States and experts begin pursuing a coronavirus national strategy in absence of White H... - 0 views
-
A national plan to fight the coronavirus pandemic in the United States and return Americans to jobs and classrooms is emerging — but not from the White House.
-
a collection of governors, former government officials, disease specialists and nonprofits are pursuing a strategy that relies on the three pillars of disease control:
- ...40 more annotations...
-
Find everyone they interact with by deploying contact tracing on a scale America has never attempted before.
-
focus restrictions more narrowly on the infected and their contacts so the rest of society doesn’t have to stay in permanent lockdown.
-
Instead, the president and his top advisers have fixated almost exclusively on plans to reopen the U.S. economy by the end of the month, though they haven’t detailed how they will do so without triggering another outbreak
-
Administration officials, speaking on the condition of anonymity to describe internal deliberations, say the White House has made a deliberate political calculation that it will better serve Trump’s interest to put the onus on governors — rather than the federal government — to figure out how to move ahead.
-
The next failure is already on its way, Frieden said, because “we’re not doing the things we need to be doing in April.”
-
In recent days, dozens of leading voices have coalesced around the test-trace-quarantine framework, including former FDA commissioners for the Trump and George W. Bush administrations, Microsoft founder Bill Gates and top experts at Johns Hopkins, Columbia and Harvard universities.
-
On Wednesday, former president Barack Obama weighed in, tweeting, “Social distancing bends the curve and relieves some pressure … But in order to shift off current policies, the key will be a robust system of testing and monitoring — something we have yet to put in place nationwide.”
-
And Friday, Apple and Google unveiled a joint effort on new tools that would use smartphones to aid in contact tracing.
-
What remains unclear is whether this emerging plan can succeed without the backing of the federal government.
-
“It’s mind-boggling, actually, the degree of disorganization,” said Tom Frieden, former Centers for Disease Control and Prevention director. The federal government has already squandered February and March, he noted, committing “epic failures” on testing kits, ventilator supply, protective equipment for health workers and contradictory public health communication.
-
Experts and leaders in some states say remedying that weakness should be a priority and health departments should be rapidly shored up so that they are ready to act in coming weeks as infections nationwide begin to decrease
-
In America, testing — while still woefully behind — is ramping up. And households across the country have learned over the past month how to quarantine. But when it comes to the second pillar of the plan — the labor-intensive work of contact tracing — local health departments lack the necessary staff, money and training.
-
In South Korea, Taiwan, China and Singapore, variations on this basic strategy were implemented by their national governments, allowing them to keep the virus in check even as they reopened parts of their economy and society
-
In a report released Friday, the Johns Hopkins Center for Health Security and the Association of State and Territorial Health Officials — which represents state health departments — estimate 100,000 additional contact tracers are needed and call for $3.6 billion in emergency funding from Congress.
-
“We can’t afford to have multiple community outbreaks that can spiral up into sustained community transmission,” he said in the interview.
-
Unless states can aggressively trace and isolate the virus, experts say, there will be new outbreaks and another round of disruptive stay-at-home orders.
-
“All people are talking about right now is hospital beds, ventilators, testing, testing, testing. Yes, those are important, but they are all reactive. You are dealing with the symptoms and not the virus itself,”
-
The nonprofit Partners in Health quickly put together a plan to hire and train 1,000 contact tracers. Working from their homes making 20 to 30 calls a day, they could cover up to 20,000 contacts a day.
-
Testing on its own is useless, Nyenswah explained, because it only tells you who already has the virus. Similarly, tracing alone is useless if you don’t place those you find into quarantine. But when all three are implemented, the chain of transmission can be shattered.
-
Until a vaccine or treatment is developed, such nonpharmaceutical interventions are the only tools countries can rely on — besides locking down their cities.
-
to expand that in a country as large as the United States will require a massive dose of money, leadership and political will.
-
“You cannot have leaders contradicting each other every day. You cannot have states waiting on the federal government to act, and government telling the states to figure it out on their own,” he said. “You need a plan.”
-
When Vermont’s first coronavirus case was detected last month, it took two state health workers a day to track down 13 people who came into contact with that single patient. They put them under quarantine and started monitoring for symptoms. No one else became sick.
-
He did the math: If each of those 30 patients had contact with even three people, that meant 90 people his crew would have to locate and get into quarantine. In other words, impossible.
-
Since 2008, city and county health agencies have lost almost a quarter of their overall workforce. Decades of budget cuts have left the them unable to mount such a response. State health departments have recently had to lay off thousands more — an unintended consequence of federal officials delaying tax filings until July without warning states.
-
In Wuhan, a city of 11 million, the Chinese had 9,000 health workers doing contact tracing, said Frieden, the former CDC director. He estimates authorities would need roughly one contact tracer for every four cases in the United States.
-
“In the second wave, we have to have testing, a resource base, and a contact-tracing base that is so much more scaled up than right now,” he said. “It’s an enormous challenge.”
-
“You will never beat a virus like this one unless you get ahead of it. America must not just flatten the curve but get ahead of the curve.”
-
The group is paying new hires roughly the same salary as census takers, more than $20 an hour. As of Tuesday — just four days after the initial announcement — the group had received 7,000 applicants and hired 150.
-
“There needs to be a crash course in contact tracing because a lot of the health departments where this is going to need to happen are already kind of flat-out just trying to respond to the crisis at hand,”
-
Experts have proposed transforming the Peace Corps — which suspended global operations last month and recalled 7,000 volunteers to America — into a national response corps that could perform many tasks, including contact tracing.
-
On Wednesday, the editor in chief of JAMA, a leading medical journal, proposed suspending the first year of training for America’s 20,000 incoming medical students and deploying them as a medical corps to support the “test, trace, track, and quarantine strategy.”
-
The national organization for local STD programs says $200 million could add roughly 1,850 specialists, more than doubling that current workforce.
-
Technology could also turn out to be pivotal. But the invasive nature of cellphone tracking and apps raises concerns about civil liberties.
-
Such technology could take over some of what contact tracers do in interviews: build a contact history for each confirmed patient and find those possibly exposed. Doing that digitally could speed up the process — critical in containing an outbreak — and less laborious.
-
In China, authorities combined the nation’s vast surveillance apparatus with apps and cellphone data to track people’s movements. If someone they came across is later confirmed as infected, an app alerts them to stay at home.
-
In the United States, about 20 technology companies are trying to create a contact tracing app using geolocation data or Bluetooth pings on cellphones