Four guiding principles to extinguish the public health wildfire

The holiday season is officially here and the General Services Administration (GSA) has notified President-elect Joe Biden that his transition can begin.  

Among his top priorities is his seven-point plan to combat the spread of COVID-19. The Trump administration has mentioned all these points at some point, with support ranging from neglect to passive endorsement. While the Trump approach tipped the scale towards economic recovery, the Biden approach focuses more heavily on public health benefits. The likely optimal path lies somewhere in between, with real-time adjustments needed to steer the nation forward based on the current state of affairs.    

The general principles contained within Biden’s seven-point plan have support from scientists and public health officials. The challenge is transforming these ideals into practical actions that define the necessary steps required to achieve them. 

To be successful, the following four guiding principles are necessary to define such practical actions. 

Flexibility. There are no one-size-fits-all solutions. Every city, every town, every community, from urban to rural, has its own unique characteristics that must be considered when taking action. Resistance to top down edicts and policies will make them ineffective. In a perfect world, we know that if every person is isolated for one month, the virus would have no new people (termed hosts) to spread to, and would die out. The shelter-in-place orders in March and April were a weak attempt to achieve this, limiting the spread of the virus and keeping hospitals and the health care infrastructure from being overwhelmed. These objectives were partially achieved. With the virus now mounting a newfound vengeance, directives from local community leadership, guided and supported by state and federal governments, will lead to higher adherence and responses that are more effective. The key is empowering people to make smart choices that are in everyone’s best interest.   

Sustainability. Any actions taken in response to COVID-19 must be sustainable. Stay-at-home-orders were tolerated in March and April with a plethora of unknowns surrounding the virus. Nine months later, more is understood as to how the virus is spread, how it can be treated and those at the highest risk. We now understand that asymptomatic transmission is public health enemy number one, the insidious means by which the virus spreads and finds new hosts. Heavy-handed actions that are unsustainable will be poorly received, and in some places, outright ignored. Everyone is suffering from face covering and physical distancing fatigue, though they represent the only tools we have to limit the spread of the virus until a vaccine is available. Adding more restrictions further exacerbates people’s resistance to necessary actions that we all must take. The key is instituting appropriate actions at the appropriate times to achieve the appropriate results. 

Transparency. The single biggest failing of the Trump administration’s COVID-19 response is the fractured and inconsistent message that it communicated. The best plans are ineffective without clear, accurate and consistent messaging. Misinformation on face coverings and asymptomatic transmission created mistrust in public health agencies and their efforts to combat the virus, exacerbated by feckless leadership. The biggest threat our nation faces is widespread asymptomatic COVID-19 infections that result in a collapse of our nation’s health care system —the consequence of which would be dire for everyone. The population fatality risk for those under 50 years of age is negligible. Yet cooperation by every person under 50 years of age is essential to protect the health care system. The sooner the virus finds fewer hosts to infect, the healthier our nation will be. 

Humility. COVID-19 has brought our nation to its knees. It is a public health inferno raging across the nation, sparing no city, no town and no community from its carnage. The virus has caused over one quarter of one million deaths, and many tens of thousands of additional deaths that have occurred likely due to acute and chronic conditions not being treated, mental health strains and delays in preventive medicine practices. The Trump administration’s attitude has been more bravado than circumspect. What we do not know about COVID-19 still exceeds what we do know. Imprudent statements that lack scientific or data support confuse rather than calm. An attitude of humility can go a long way to traverse the path of recovery for our nation. 

The worst is not yet behind us. We are on track for well over 200 thousand daily cases and 35 million confirmed cases by the end of the summer of 2021. With that will come over 500 thousand deaths, people we know, we love and we will miss. Vaccines and effective treatments can reduce these numbers. A public health wildfire is blazing, with no place to hide. Biden’s seven-point plan says all the right things, with the right tone. As always, the devil is in the details. 

Sheldon H. Jacobson, PhD, is a founder professor of Computer Science at the University of Illinois at Urbana-Champaign.  He has researched and published extensively on issues related to the economics of vaccine supply chains and risk-based analytics applied to public health and public policy.   He served as a member of the National Academy of Medicine standing committee for the Strategic National Stockpile in 2015-2017.