The United States has entered a severe and dangerous phase of the COVID-19 pandemic. Cases and deaths are surging, and many areas are facing critical shortages in hospital facilities and staff. The gap in the hardships experienced by minority and low-income people compared to the rest of the population continues to widen, with those who have low paying manufacturing, sales, healthcare and service jobs forced to work in person while others are able to work from home. This combined with generally denser living conditions and more common comorbidities has led to much higher case and death rates of COVID-19 among these individuals. Furthermore, over half of people of color surveyed are facing economic challenges as a result of the pandemic (reported here, here and here).
The depth of the crisis has been exacerbated by irresponsible actions of the government and private enterprises at national, state and local levels. At the federal level there is a glaring lack of national plan to address the pandemic with government officials failing to act and even encouraging people to flaunt public health rules. Congress continues in its failure to enact adequate legislation to provide economic relief to those impacted. The response of State governments has been uneven, with some States acting more responsibly and others being totally negligent. In the private sector, employers are unrestrained by any pandemic-related safety regulations. Universities, pursuing a business model of success, prematurely opened for in-person instruction, creating hot spots for spreading COVID-19.
In justifying failed policies, government officials often promote a false and dangerous dichotomy between public health and economic growth. In fact the two are deeply intertwined. Economic deprivation increases morbidity and mortality, while opening businesses and permitting public gatherings without adequate planning and testing, leads to outbreaks which disrupt economic growth. Indeed, countries that have used strong social policies to contain the cases and deaths in the pandemic have tended to do the best economically.
Scientific facts and concepts are critical to developing an effective pandemic policy. Yet these concepts have been distorted and “weaponized” by government actors and conservative politicians. Added to the outright lies that COVID is no worse than the flu and that a vaccine would be available in a few weeks are more subtle distortions. For example:
- Herd immunity is a valid concept that describes how the spread of an epidemic declines when enough members of a population become immune to an infection so that propagation of the infection in the population is not sustained. It is most safely achieved by mass vaccination. This concept has been used to irresponsibly suggest that letting the pandemic run its course without public health intervention is a reasonable public health strategy.
- Vaccines are expected to be effective in protecting individuals and slowing down the pandemic. But they are not a panacea that negates the importance of public health restrictions and safer workplaces. To do so, will result in many more lives lost and slow the process of economic recovery. Every case prevented before and as vaccines are distributed will make vaccines more effective in limiting the spread and impact of the pandemic..
At the same time that scientific concepts are distorted in justifying irresponsible policies, important scientific research is neglected. In order to minimize the spread and impact of COVID-19 we need more scientific knowledge on multiple fronts: For example, we need studies to understand how long immunity lasts after recovery from COVID-19 and the long-term effects after recovery. We need better information on the comparative dangers of various activities, e.g. opening elementary schools, outdoor social gatherings, as well as the impacts of pandemic-related restrictions on child development and how to address them. We also need to determine the extent of additive and synergistic effects of COVID-19 and environmental exposures like air pollution, and the efficacy of vaccines across virus strains and against transmission from asymptomatic individuals. Finally, we must understand and address the reasons for “vaccine hesitancy”. Answers to these questions will enable us to save many lives and promote economic recovery. But research on these questions is inadequately supported by government and private sector organizations and when it is done it is often scattered, incomplete and distorted by political agendas.
The use of scientific work in combatting the pandemic has also been set back by an erosion of trust in critical federal public health agencies such as the CDC and FDA. Scientists exposing problems in public health policy in these agencies have been silenced or intimidated, and the agencies have often provided conflicting and inconsistent information to the public. Although workplaces are key settings for spreading the pandemic, the leading federal agencies on occupational health, OSHA and NIOSH, have been almost completely ineffective in making workplaces safer in terms of the spread of COVID-19. OSHA has received thousands of whistleblower complaints related to COVID and has failed to act on almost all of them. Federal emergency paid sick leave is far from adequate and leaves many workers uncovered.
It is expected that the new administration in Washington will be more truthful in reporting on the status of the pandemic and will rely more on public health and scientific expertise in making policy decisions. These are welcome changes. However, this will not be enough to combat the health and economic crisis we are facing. To do so we need:
- A national plan to control the pandemic that combines stringent public health restrictions with generous economic support to those most impacted by the pandemic.
- Strong federal and state legislation providing economic support to those most impacted by the pandemic, including ample, comprehensive and extended unemployment benefits, child care support, an end to evictions and support for gig, contingent and contract workers.
- Development and enforcement of regulatory standards for protecting workers from COVID hazards, including provisions for decreasing worker density, minimizing exposure, protection for whistleblowers and comprehensive extended paid leave for those ill with COVID, in quarantine, isolation or needed to provide assistance to family members. These must be applied for all workers including undocumented, temporary, contract and gig workers.
- A detailed plan to distribute vaccines when they become available with proper consideration of optimizing deployment to minimize the spread and impact of the pandemic, and equity in distribution to different sectors of the population. For example, priority must be given to vaccinating prisoners and prison workers, because prisons are hotspots of the pandemic.
- Rebuilding and enhancement of the scientific and public health infrastructure that has declined in recent years, and promotion of research that examines the social and political determinants of disease spread and impact.
- A national plan to provide free universal healthcare coverage to all people, including undocumented immigrants.