Why We Can’t Turn the Corner on Covid

For public health, maintaining that equilibrium means maintaining testing capacity, data collection, contact tracing and genomic surveillance. Generally, those tools, though still imperfect, are far stronger now than they were in the early months of the pandemic under the Trump administration. The Centers for Disease Control won plaudits recently for kicking it all up a level by creating the Center for Forecasting and Outbreak Analytics, staffed by some of the nation’s top experts. “It’s the A team — it has the potential for changing the CDC’s approach,” said Mark McClellan, a former FDA Commissioner who now leads the Duke-Margolis health policy center.

Keeping the virus at bay will also require focusing a lot more attention on improving and expanding access to treatments, particularly medications that can be taken orally outside a hospital or infusion center, McClellan and other experts say. In one bright spot, the monoclonal antibodies that are currently available, which do have to be injected or infused, are coming into broader use and saving lives. White House Coronavirus Response Coordinator Jeff Zients announced this week that 670,000 courses of monoclonal antibodies were shipped in August, “six times as many as we shipped in July.”

“I’m a big fan of the monoclonal antibodies,” said West Virginia Health Commissioner Ayne Amjad. These treatments are lab-produced versions of human antibodies that target the coronavirus, often preventing infected people from becoming seriously ill. Trump was treated with monoclonal antibodies when he got Covid last fall.

Amjad is trying to make the injectable version much more accessible in her state, including through home health agencies and mobile vans that are doing coronavirus testing and vaccination — theoretically, a mobile van could test you for Covid and if the test is positive, immediately give you a shot of antibodies. In the meantime, she’s also trying to raise public awareness so at-risk people know to ask health providers for it; the treatment works best if administered in the first few days after exposure.

Delta is more dangerous to kids than prior versions of the coronavirus, and kids who aren’t old enough to be vaccinated may also spread it. So schools are going to be a flashpoint. In fact, schools already are a flashpoint, as shown by the legal and political wars over mask mandates, in some cases driven by Republican governors like Florida’s Ron DeSantis with presidential aspirations. More battles are likely as school systems try to enforce — or forego — quarantines when cases are detected.

Navigating the new school year — which overlaps with many office reopenings — will require a lot of nuanced public health communication — and nuance is not the strong point of the American public. In a politically riven country, where even those who accept and recognize the Delta threat crave certitude, parsed statements from public health officials like “up to a point,” “the science is evolving” or “we’ll have to wait and see” — are not the medical comfort food people seek, particularly where their kids are concerned.

That makes messaging hard, especially when some Americans see changes in public health communication as lying or betrayal, not the natural outcome of learning more about a hitherto unknown disease. The changing guidance around masks is part of why a segment of the public turned on Anthony Fauci, the nation’s top infectious disease doctor and a key Biden adviser.

“We are continuing to learn about the virus and vaccination and our guidance and recommendations have to change and keep up,” Murthy, the surgeon general, said. “What we have to do is make sure we’re communicating clearly and transparently about what’s changing and why it’s changing. It’s easy to say, harder to do.” It requires making the public understand both the ongoing risks, as well as the steps they can now take “to see family, to see friends, much more safely.”

As grim as Delta is, there has been progress, above and beyond vaccination. Many policy levers have already been pulled, although they can still be fine-tuned and expanded.

That new CDC analytics center should be able to track new variants, making it less likely that an Epsilon or Zeta will clobber us as hard as Delta has.

The monoclonal antibodies, combined with steroids and other medications used in hospitals, are saving lives, even though more treatments are needed, here and abroad.

Testing labs are for the most part keeping up with demand amid the surge, and the government just invested $200 million to boost supplies of rapid tests people can take at home (or work). But to be a game changer, the price has to come way, way down, said Gounder. “Nobody wants to spend $25 per person per day. If we could get them down to a dollar apiece” people could test before a dinner party, before a play date, before a visit to Granny and Grandpa.

There’s a better understanding of how to manage even big events, with vaccination, testing and masking requirements. There was a lot of trepidation about Lollapalooza in Chicago earlier this summer, but according to city health officials, there were about 200 cases among the 385,000 attendees. Half were breakthroughs; the unvaccinated (who had to present a negative test taken within 72 hours of attending) were at higher risk of getting sick. Masking, which was not required throughout the festival, might have added another layer of defense.

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