Doug Badger / @Dougsbriefcase / Norbert Michel / @norbertjmichel /
COVID-19 cases and deaths continue to surge. The seven-day moving
average of daily confirmed new cases eclipsed 260,000 on Jan. 9, the
highest rate yet recorded. The U.S. is expected to reach the grim
milestone of 400,000 COVID-related deaths later this month, around the
anniversary of its first confirmed case.
These numbers suggest that the strategy of relying predominantly on
social distancing, lockdowns, and mask-wearing is not working. We need
better interventions.
Some have called for national mask mandates. We recently examined the
effects of mask mandates in the U.S. and Italy, and our findings are not
encouraging.
Of the 25 U.S. counties reporting the highest number of new cases during
the current surge, 21 had mask mandates in place before August. Looking
at the 100 counties with the most confirmed cases during this period,
97 had either a county-level mask mandate, a state-level mandate, or
both. Of these 97 counties, 87 instituted their mandates prior to
October.
Mask mandates failed to prevent a surge in cases in other countries as
well. Italy enforces a national mask mandate, imposing fines of up to
1,000 euros. That mandate did not prevent a surge of cases that began in
October and peaked in mid-November. As of early January, Italy was
still recording new infections at four times the early October rate.
Our findings do not deny the efficacy of mask-wearing. Nor should they
discourage the practice. Public health authorities in the U.S. and
throughout the world cite studies showing that mask-wearing slows the
pathogen’s rate of spread.
Although mask-wearing may reduce transmission rate, it has not prevented cases from spiking either here or abroad.
Governments should pursue additional strategies. These include adopting
better measures to protect nursing home residents and enabling
nationwide screening through the widespread use of rapid self-tests.
The U.S. and other governments have done an abysmal job at protecting
nursing home patients. As of Jan. 7, U.S. nursing home residents
accounted for less than 0.5% of COVID-19 cases but 37% of COVID-related
deaths.
Cases and deaths continue to mount even as the process of vaccinating
residents and staff has begun. The current federal policy of requiring
weekly tests of staff and temporal thermometer screenings of visitors is
inadequate. Government should require daily testing of staff, at least
until all residents and staff have been immunized. Visitors should be
tested before entering the facility.
Government should also take steps to protect the general population. The
distribution of rapid, at-home tests that don’t require a prescription
or laboratory analysis would inform people of their COVID-19 status and
limit the disease’s transmission.
The technology exists to produce low-cost, rapid home tests in
sufficient volume for tens of millions of Americans to test themselves
daily. Unfortunately, the U.S. Food and Drug Administration has not
approved these tests. The agency’s concern is that self-administered,
in-home tests are less sensitive than laboratory-analyzed tests used for
clinical diagnosis. This view allows the perfect to be the enemy of the
good.
Acknowledging this, Dr. Anthony Fauci, director of the National
Institute of Allergy and Infectious Diseases, recently embraced the
notion of “flooding the system with tests, getting a home test that you
could do yourself, that’s highly sensitive and highly specific.”
Rapid tests are marginally less accurate, but that is more than offset
by their volume (testing tens of millions of people daily, as opposed to
2 million), frequency (people can test themselves often), and immediacy
(results within minutes, rather than days).
Unlike mask-wearing and lockdown edicts, widespread self-testing is
neither culturally nor politically divisive, making it more likely to
gain population-wide acceptance. It combats the contagion by empowering
and informing people, not confining them, restricting their activities
and suggesting that they are to blame for the spread of a contagious
pathogen.
Equipping people to make the best decisions for themselves, their
families, and their fellow citizens offers a promising new approach to
combating the pandemic.
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