Reviews | It’s time to rethink when we should reimpose covid restrictions

As the pandemic worsens in Europe and elsewhere, there is already talk of when public health officials in the United States should reimpose covid-19 measures such as mask mandates. But they should be wary of re-establishing rigid “on-ramps” to restrictions.

If the past two years have taught us anything, it is that predetermined thresholds for public health policy do not work well in practice and risk undermining public trust.

Time and time again, the rapidly evolving pandemic has shown us that predictions age poorly. Scientific knowledge evolves, and measurements fixed in a fleeting moment have often proven ineffective in guiding policy-making in the real world.

Experts and policymakers have tried countless combinations of metrics to guide decisions, from case counts to test positivity to community-level vaccination rates. In theory, these parameters can keep transmission to a minimum, prevent serious disease outbreaks and, if vaccination rates are included, encourage vaccination. In the absence of a clear alternative strategy to lift mandatory masking policies, we have also encouraged policymakers to implement “ramp exit” measures in the summer and fall.

But in reality, the thresholds for changing covid policies are always somewhat arbitrary, and the context is constantly changing. By the time the predefined metrics are triggered, they are often out of date.

Last summer, for example, Massachusetts implemented a simple off-ramp for school mask mandates: if a school had an 80% vaccination rate in the building, then its leaders could apply for a waiver. of mask. We supported this plan, arguing that a high vaccination rate would provide strong protection against serious disease outbreaks in schools, even in the face of the delta variant.

But few schools have asked for the waiver, and even fewer have lifted the mandate. Why? Because some local and district health officials objected, arguing that because the Pfizer/BioNTech vaccine for ages 5-11 would soon be available when the metrics go live, they felt they should wait “just a little longer”. Then the omicron came along and the vaccine wasn’t as good at preventing infections (although it was still very protective against serious illnesses). In other words, the context of the pandemic has changed.

A similar thing happened in many schools in the 2020-2021 school year, but in reverse. Schools have established thresholds, such as community spread rates, that would trigger a return to remote learning. Many of them crossed these thresholds during the winter peak, but in the meantime the situation had changed. School transmission has proven to be rare enough that following the arbitrary predefined plans established over the summer does not make sense.

Using today’s metrics to guide school policy in tomorrow’s surges would be a mistake. Scientific factors interact in complex and unpredictable ways. Perhaps new advances, such as better or more accessible treatments for those who fall ill, will significantly reduce community risk. Or perhaps the next variant will be more evasive of previous immunity or resistance therapies. Any of these factors would complicate the real-world application of a predefined on-ramp.

We support the Centers for Disease Control and Prevention’s conceptual shift to focus its latest framework for determining covid policies on cases of severe illness and hospital capacity. But when it comes to the school mask policy, what happens in hospitals may have little relation to what happens in schools. Local factors – such as vaccinations, previous infections, who is hospitalized and whether admissions are “for” covid – must all be taken into account in determining the need for public health interventions.

So what can be done to chart future strategies? First, public health authorities should incorporate up-to-the-minute scientific information, while being transparent about what is uncertain and recognizing that things could change quickly. This will require additional investments in public health infrastructure to provide robust, real-time surveillance and data analysis.

Second, policy makers should demand continuous reassessment of policies that acknowledge past successes and failures. They should also opt for strategies adapted to local situations, rather than uniform standards, and strive to gather scientific evidence to support the effectiveness of measures to achieve a political objective.

Finally, we need to set clear goals for any intervention and update those goals and metrics in real time. This will allow us to better understand how, when and for how long interventions will be recommended.

It’s time to move away from predetermined and static metrics. The public is remarkably adept, especially in the information age, at sensing when political decisions are arbitrary. Americans can tell when rules lack a clear evidence base or are irrelevant to the specifics of the situation in a given community. Accepting uncertainty and rapid change is scary, but it’s also our only realistic path.

Comments are closed.