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Viewpoint: Government can do better with COVID-19 : Emergency Medicine News

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public health policy, COVID-19, government

I often ruminate on the first patient I lost to COVID-19. What was different about her, besides being young and pregnant, was that she was my first. We knew so little in the spring of 2020 and we had so few tools to fight the virus. These losses sometimes seemed inevitable but always tragic.

Now, as we enter the third year of this disease, long after an effective vaccine has been invented and with more data and knowledge on prevention and treatment, I am baffled by the government’s consistently inadequate response to end the pandemic, which has always been too little too late.

My colleagues and I have lamented the absence of a cohesive and widely adopted strategy to end this pandemic for more than 18 months. What seems so obvious to the typical emergency doctor and nurse has systematically eluded our elected officials at all levels. But a clear strategy to end this pandemic is achievable.

The first pillar is testing. My emergency department is full of patients seeking a COVID test, as are many departments across the country. Some patients are symptomatic and worried, others just need confirmation, and still others need oxygen and more. Either way, the government has failed to reliably provide convenient and affordable testing across the country.

We should have had (and still have time to implement) a WWII scale testing strategy. I dream of posters in the style of Rosie the Riveter and Uncle Sam asking YOU to use our federally owned testing facilities. Giving the unemployed good jobs to make swabs and reagents is a dual strategy for providing testing and reviving our economy. Tents should be set up in every city block and in every city center with fast and reliable testing capabilities. Until then, the expectations will continue.

The second pillar of this strategy is vaccination. The R0 because the Omicron variant can reach 10, which means that one patient can infect up to 10 others. (Respir Med Lancet. 2021;S2213-2600[21]:00559; https://bit.ly/3qJUzZC.) For comparison, the original COVID outbreak had an approximate R0 by just 2.5 and measles a whopping 18. (NPR. Aug. 11, 2021; https://n.pr/33twrSp.)

If the estimate for Omicron is true, we will need a 90% vaccination rate to contain the disease. (A quick aside to proponents of natural immunity: This strictly theoretical strategy seems feasible, but it ignores the beckoning question, what happens to our hospitals if everyone gets sick at the same time?)

We are unfortunately well below this 90% mark, even before considering whether a booster is necessary to be considered fully vaccinated. (US COVID-19 Vaccine Tracker. January 5, 2022; https://mayocl.in/3lM3OFK.) The current education, incentive and employment penalty campaigns have clearly not worked. To get people vaccinated who otherwise wouldn’t — either because of time constraints, procrastination, or misinformation — the answer is simple: pay people to get vaccinated. The last stimulus check should have been conditional on receiving at least one dose of vaccine. We should consider another round of stimulus, this time tied to full immunization against this pervasive and preventable disease. Needing the day off to recover from a sore arm and a low fever is more acceptable with a check for $1,200 in your pocket. The current failed strategy is undoubtedly more costly than incentivized prevention.

The third pillar is to ensure that the rest of the world is also vaccinated, lest other mutations and variants continue to overtake our response. Indeed, the new coronavirus has proven that it is not interested in respecting international borders. We will be in a constant evolutionary battle with variants if we don’t take this as seriously as we did polio or smallpox, the latter representing perhaps the greatest testament to human cooperation in history. . Smallpox, once a disease that ravaged mankind for millennia, was effectively eliminated in 1980. (Centers for Disease Control and Prevention. February 20, 2021; https://bit.ly/3qNokbS.) Today’s technology means the same fate for SARS-CoV-2 is not a fantasy.

A solution to COVID is viable; we need tests and we need to be vaccinated. It is only political will and, dare I say, leadership that stand in the way. Our response was too weak and too late. Until we are ready to invest in these resources, the death toll will continue to rise and the waiting room will continue to wait.

Dr Gayloris an emergency physician in Washington, DC and Baltimore, and a member of the Medstar-Georgetown Emergency Medicine Health Policy Fellowship.