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Reimagineering Public Health

As we start 2022, and the third year of the pandemic, it is time to reimagineer the future with the tools in our hands, the systems we can create and lifestyles we can enable.




What better way to accomplish this than to bring together the collective thoughts of the leading minds in public health? We start by reviewing a few papers in JAMA today:

Review: A National Strategy for the “New Normal” of Life With COVID

Ezekiel J. Emanuel, MD, PhD, Michael Osterholm, PhD, MPH2, Celine R. Gounder, MD, ScM3


Defining A National Risk Level


A modern problem definition
The “new normal” requires recognizing that SARS-CoV-2 is but one of several circulating respiratory viruses that include influenza, respiratory syncytial virus (RSV), and more. COVID-19 must now be considered among the risks posed by all respiratory viral illnesses combined. Many of the measures to reduce transmission of SARS-CoV-2 (eg, ventilation) will also reduce transmission of other respiratory viruses. Thus, policy makers should retire previous public health categorizations, including deaths from pneumonia and influenza or pneumonia, influenza, and COVID-19, and focus on a new category: the aggregate risk of all respiratory virus infections.

Components of a Solution


Data
First, the US needs a comprehensive, digital, real-time, integrated data infrastructure for public health.
Workforce
Second, the US needs a permanent public health implementation workforce that has the flexibility and surge capacity to manage persistent problems while simultaneously responding to emergencies.
Reregulation
Third, because respiratory infections ebb and flow, institutionalizing telemedicine waivers, licensure to practice and enable billing across state lines, and other measures that allow the flow of medical services to severely affected regions should be a priority
Trust
Fourth, it is essential to rebuild trust in public health institutions and a belief in collective action in service of public health

Review: A National Strategy for COVID-19 Testing, Surveillance, and Mitigation Strategies

David Michaels, PhD, MPH; Ezekiel J. Emanuel, MD, PhD; Rick A. Bright, PhD

Testing


Ubiquitous access
Every person in the US should have access to low-cost testing to determine if they are infected and infectious.

Real-time reporting
Deploying multiplexed molecular and rapid antigen tests for respiratory viruses that detect multiple respiratory pathogens will distinguish SARS-CoV-2, influenza, respiratory syncytial virus, other viruses, and bacterial pathogens.


Surveillance


Multimodal environmental surveillance
Great progress has been made toward establishing environmental surveillance programs for SARS-CoV-2, but there is a need to rapidly expand to other pathogens and reach rural and other communities that lack wastewater systems.

Genomic surveillance
The country needs a system organized by the CDC to sequence a far greater and more geographically representative proportion of positive COVID-19 tests than is currently being sequenced, with the results uploaded into global databases in real-time.

Medical outcome surveillance
The US needs to establish a real-time, opt-out digital surveillance system to monitor all vaccinated individuals for the frequency and severity of adverse effects, post-vaccination infections, and waning immunity.


Mitigation


Stay home when sick
The most effective way to prevent transmission of respiratory diseases, including COVID-19, is to eliminate exposure to potentially infectious individuals, encouraging individuals who may have illness to stay home. This requires systematic access to testing and paid sick and family medical leave for all US workers, especially low-wage, temporary, freelance, contractor, and gig economy workers.

Ventilation
The next most effective mitigation approach focuses on upgrades to ventilation and air filtration systems, including increasing the intake of outside air, using efficient filters and adding high-efficiency particulate air filtering devices.

Filtration
The country needs to encourage use of high-quality filtering facepiece respirators (FFRs), such as N95s or KN95s, rather than cloth or surgical masks, to reduce transmission of respiratory viruses including SARS-CoV-2 in crowded indoor settings where community exposure risk is elevated.


Review: A National Strategy for COVID-19 Medical Countermeasures

Luciana L. Borio, MD; Rick A. Bright, PhD; Ezekiel J. Emanuel, MD, PhD

Vaccines


Update vaccines and vaccinations
Unless SARS-CoV-2 evolves to become more attenuated than its current form, the nation should anticipate needing regular, possibly annual, COVID-19 vaccines. It is still unclear at what point protection against severe disease will wane. As with yearly influenza vaccines, an updated formulation targeted to the circulating variants will likely be needed to maximize protection from infections and severe disease

Alternate regimens
Despite COVID-19 vaccines being authorized for more than 12 months, there is insufficient data on what constitutes an optimal vaccine combination and schedule. Is there a more effective prime/boost regimen when combining mRNA, viral-vectored, or protein vaccines? Is there an optimal dosing interval? Is there a correlate of protection to expedite further vaccine development?

Pan coronavirus vaccine
A more broadly protective vaccine would allow the world to limit the effects of emerging variants and nimbly react to novel coronaviruses that are likely to emerge in the future.

Electronic vaccine certificates
In addition, to facilitate verification of vaccination status and to better track post-vaccination infections, there needs to be an electronic vaccine certificate platform.


Therapeutics


Viral evolution pressure

Further, the use of antiviral agents warrants close monitoring for emergence of viruses resistant to treatment.

Streamlined supply-chain
The US government should accelerate development, production, and procurement of COVID-19 drugs that are easier to manufacture and administer.

Access
Outpatient COVID-19 treatments need to be made widely available at no cost—no deductible, no co-pay, no pay for the uninsured—for anyone testing positive for SARS-CoV-2 infection and meeting FDA indications. Importantly, there must be a mechanism to ensure every person who tests positive is proactively offered appropriate and rapid treatment.

Together, a safer world

This year we at Hubbub World will be launching a series of products and services that help accomplish many of the goals outlined in the above visions for the years ahead, starting with


Open Self Test



Join us in this journey...