Feb 14, 2022 - Health

The U.S. needs a COVID forecast

Illustration of a weather forecast with COVID predictions.

Illustration: Shoshana Gordon/Axios

Experts say the U.S. needs clearer, more defined standards that will help the public understand when it's safe to relax COVID restrictions — and when it might be necessary to bring them back.

Why it matters: Experts compare this need to a weather forecast or air-quality warnings: People are more willing to accept inconveniences if they understand the reasons why.

"I think what people are tired of are these protracted, long periods of disruption with no clear goal and, therefore, this anxiety that it's going to keep going," Jeremy Faust, an emergency physician at Brigham and Women's Hospital in Boston, told Axios.

  • Instead, local officials could say: "Listen, we're trying to get the hospitals to under 75% full. We're trying to get case rates under 50 per 100,000 ... Once that happens, great, masks can come off again," Faust said.

State of play: Several states across the country recently laid out their timelines for removing community masks mandates, as well as mask rules in schools.

  • "Governors had to act because they could not wait any longer. They ultimately respond to their constituents and the sentiment has really changed in the country over the last several weeks," Leana Wen, an emergency physician and public health professor at George Washington University, told Axios.
  • "I wish the CDC had laid out these off-ramps and on-ramps," she said. But "they still have a very narrow window of opportunity to do so because many of the mask-easing rules have not gone into effect yet."

What they're saying: Public health experts said there are a number of different ways for officials to think about what guideposts they're using to remove restrictions — and communicate them to the public.

  • "Let's make it really simple," Wen said. "There should only be two things we look at at this point. No. 1: Are hospitals and ICUs overwhelmed? No. 2: Are the vaccines still protective against severe illness? As long as hospitals are not overwhelmed and vaccines protect against severe illness, we should not have required masking or other restrictions."
  • Faust pointed to California's "Spare the Air" days where the public is alerted that air quality is poor on certain days. "Officials say: 'OK, the pollution is really bad? Today public transportation is free. Or people are going to telecommute.' They make changes to get the pollution down," Faust said."The same thing is true here. We have an outbreak here. Let's do something about it and then we can go back to normal," he said.
  • Officials need to find a way to consider the combination of local vaccination rates, particularly in schools, as well as local case rates and hospital ICU capacity, Megan Ranney, academic dean at the Brown University School of Public Health told Axios. She said the scientific community seems to be coalescing around a goal of an 80% to 85% vaccination rate, case numbers of somewhere between 50 to 100 per 100,000 people for seven days, and ICUs around 20% capacity, she said.

Yes, but: "You can't rely on any one of those in isolation," Ranney said. "Hospitalization rates are certainly influenced by COVID, but not purely COVID. So are we going to tell people to put masks back on if there's a mass casualty incident? There's a reality check there. It's got to be a combination of those three."

But, but, but: There's one metric that's still highly concerning to Faust. "The data I'm looking at shows we're still at the acute phase where we have historic levels of all-cause, increased mortality as compared to our usual norm."

The bottom line: "We're still in it. Let's be nimble. And let's be willing to take off-ramps when possible when safe," Faust said.

  • Yes, but: "That doesn't mean it's a one-way trip," he said.
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