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What Happens When Cases Rise?

What Happens When Cases Rise?

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Right now COVID cases are down, everyone is thinking about Ukraine, and restrictions are falling, but it won’t stay that way. Testing capacity is now abundant, and vaccines and boosters are incapable of preventing covid’s eventual breakthrough. As time goes on, boosters’ effectiveness will further wane. Even some people who were initially infected with COVID early on will be susceptible to reinfection. Cases will again rise, and it will be ugly. Here are my suggestions:

  1. Don’t test an asymptomatic person. Stop testing people who have no symptoms and advise people without symptoms not to test. People who feel ill should test if they wish, and people who seek medical care should, of course, be tested, but asymptomatic testing will be massively disruptive. The idea that asymptomatic testing can shield others from infection was never proven— it is still only bio-plausible. It can be directly interrogated with a study, but its downsides should be carefully examined, including disruption to health systems and other enterprises.
  2. Do not reinstitute mask mandates when cases climb. Every single US mask mandate by a governmental body was for a cloth mask mandate— a mask that did not work in the Bangladesh randomized trial. People have always been free to wear a high quality mask if they wish (I analyze that question here), but there is no reason at all to compel 3rd parties to wear a mask. If a policy maker wishes to reimplement mandates, it should only be done as part of a cluster RCT, to finally answer the question if these work in against the messy backdrop of the USA.
  3. Do not close schools. It should go without saying that closing schools was a calamitous error. Zoom school is deeply inferior; it should not be considered.
  4. Boost elderly and vulnerable people in advance. This might actually avert deaths, and the US lags peer nations.
  5. Do not push vaccine mandates for kids 5-11 out of misplaced anxiety. The cost of this policy will be to deepen distrust, and the gain is going to be very marginal among healthy kids, particularly given that so many have had Covid-19.
  6. Do not consider business closures. The effect was always disputed and it is politically untenable. Provide businesses with recommendations for increasing ventilation during surges
  7. Expand hospital capacity. Be prepared for a possible influx. Be ready to cancel no value medical practices. Actually, you should just cancel them anyway.
  8. Hire back health care workers who have had and recovered from Covid-19, irrespective of vaccine status (natural immunity).
  9. Give credit for natural immunity. People debate how many shots natural immunity is the equivalent too, and look at antibody levels to decide. That’s the wrong way. Look at rates of repeat hospitalization FROM covid19.
  10. Clearly delineate hospitalizations FROM covid vs. hospitalizations WITH Covid.
  11. Run a cluster randomized trial of Covid testing upon hospital entry/ pre-op (current standard) vs. no such entry screening. Endpoints are iatrogenic spread from clinical suspicion, and hospital outcomes.
  12. Publicly report all outcomes in real time— hospitalizations, deaths from Covid, and excess mortality.
  13. Run serial seroprevalence or random PCR testing as a research program by CDC, and disseminate results to researchers.
  14. Power omicron-specific vaccine trials to show a reduction in HOSPITALIZATION and DEATH, and not merely symptomatic disease or antibody titers.
  15. Rehire Gruber and Krause to FDA vaccine products.
  16. Fire…. you know who (plural).
  17. Increase insurance coverage; It is time for Medicaid expansion in non-expansion states — so the vulnerable can seek treatment.
  18. Expand paid sick leave and paid leave for dependent care — so those with mild symptoms can isolate or take care of sick children; Denmark and Sweden actually made existing generous paid leave programs *more generous* — 100% of compensation from day one of illness — during their surges.

Covid-19 cases will eventually rise. I don’t know when, but we are extremely vulnerable to an ill-formed and schizophrenic response. As we near midterm elections, politicians will be more volatile, and seek to control news that is seen as a threat to political fortunes. That’s the territory for bad decision making.

Republished from the author’s Substack

Author

  • 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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