Wanted: Clear goals to end the pandemic

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Nearly two years after the discovery of Covid-19, we still don’t have a good answer to the biggest question: When will the pandemic end?

One obvious complication is that the coronavirus has proven very good at unexpected twists and turns, as it recently reminded us with the omicron variant.

But part of the problem, experts told me, is that US officials have never done a good job making it clear what the end goal even is and what it would mean for the country to return to something closer to normal. (While much of the US has started to move on, restrictions remain in place, particularly in schools, public transportation, and health care settings.)

“It’s been a major problem,” Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, told me. “If you’re not articulating what the metrics are that are driving your public health decision-making, it makes everything more opaque to the general public.”

At the beginning of the pandemic, the public was told the goal was to “flatten the curve” — a vague premise meant to ensure health care systems aren’t overwhelmed. Besides that, it was never clear whether the goal was “Covid zero” — true elimination of the virus — or something else.

We now know that the elimination of Covid-19 is unlikely, if not impossible. The coronavirus spreads too quickly, and is too adaptive, to truly eliminate. So a more reasonable goal would be to treat it a bit like the flu: a threat we mitigate with vaccines and other treatments, but to some extent learn to live with.

What, specifically, that looks like remains unclear.

What we can say is Covid-19 isn’t like the flu yet. America seems to be seeing a fall-winter spike in cases, and omicron could make things worse. But precisely because a surge could require new precautions again, it’s important to set a clear goal.

“If you have a set of policies that restrict people’s behavior, having pretty clear guidelines about when you will pull those back seems like a reasonable thing,” Robert Wachter, chair of the University of California San Francisco Department of Medicine, told me.

Authorities could tie restrictions to rates of cases or hospitalization (the latter will become more relevant as more people get vaccinated). The specific threshold will always be somewhat arbitrary, but the idea is to pick a number that is low enough to ensure the virus is under control and that the public can look at to understand if restrictions are warranted.

For example: A community could tie school mandates for masking and quarantining to staying below 10 daily new cases per 100,000 people for two weeks. If cases remain below that threshold, the mandates end. As cases rise toward and above that threshold, restrictions phase in.

Then there’s the vaccination rate. A community could ease restrictions as its vaccination rate climbs to 70, 80, or 90 percent. Higher is always better, but experts say it’s these higher thresholds that can provide solid community protection, barring new virus variants that evade immunity.

In the current context, some of these goals might seem unfeasible — a 90 percent vaccination rate is very high, and no state has hit that threshold. But an ambitious goal can acknowledge how far we are from beating Covid-19, and potentially provide motivation for officials and the public to work to improve things.

Another possible goal might be based on the time since vaccines became readily available: After two months of widespread vaccine availability (to allow people to get two shots and let them take effect), restrictions could ease.

These goals aren’t exclusive to one another, and could be tracked together.

But first, US leaders have to make their goals clear. From the start of the pandemic to now, that hasn’t been the case — and it’s made any light at the end of the tunnel harder to see.

A new working paper published by the National Bureau of Economic Research investigated whether there’s racial discrimination in housing — and found evidence that there is still significant levels of racist actions.

For the study, researchers Peter Christensen, Ignacio Sarmiento-Barbieri, and Christopher Timmins used a bot to send correspondences to property managers in the 50 largest US cities. Posing as renters, they used names that invoked associations with racial and ethnic groups: white, Black, or Hispanic. They then gauged if names associated with each group received different response rates.

Sure enough, there were significant differences: Response rates were 9.3 percent lower for Black renters, and 4.6 percent lower for Hispanic renters. Black renters faced higher levels of discrimination in the Midwest and Northeast, while Hispanic renters faced higher levels of discrimination in the Northeast and South.

NBER

The three worst cities for Black renters: Chicago, Los Angeles, and Louisville, Kentucky. And for Hispanic renters: Louisville, Houston, and Providence, Rhode Island. (Yes, Louisville is on both lists.)

The researchers noted that “non-response to a renter of color corresponds to a 40.2% reduction in the probability of a subsequent lease by a renter of color” — meaning this does translate to a reduced likelihood of a renter living at a property. More broadly, this trend contributes to racial segregation and inequality, since housing is a crucial ingredient to economic prosperity in America.

source https://www.vox.com/the-weeds/2021/12/3/22815961/covid-19-pandemic-policy-goals-weeds-newsletter