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Three Wise Men: National Strategy for COVID-19 Testing, Surveillance, and Mitigation by rinselberg
Started on: 01-13-2022 12:41 AM
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Last post by: rinselberg on 01-13-2022 12:41 AM
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These are excerpts from recently published articles and reports.

Omicron is forcing us to reconsider how we deal with mild cases of COVID, which will never completely go away. It is doing so, unfortunately, in a chaotic and dangerous moment. For the next variant and for next winter, we need to plan in advance. The challenges ahead are already clear. Hospitals, which are stressed even in bad flu seasons, will have to deal with combined COVID and flu every winter. The coronavirus will also keep evolving, and new variants that keep eroding our immunity will emerge. In a series of three papers last week, a group of [three] former Biden advisers laid out a long-term strategy to monitor all respiratory infections—including COVID, flu, and respiratory syncytial virus—and keep their collective burden below that of a bad flu season through more robust testing, surveillance, mitigation, and vaccine and therapy development. We’ve spent the past year lurching in reaction to new variants, but what the U.S. needs now is a big-picture goal for COVID, even if the coronavirus surprises us again.
"Omicron Is Forcing Us to Rethink 'Mild' COVID"
Sarah Zhang for The Atlantic; January 10, 2022.

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At the beginning of the COVID-19 pandemic, the response of the US federal government was seriously flawed. For example, the Centers for Disease Control and Prevention (CDC) erred when it came to policy development and messaging for testing, surveillance, masking, and ventilation, and CDC-developed test kits were also defective. Some policies from the Department of Health and Human Services restricted private sector progress, further delaying availability of tests. Early guidance on testing was mis-targeted, getting tested was a logistical nightmare, and too few tests were performed. Once an acceptable, yet suboptimal, testing infrastructure was established, it was marginalized, thought to be superfluous because of the vaccines. Even now, testing results are not reliably linked with sociodemographic data, vaccination status, or clinical outcomes; the availability of reliable rapid tests remains limited; and prices are too high

Similarly, there has never been comprehensive, geographically and population representative genomic surveillance to effectively detect and track variants of SARS-CoV-2, leaving the US with limited and delayed information about the emergence of new variants until other countries identify them. In addition, from the beginning of the pandemic until May 2021, the importance of aerosol transmission of SARS-CoV-2 was not fully recognized and appreciated,2 leading to incorrect, delayed, and highly confusing recommendations on masking, wearing high-quality respirators, and improving ventilation.

It appears that SARS-CoV-2 will persist, and the COVID-19 pandemic will continue for some time. Consequently, to achieve a sustainable “new normal” with substantially lower virus transmission and mortality from COVID-19, testing, surveillance, masking, and ventilation all need significant improvement.
"A National Strategy for COVID-19 Testing, Surveillance, and Mitigation Strategies"
David Michaels, Ezekiel Emanuel and Rick Bright for JAMA; January 6, 2022.

Today, news reports are using mild and COVID-19 together more than ever before, Elena Semino, a linguist at Lancaster University, in the United Kingdom, told me. Medically, the term mild originated as an academic catchall for all SARS-CoV-2 infections not severe enough to get someone admitted to a hospital—everything from asymptomatic cases all the way up to people just short of going into respiratory failure. But most of that range squares poorly with mild’s colloquial connotations regarding “temperate, pleasant, generally benign” food, weather, even people, Semino said. Mild, to most of us, is whatever, something that blows almost imperceptibly by.

That’s the trap of mildness: the underlying sense of fatalism it engenders. “People say, it’s inevitable; it’s mild; I hope I can catch it and move on,” Santhosh, of UCSF, told me. Calling Omicron “mild” implies that the virus is spontaneously domesticating itself; it punts the responsibility of harm reduction to the pathogen, and away from us. But Omicron is not our deus ex microbe. As Goldstein, of the University of Utah, points out, a virus’s imperative is only to spread—not, necessarily, to treat its hosts more genially. (Omicron is not even descended from Delta, so we can’t frame their severities as a stepwise evolutionary drop.) The attitude that Omicron is hardly anything to worry about is compounding the disaster we’ve found ourselves in: The more opportunities the virus has to enter new hosts, the more variants will arise. And there’s no telling what harm the next SARS-CoV-2 iteration will bring.

It’s worth remembering, then, that severity, or lack thereof, is not up to the virus alone. We, as hosts, dictate its damage at least as much—and that’s the side of the equation we can control. SARS-CoV-2 can’t be counted on to pull its punches, but we have the vaccines to pummel it right back. If mildness is what we’re after, that future is largely up to us.
"Calling Omicron ‘Mild’ Is Wishful Thinking"
Katherine J. Wu for The Atlantic; January 12, 2022.

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