’Significant gaps’ in pandemic response need to be addressed

Safely easing social restrictions against Covid-19 will take time, money, and patience, and the U.S. is nowhere near ready, experts said.

Before any part of the country can re-open, “significant gaps” in the pandemic response have to be addressed, according to John Lynch III, MD, of the University of Washington in Seattle.

In particular, outbreaks in vulnerable communities remain uncontrolled, access to diagnostic testing is “disjointed,” there’s no clear sign of a decrease in the number of hospital and ICU beds needed by Covid-19 patients even where new cases are falling, and understaffed public health authorities remain overwhelmed, Lynch told reporters during a briefing organized by the Infectious Diseases Society of America.

Any move to lift restrictions “has to be based on the scientific data we have,” but there are major holes in that information, commented Tina Tan, MD, of Northwestern University Feinberg School of Medicine in Chicago.

Specifically, both she and Lynch said, no one has a good idea of exactly how widespread the disease is, largely because not enough people are being tested for the SARS-CoV-2 virus to develop any picture of prevalence.

Until that information gap is filled, she told BreakingMED, “there’s no way to know what the appropriate time to reopen certain parts of the country will be.”

The comments came as the IDSA released a six-point program to help guide public policy, calling for:

  • Widespread, sustained availability of accurate diagnostic testing.
  • Continued physical distancing, until transmission is measurably slowed to a manageable level with a reproduction number (R0) of less than one and new cases are low enough to allow rapid case finding and contact tracing.
  • A phased re-start, based on the ability of states and regions to “safely, successfully, and rapidly diagnose, treat, and isolate” people with Covid-19 and their contacts, with an emphasis on vulnerable populations, such as African Americans and those in long-term care facilities.
  • A rebuilt health infrastructure that can be rapidly scaled up to manage recurrent outbreaks, including adequate resources, such as ventilators and personal protective equipment.
  • Some degree of physical distancing measures to guard against recurrences and a readiness to increase those measures quickly when needed.
  • A complete end to physical distancing restrictions only when treatments and a protective vaccine are available.
  • Rebuilding U.S. pandemic preparedness.

A central issue, Lynch said, is that the country is essentially working in the dark because access to diagnostic testing is still limited, in most cases to people already presumed to have the illness because they have symptoms.

“We do not know what the prevalence is,” he said, and because of that it’s not even clear how deadly the disease really is or how many people might be asymptomatic but infectious. One reason for that, he said, is that testing is still “embedded” in a clinical mode that slows down the process and makes it difficult to aggregate the resulting data.

Ideally, he said, public health authorities would have the ability to test large numbers of people, without regard to such things as insurance and then follow up on positive tests with contact tracing. But years of tight financing have left most such agencies without the needed resources, Lynch said.

Michael Smith, Contributing Writer, BreakingMED™

Cat ID: 125

Topic ID: 79,125,730,933,125,190,520,926,192,927,151,928