series of subsequent waves, the virus will eventually reach all people.  You cannot avoid it forever. There are five key policy lessons from all this.

First, mask mandates make no sense.  Almost all community wide mask mandates this entire pandemic asked people to wear any mask, and most people chose a cloth one.  Cloth masks never worked to slow the spread of the virus.  We analyzed all relevant studies months ago, and found no benefit, and a cluster randomized trial in Bangladesh found that cloth masks failed. Recently, CNN admitted as much.

Now, some argue that we need to wear higher grade masks, such as n95s or equivalent.  Anyone who wishes should be free to do so, but they should not be mandated.  We have no evidence such population wide mandates will help, and the truth is, even if worn perfectly, the mask might only delay the time until you are eventually infected, and not avert it. Worse, along the way you will suffer the discomfort and inconvenience of the mask. 

Second, schools should not close.  Closing schools was always a fool’s errand. High quality studies show school closure does not even slow spread in communities. Kids, working moms and society suffer significantly when schools close.  Kids have bigger worries in life than COVID19. Outcomes for healthy kids are excellent and on par with seasonal flu.   School closure in the USA was disproportionately an indulgence of liberal cities with strong teacher’s unions.

Third, we cannot keep the brakes on society. People are voting with their feet, and outside of urban liberal enclaves, people are enjoying restaurants, bars, and vacations. In many regions, you would not know a pandemic is going on. This reflects a fundamental exhaustion of the public.  Given that so much of the public is done with restrictions, placing extremely harsh ones on college campuses, for instance, makes no sense.  Colleges are full of the healthiest members of society. Asking these kids to be imprisioned in their rooms or dorms or on campus neither helps them or broader society.

Fourth, we have to focus on the most vulnerable people in society, as we always should have. The CDC director has now admitted this, in a remarkable turn. Nursing homes should get booster shots right now. We should think about improving staffing and infection control at these settings.

Fifth, hospitals should improve their capacities. Some health care workers were fired or forced out because of not receiving the vaccine.  Some of these people had already had COVID19.  These people should be permitted to return to work, with appropriate precautions, because at this juncture we need them far more than any risk they pose. 

The CDC director’s tweet won’t settle all the COVID19 debates, but it is an admission that our current policies have failed and must be abandoned. We cannot eradicate the virus. We have to live with it, and balance it against all the other important things: school, work, and our mental health. 

Reprinted from the author’s substack.

Author

  • Vinay Prasad

    Vinay Prasad MD MPH is a hematologist-oncologist and Associate Professor in the Department of Epidemiology and Biostatistics at the University of California San Francisco. He runs the VKPrasad lab at UCSF, which studies cancer drugs, health policy, clinical trials and better decision making. He is author of over 300 academic articles, and the books Ending Medical Reversal (2015), and Malignant (2020).


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