• February 4, 2023

The Road to Reopening Won’t Be a Straight Line

Since the lockdown orders a year ago, Americans have made enormous sacrifices, sticking to government guidelines on masking and social distancing in hopes of spawning the trends we are finally seeing. Covid cases and hospital stays are on the decline, and according to the White House A majority of older Americans have had at least one shot of the various vaccines that are now available. Nursing home deaths have dropped to levels not seen since spring 2020. The companies are reopening. Grandparents hug their grandchildren again. The pandemic is not over yet, but people are realizing that the danger is decreasing. They want more of their normal life back.

Federal, state, and local officials need to develop public health guidelines that pave the way for normalcy. We can’t lean too far forward and risk a fourth wave of hospitalizations and deaths. But neither can we lean too far in the other direction with overly restrictive measures that people will ignore. Effective leadership means finding a middle ground.

The more people vaccinated, especially older Americans, the less vulnerable the population is. The Biden administration reports that more than 20% of adults had at least one shot, including 56% of those over 65. Measuring the Covid risk is no longer primarily about recording daily cases or analyzing the positivity rate. As the most vulnerable Americans are increasingly protected by vaccines, it is also a question of determining the number of people who have a serious illness.

Even if the pandemic pulls back, we won’t get rid of all Covid infections, but we can ensure that no major spikes in hospital stays and deaths recur. An important indicator for tracking is whether the burden on the health system remains low. For a full year officials have been trying to ensure that hospital use does not reach crisis levels. Now the goal should be for hospitalization rates to be similar to those associated with routine infectious diseases. Combined with better control of the seasonal flu that plagues hospitals every winter, Covid transmission can be suppressed to a manageable level.

Stepping up vaccinations is the most critical step. The supply is increasing and the rate of vaccination must also increase. Last week, for the first time, there were days when the number of second recordings delivered roughly matched the number of first recordings, so we still have room to expand the distribution. We need to expand access well beyond mass vaccination sites and make it easier for people – especially hard-to-reach communities and groups – to answer questions from clinicians they trust. Allowing those who received the vaccine the flexibility to engage in a wider range of activities could provide an additional incentive to vaccinate.

Better monitoring of the viruses is also needed to protect against a possible surge in serious cases. People with symptoms need easy access to diagnostic tests. Those who get sick need therapies like antibody drugs to reduce the chances of developing serious illness. Monitoring should also include routine assessment of the genetic sequences of different strains that are collected to quickly identify new variants and determine whether they pose an increased risk.

More people who are vaccinated are likely to mean an increase in the proportion of infections with no or minimal symptoms. So, tracking and tracking symptomatic individuals is not enough to identify and mitigate the spread. Communities, workplaces, and other facilities that are at higher risk for outbreaks and those where outbreaks are detected need access to reliable screening tests to prevent new epidemics.

Health officials have asked Americans to make enormous sacrifices, and the country has come together to help contain the Covid threat. Most people wore masks, small businesses took massive strain, and key workers took great risks. Sure, there was murmur and protests against certain measures in some places. Not everyone took the advice of public health experts. For all the reporting of things that didn’t work, valiant efforts were made everywhere to protect one another.

The path to normal will not be linear. As summer approaches, things will likely ease up, but we may need to take stricter precautions in the fall or winter. Not everyone will choose to vaccinate, and new varieties can make more of us vulnerable. The good news is that the risks of Covid keep dropping and taking the right steps now will limit the risk of future disruption from Covid and let us reclaim the things we value.

Dr. Gottlieb is a Resident Fellow at the American Enterprise Institute and was Commissioner of the Food and Drug Administration from 2017-19. Dr. McClellan is director of the Duke Margolis Center for Health Policy at Duke University and was FDA commissioner from 2002 to 2004. Dr. Gottlieb is a board member of

Pfizer

and

Illumina

and Dr. McClellan on the board of

Johnson & Johnson

and

Cigna

;; Every company is involved in aspects of the Covid response.

Journal Editorial Report: Paul Gigot interviews Marty Makary of Johns Hopkins. Image: Kamil Krzaczynski / AFP via Getty Images

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