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Public and Government Responsibility as we Reopen

Illustration by Pat Byrnes on Cagle Cartoons.

Widespread vaccine coverage in the US is rapidly reducing new infections, illnesses and deaths from COVID-19. States and cities are quickly removing restrictions on business and leisure activities. Yet, while the public enjoys the return to normalcy, governments behind the scenes should be ramping up public health systems to guard against another possible wave and to build more competency for the inevitable next epidemic, whenever it may arise. 

First, a note of warning.

Newly confirmed cases in the US are now below 40,000 per day. This is down from the peak in January, when new cases reached over 300,000 per day. And daily cases continue to decline, even more rapidly.

Yet, just before India's recent surge to over 400,000 cases per day, that country had reported just over 10,000 cases per day as recently as early March. It's a reminder that the COVID-19 epidemic can spread from very few cases to a devastating surge at a terrifying rate.

With summer comes the reopening of daily life and calls for steadfast precaution alongside celebration, both from the public and government.

India's surge resulted from two factors:

  1. The government completely let down its guard in March, declaring that the pandemic was "in the endgame."
  2. The Indian public engaged in the breathtakingly risky behavior of mass gatherings, most notably the mass religious celebration, the Kumbh Mela, gathering around 3.5 million people, which should surely have been postponed. Large political rallies were also encouraged.

The US would seem to be protected from any such surge, given the mass immunization coverage in the US today (with 46% of the population having received at least one shot) compared with the negligible vaccine coverage in India at the time of India's surge (just 2% in mid-March with at least one jab, and around 10% now). Yet any sense of invulnerability, which many Americans displayed even before the arrival of mass vaccinations, would be misplaced.

Though almost half of Americans have received at least one dose, the unwillingness of many Americans to be vaccinated is strong. Unvaccinated people will continue to fall sick, transmit the virus to others, and in unlucky cases, die.

The vaccinated population will indeed protect those who are not vaccinated by reducing the transmission of the virus, but sporadic and serious outbreaks are likely to continue, especially in places with low overall vaccine coverage. And, while the vaccines are wonderfully effective in preventing serious illness, some vaccinated individuals can become infected and may possibly transmit the virus to others.

Other more systemic risks are also lurking. As the pandemic rages in many parts of the world, India and beyond, the virus will continue to mutate. The existing vaccines may prove to be ineffective against one or more of the new variants. The vaccine companies are experimenting with modified vaccines and new vaccine regimens.

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There is also significant uncertainty about the duration of protection provided by the current vaccines (or past infection). Experience will tell us whether another jab will be needed in a year, or perhaps sooner, to prevent reinfection.

For all of these reasons, the arrival of summer and the reopening of daily life calls for steadfast precaution alongside celebration, both from the public and by governments at all levels. For the public, there is one overarching message: get vaccinated.

The lies of the anti-vax community are disgusting and must be countered. Voices like Tucker Carlson and anyone enabling him (like his employer Fox News and the advertisers) should face opprobrium and consumer boycotts, and perhaps class action lawsuits, for purveying reckless lies about vaccinations.

Another message for the public is to be aware of and to heed the continuing risks. We should:

  • Avoid mass indoor gatherings
  • Welcome the use by businesses of "vaccine passports" to ensure safe places for vaccinated people to gather
  • Use face masks whenever in doubt
  • Monitor one's own symptoms and possible COVID-19 illnesses among close contacts and get tested immediately if necessary
  • Heed the professional public health advice
  • Businesses should improve indoor ventilation systems to reduce indoor viral transmission.

Too many Americans have been heedless of risks during the pandemic, and by doing so contributed to the confirmed death toll of nearly 600,000 Americans.

An even greater responsibility lies with governments at all levels. The federal, state and local governments in the US have so far failed during the pandemic, with few exceptions.

Most importantly, they didn't properly track the community transmission of the virus through active surveillance methods, including widespread testing, contact tracing, and systematic isolation of infected individuals, which could have broken the transmission of the epidemic. This is what Australia, China, Korea, New Zealand, Vietnam, and others have done very successfully, with Covid-19 death tolls that are a tiny fraction of America's.

As the new daily cases in the US come down to much lower levels in future weeks, every city and state government should begin tracking each case among the public. The caseload will be low enough to make this manageable. Each new case should be investigated.

Was the person vaccinated? Was this a reinfection? Who are the possible sources of the infection? To whom else might the virus have been transmitted? All potential contacts should be traced. Superspreader events should be quickly identified for tracing those who were present.

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Rigorous laboratory work should pursue sampling of the population to check for dangerous variants and for early evidence of any new outbreaks caused by these variants. This data should also be collated rapidly and routinely at the national level by the Centers for Disease Control and Prevention and made public with detailed briefings to explain their ongoing significance. Government officials at all levels should be emphasizing the need for immunizations for those who are not yet vaccinated, and should be publicizing the findings regarding the variants.

Jeffrey Sachs
JDS