COVID

‘I remain very concerned’: Local public health experts say now is the time to prevent future surges

“The mistake that we’ve made in the past is to think that when cases drop that means that COVID is done.”

FILE -- An N95 mask hangs from the rearview mirror of a car in Brooklyn on April 7, 2020. Hospital contracts for N95 masks created problems in the supply chain. (Demetrius Freeman/The New York Times) Demetrius Freeman / The New York Times, File

Mask requirements have been lifted in many schools and other indoor public spaces around Massachusetts in response to the plummeting of the COVID-19 cases driven by the omicron surge.

The change in the level of cases has local public health experts and doctors warning that now — at a time when the wave of cases has receded — it is essential for state and federal leaders to make significant investments and changes in order to protect against future surges and variants. 

So far, they are concerned those preparations are not occurring. 

Dr. Megan Ranney, an emergency physician and academic dean of public health at Brown University, told Boston.com she sees “a little more work going on now” in terms of bolstering preparedness systems compared to last summer, when everyone was banking on vaccines being the end of the pandemic. 

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But she said if anything has been learned from the last two years, it is that the coronavirus is unpredictable. 

“The mistake that we’ve made in the past is to think that when cases drop that means that COVID is done, and then we’ve been caught flat-footed over and over and over when a new variant has emerged, or when there’s been another surge,” she said.

The Rhode Island doctor said it is going to require “sustained attention” from the public, politicians, and public health specialists to ensure the nation is prepared for the next variant — or even the next pandemic. 

But she acknowledged it is “human nature to not want to put prevention or monitoring measures in place.”

“I think we are at a really important transition point for the country and for our states where our governors and departments of health and our businesses and, of course, the federal government as well, can have the opportunity to choose to invest in improving the resilience of our public health and health care systems,” Ranney said. “Or could close their eyes and ignore it and just put us back in the same place that we were three months ago, nine months ago, 24 months ago, which was woefully unprepared.”

Is Biden’s plan enough?

President Joe Biden announced last week during his State of the Union address that the United States will “never just accept living with COVID-19,” stressing that the country will “stay on guard” and fight the disease “because this is a virus that mutates and spreads.”

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The president said his administration is focused on continuing to get more Americans vaccinated; making more free COVID-tests available; creating stockpiles of tests, masks, and treatments to prepare for the emergence of new variants; aiding in global vaccinations; and launching a “test and treat” initiative that would allow Americans who test positive for COVID-19 at a pharmacy to receive antiviral pills “on the spot at no cost.”

“If you’re immunocompromised or have some other vulnerability, we have treatments and free high-quality masks,” Biden said. “We’re leaving no one behind or ignoring anyone’s needs as we move forward.”

Biden’s strategy hit a snag this week when funding for his plan for addressing COVID-19 was dropped from the broad federal spending package approved by the House on Wednesday. According to the New York Times, the exclusion of the $15.6 billion pandemic aid package leaves the fate of Biden’s effort unclear.

Dr. Ranu Dhillon, physician at Brigham and Women’s Hospital and Harvard Medical School in the Department of Social Medicine and Global Health, is another local physician who for weeks has been urging officials to take action while case counts have fallen. 

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He told Boston.com it was “heartening” to see some of the details in Biden’s plan last week that have been “consistently underemphasized, or overlooked, or not part of the agenda, now on the agenda.” 

The focus on preparing for new variants, stockpiling masks and tests, and the test and treat initiative are all things he’s happy to see. But Dhillon said he remains troubled that the attitude still seems to have shifted out of an emergency mode. 

“I’m not optimistic yet because we’ve not done any of the things we’ve known we should be doing and stated that we would be doing throughout the pandemic, including the last several months,” he said.

Even though cases are down, the doctor said, the country is still seeing “high levels of transmission.”

Most days, 1,800 deaths continue to be reported in the country, according to the New York Times COVID-19 tracker, and the daily average for new cases as of March 6 was still 44,386, though down 57% from two weeks ago.

Dhillon said he’s concerned that in the push to lift mask mandates, officials are ignoring that there are large swaths of people — such as those who are immunocompromised or who are too young to be vaccinated — who will remain vulnerable to infection, at a time in the pandemic when the long-term complications and implications from the virus are still being understood.

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“What I’m concerned about is that the overarching framework is still one where we’re trying to shift away from treating an emergency as an emergency, and also not really being thorough about understanding the impacts to the people who are still vulnerable,” he said. “To my mind, you could start relaxing certain types of mask mandates if number one, cases were lower, and number two, if the measures are in place for people who are going to remain vulnerable to be able to protect themselves with N95 masks, the rapid tests, test-to-treat — [they] really need to be fully in place. Those things are not really fully in place.”

Biden’s speech and subsequent plan didn’t do anything to assuage concerns for Julia Raifman, an assistant professor at the Boston University School of Public Health who runs the COVID-19 USG policy database.

“I remain very concerned we are not prepared to take decisive, early action to reduce the harms of future surges,” she told Boston.com.

Raifman pointed to the past surges seen in July, November, and December, and urged that the public and officials expect that another wave of cases “could be around the corner at any time” and to prepare for it.

Surges are harmful not just to health and the lives of everyone, but also the labor supply, the supply chain, schools, hospitals, and health care workers, she said. 

And “adequately” preparing for the surges can reduce those harms, the professor stressed.

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“The United States has not been prepared for surges in part because they had overconfidence that the pandemic was ending,” Raifman said. “And it’s very important that we recognize that it did not end this summer; it is not ending now. The suggestion that omicron would be mild — the impacts were not at all mild at the population level. It hospitalized people at a record rate, it killed children at a record rate.”

She said it is essential to prepare for future variants that may do worse.

“We have to have humility and know that it’s not up to us what the virus does next,” she said. “What’s up to us is what we do to prepare for what the virus does next.”

What needs to happen

At the top of Dhillon’s list for steps he wants officials to take to prepare for future surges and pathogens is ensuring all households in the United States have access to high-caliber masks, such as N95s. He encouraged officials and the public to think of the high-filtration face coverings like fire extinguishers, which should be in every building and household in case of a fire. 

“That is something that gives people agency, that gives people the opportunity to protect themselves irrespective of what everyone else is doing,” he said. “So that should be in place.”

The Biden administration began plans to ship free masks in January, but Dhillon said he is concerned the effort has lost momentum alongside the timing of states and municipalities pulling back on mask mandates. 

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“Right now would really be the time to get those masks out to everyone and get people to have a stockpile of their own masks so that when the next variant hits, or a future pathogen hits, they’re ready for it,” he said. 

Likewise, he said now is the time for air filtration to be a top priority. 

“We have water quality standards, we should have air quality standards,” Dhillon said. “And what that would look like is that the federal government should come up with new revised air filtration standards and then give money and incentives to businesses and indoor settings such as libraries, etc., so they can make those kind of air filtration standards. That would make a huge difference.”

Like high-caliber masks, it’s a step that would allow people to live life “somewhat normally” while keeping people safe irrespective of what else is going on around them. 

“You put on high-caliber masks if you’re concerned about getting infected or you can go to a place where there’s air filtration,” he said. “So there’s an opportunity if other people are not respecting that or aren’t concerned about it, at least you’re protected.”

In addition, the doctor said that officials need to keep scaling up the production and distribution of rapid tests. Just sending four rapid tests to each household isn’t enough, he said.

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Lastly, Dhillon said any preparations have to include paid sick leave. It needs to become federal policy at this point, he said.

The pandemic saw many frontline, essential workers forced to choose between a paycheck and their health or the health of their loved ones, he said.

“To them, it’s, ‘I have to put food on the table for my kids or stay home and be sick,’” Dhillon said. “And that should not be a choice that anyone has to make.”

If those efforts are put in place — high-caliber masks, rapid testing, air filtration, and paid sick leave — the doctor said when the next variant comes, it will be possible to manage it differently than the waves seen in the last two years.

In addition to those measures, Ranney said efforts to provide boosters to the elderly and immunocompromised need to continue.

The emergency room doctor said it is also important that officials continue to maintain and build up data infrastructures around testing, case counts, and hospitalizations and then share that information transparently with the public. 

“I’m seeing many states across the country unfortunately drop those tracking systems or get rid of their transparency to the public, which is not a good idea,” she said. “It’s important for us to think about creating systems for how we would surge up testing or boosters should it be needed.”

Work also has to be done to improve surge capacity and the resilience of the nation’s health care systems, which Ranney pointed out have been battered under the two years of COVID waves. 

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“We need to invest in training new nurses, techs, social workers and more,” she said.

Community outreach needs to be undertaken to reach the many people who haven’t gotten non-COVID-related medical care in the last two years, Ranney said. 

“Our rates of mammograms and childhood vaccinations and other basic preventive care have dropped dramatically,” she said. “There’s a lot of people that have put off needed surgeries. So there’s a lot of community outreach that has to happen so that we don’t end up with surges of other problems in the months to come.”

All of the work that needs to be done now, the public health experts agreed, needs to be led with a focus on equity. 

Who needs to do it

Raifman stressed that all the steps that need to be taken now are in the plan presented by the Biden administration in 2021.  

What is needed, she said, is leadership at both the federal and state level.

We have not implemented that plan,” she said. “The State of Massachusetts and the City of Boston don’t have the capacity to implement that plan, but the federal government does. We need federal leadership. We need federal funding. Only the federal government has the financial resources to invest in widespread delivery of free masks and tests and scaling up production of masks and tests. Planning for surges and putting the whole weight of the federal government behind policy guidance for what we need to do.”

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In the absence of the work being done, and irrespective of what happens in terms of COVID-19 related policies, Dhillon said members of the public should get and maintain their own supply of high-caliber N95 masks and figure out which one works best for you, in terms of fit.

“Right now is the time to do that and then get a supply of those and have them handy,” he said. “Because when the next surge hits or a future pathogen hits, you’re prepared, you have that in hand. And that gives you protection off the bat, something you can do yourself that doesn’t rely on anyone else or anything else happening.”

Similarly, he advised building up your own supply of rapid tests in preparation for future surges, when the kits become scarce, and evaluating the options for improving air filtration in your home or business. 

“Right now is the time when they could do that for themselves to be prepared,” he said. “Even better if there’s a push to do this generally for the whole country. And when the next variant hits, we’re ready for it.”

Raifman pointed out that no individual can take any step that will “clear the air of COVID.” The pandemic can only be overcome together, as a society. 

“To do something together we need leadership to do it together; we need state leadership on strong policies,” she said.

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Centering equity will benefit everyone, she said.

“You really need to keep working to ensure that everyone gets vaccinated and you need to keep working to ensure everyone gets boosted,” Raifman said. “And you need to keep working to have mask mandates that protect ourselves and each other when vaccines alone aren’t enough to control transmission. We see real harms, we see long COVID, we see kids dying, we see parents dying. Every number is a life and a family, and so much of it is preventable.”

During this time in the pandemic, at the end of a surge, it is important for everyone to insist that planning be done to protect against ever being back in situations where society and hospitals are overwhelmed by COVID-19 cases, Ranney said. 

“There are ways to do this better,” she said. “We’ve learned a lot over the last two years, and this is the moment to bake those into our public health and preparedness and emergency response systems, rather than losing these lessons and being back to square one.”

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