What the President Could Have Done Today to Counter the Pandemic
https://erictopol.substack.com/p/what-the-president-could-have-done" Admittedly, there are many things the White House and President Biden cannot control. Like the opposition to vaccines, masks, science, and our main defense tactics to counter the pandemic. Like facing very challenging versions of the virus that are hyper-contagious and evade our immune system. Yet there are certainly several strategic points that could have been enacted today, such as:
1. Booster shots at 4 months after the 2nd dose, not 6 months. The data are overwhelming and many countries have already switched to 3 months.
2. Redefine "fully vaccinated" as 3 shots, unless it is after J&J for which we do not have data for a 3rd shot, or Prior Covid with uncertainty as to whether more than 1 or 2 shots is necessary. Maybe these data will help get the point across about the value of boosters for protection vs infection.
This is important since it will help get our inadequate booster protection up where it needs to be, fully backed by the extensive data for protection vs Delta (such as 90% reduction in death for age 50+, marked reduction in hospitalizations for age 40+, 95% protection vs symptomatic infection for all ages in a large randomized trial). That's even more an issue for Omicron, for which protection drops to ~35% without a booster, but increases vs. symptomatic infection to about ~75%.
3. No airplane passengers who are not fully vaccinated, or having medical documentation for why that is not the case, such as the policy in Canada and many other countries. The federal government should have authority for any interstate transportation.
4. 500 million free rapid tests by request sometime in January is totally inadequate. We need several billion of these, and have needed them for over a year to help prevent spread, as validated and relied upon in many countries throughout the world. It's good that the Administration has finally responded to the loud voices of frustration but it's an exemplar of too little, too late.
5. Distribute KN95 masks to all households. The US government can purchase these for very low cost (i.e. pennies) and get them widely distributed as has been done in other countries to enhance protection.
6. Rapidly scale the production of the anti-Covid pill Paxlovid, which is about to get FDA emergency authorization and the topic of my last post here. There will be a large number of non-mild infections going forward and we now have a treatment that' is expected to wrk extremely well against Omicron, but the supply is dreadfully short. I wrote more about this today Enacting the Defense Production Act, as the President has done for rapid test production, is one way to solve this shortage problem. Our healthcare workforce, already compromised in numbers and morale, will likely be hit hard by Omicron infections. Having a pill treatment that knocks viral load down by 10-0fold quickly, to potentially get them back in action in a short time lag (e.g. 2 days instead of 10) may prove vital. We need to get studies on transmission of Omicron done ASAP, and particularly with Paxlovid treatment to nail this time interval down, as discussed in my recent Q&A with New York magazine.
7. Fix the data mess. The CDC is apparently unable to track hospitalizations and deaths by vaccine status, timing, age of the patient and their relevant co-existing medical conditions. Secretary Xavier Becerra of HHS hasn't yet shown up for the pandemic but has authority to mandate such data collection across the country. We are trying to determine the clinical severity of Omicron but have no ability to track the data here! The inability for CDC to see what was happening during the Delta wave, and their >2-month delay in recommending boosters for all adults, resulted in a large number of unnecessary cases as shown here, on the CDC website just published over the weekend, with only 1 of 3 snapshots since May, already a month old, with only a bit of data tracking cases and deaths, but not hospitalizations, in a limited number of regions of the country. In not a single speech that President Biden has given since taking office has he mentioned any effort to improve data collection and reporting. Just crickets on this issue. How can you navigate in a pandemic without data?"
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