Thread by @ASlavitt

COVID Update: February 2022 would be a perfect time for a reset in our pandemic response to face whatever lies ahead m. 1/

A proper reset would include the best statement of the facts as we know them, clear messaging about what to expect, and a commitment of resources and initiatives to give all of us the tools we need. 2/

So what are the facts?

We have a wily, shape-shifting & unpredictable virus. It will continue to mutate.

We have a vaccine that if taken can prevent death in most people & boosters or antivirals for people who a vaccine won’t protect alone. 3/

What else do we know?

With the current mutation & the current vaccine we can’t protect against spread without the use of high-quality masks.

The virus will continue to mutate & the vaccines will continue to evolve but there will likely be periods where this remains true. 4/

What else?

We are only partly there in vaccinating the globe w 60% global coverage. But that’s not all that meets the eye.

The Sinopharm vaccines, Sputnik & others are less effective than the mRNA vaccines. And high income countries are 14x more vaccinated than low income. 5/

What this means…

Until that changes, or the Chinese change their zero-COVID policy, the Chinese economy will remain locked down.

And the developing world will face a significant ongoing public health challenge long after the richer world adjusts. 6/

This also means…

As we add further to global inequities in disease prevelance, we also allow the virus ideal hosts to create more variants of concern.

The virus is also in many animal species. Together this means we will be likely to see more variants of concern. 7/

The facts, even if they’re stark, are important to share broadly & directly & consistently with the public.

There are some who feel like we have the “right” to have the virus out of our lives or to ignore it. That’s a nice thought but a virus will respect no one’s rights.

8/

We have no “right” to a virus free planet. Just as we have no right to planet without climate change or a right to our democracy.

We may not like it but we don’t get nice things unless we are willing to fight for them. 9/

A proper reset would begin with not only presenting & continually updating these facts but also laying out what we can do about them. 10/

Public health messaging is harder than it looks. But to help people understand how to manage their risk tolerance, we should present the full nuance around difficult topics— not the oversimplified messaging that can be confusing. 11/

What do I mean?

Some simple stuff.

None of our tools work perfectly. Boosters wane. At home tests don’t detect virus in the early stages. Masks that don’t fit don’t work. Anti-virals require quicker diagnosis.

Still they are valuable tools worth using. 12/

For most people, a combination of these tools, used properly, including proper ventilation, can make virtually any activity low risk: school, work, travel, seeing friends, attending events.

Not using them, particularly during hot periods, will present risk.13/

Even without predicting the future we can layout some expectations & plans for ‘22:

-In March we will know about Omicron-specific vaccines
-In April we will have enough anti-virals for millions.
-By June we should know about vaccines for infants & toddlers 14/

-In July we should have a feel for how much protection we are getting from the wave of omicron infection
-By Fall, we should reach key milestones in global vaccination rates
-By winter we should be boosting the most vulnerable
15/

We may also see vaccines targeting immunocompromised, the first good research into causes of long-COVID, and new environmental surveillance capabilities to detect virus.

The public should be kept abreast of all of these developments—the steps forward & the ones back.16/

We can’t predict when the next variant of concern will show up or if one that can outcompete Omicron will this year.

But our core message should be tools > virus. And our tools will get better. But we have to use them to be fully armed for future waves. 17/

We should lay out to the public the real challenges. Supply chain shortages, labor shortages, hospital infection control, pockets of unvaccinated people, poor data, and more can hamper our efforts. We need to identify & work on those challenges.18/

We also need to finally call to account the political leaders who are standing in the path of progress. Some governors won’t lift a finger to help. Others actively aid the virus’s spread.

In November we should vote out those who don’t take nearly 900,000 deaths as serious. 19/

The message “just get vaccinated” or “just get boosted” is not without some reason. It’s the most sure fire protection you can have. By a lot.

But our message must evolve to cover the nuances, shortcomings & other tools. Risk should neither be exaggerated or downplayed.20/

At this point there are reasons for optimism but no one will be hopeful if they’re confused or don’t feel led.

A reckoning of the facts, clear honest communication & delivering on the initiatives we commit to will go a long way toward public trust in leadership. 21/

Our messaging must cut through the “expert” noise.

Take 2 leading experts I know & admire,m— one publicly saying Omicron is the last wave & the other rhat we will get worse waves.

When cases soon show dramatic decline, people far less expert will declare the pandemic over. 22/

Let’s not pin our hopes on what variants, strains, or mutations do next.

Many of the things we must do to reset are things that will help us no matter if we have 0 or 10 more waves & whether they are milder or not. 23/

If we do it right, our plan will be as adaptable. New variants could necessitate new tools. And our communication should set the stage for adjustments.

This implies we need a Congress that will supply the resources we need. Not convinced that’s the Congress we have. 24/

Only in retrospect will we know when things are stable.

But knowing that we can get to a place over the course of the year where we can be safe & live our lives should be reassuring.

Come February, as Omicron ebbs, let’s share the roadmap & get going. /end