It’s time to change how we think about COVID-19

By Arielle Kane

The COVID-19 virus is endemic — meaning it’s here to stay. Getting to a 70% or 80% vaccination rate will not stop breakthrough cases, hot spots, and vulnerable people from getting ill. As such, the United States needs to pivot its COVID-19 response strategy to focus on harm reduction to prevent unnecessary deaths without forcing people to live another year in lockdown limbo.

To do that, the U.S. can learn from other countries with fewer cases and deaths.

We need to vaccinate as many people as possible.

The United States needs to continue to vaccinate as many people as possible, including eligible children, hard to reach and underserved populations, and the vaccine hesitant. The federal worker vaccine mandate should push more people to get vaccinated, but rollout efforts should not stop there. Music venues, sporting arenas, and schools can all encourage more people to get vaccinated by requiring proof of vaccination for entry. Having vaccines available during large events could also help reach some people.

We need more testing.

The United States has roughly the same vaccination rate as Germany and France and yet they have far fewer cases. A big reason is because they have prolific, and subsidized, COVID-19 testing — though Germany just recently stopped offering free COVID-19 tests to unvaccinated adults. In the U.S., rapid tests should be readily available for people with cold symptoms, people in schools, people who work in congregant settings, and people who want to travel. In the U.K., France, and Germany, rapid testing is widely available and inexpensive. People should get tested before gathering and traveling, which helps keep transmission down.

In general, the U.S. Food and Drug Administration (FDA) has been slow to approve rapid, at-home tests because they are less accurate than PCR tests. Because it has only approved a handful of rapid tests, they are expensive and often sold out at local pharmacies. If getting a PCR test requires an appointment and has a 2–5 day turn around, people aren’t going to use them as a mitigation strategy. The government should approve more rapid tests — even if they aren’t as effective as PCR tests — so that widespread use is easy and affordable.

Kids need to be in school as much as possible.

After a year and a half of closures and remote learning of uneven quality for many children, it is paramount that they stay in school. Children who are exposed to infected people should not be forced to stay home if they are vaccinated. Exposed unvaccinated children should be tested and stay in school unless they test positive. As vaccines become available for school-aged children, they should get vaccinated against COVID-19 as they are against other diseases. Local policymakers should work on appropriate vaccine mandates for school and school-related activities.

We need early access to treatments.

When someone tests positive, they should know where they can get treatments as quickly as possible to reduce the likelihood of hospitalization, particularly if they are more vulnerable. Research from Baylor University Medical Center found that monoclonal antibodies reduced hospitalizations among high-risk COVID-19 patients if they received the therapy early in the course of their illness. This means that doctors need to be aware of and prescribe the treatment and patients need access to infusion facilities since the drugs are delivered intravenously within the first 10 days of symptoms. But many primary care providers don’t know where to direct people to receive treatment. The federal government has announced that it will work on more equitably distributing the limited supply of monoclonal antibody treatments. But they should work with local governments and state medical boards to better reach vulnerable patients who test positive.

Everyone needs insurance coverage.

While the uninsured rate largely remained unchanged during the pandemic, where people were getting their coverage from changed. As people lost their jobs, more people enrolled in Medicaid. This prevented a huge loss of coverage. But in Republican-dominated states that haven’t yet expanded Medicaid under the Affordable Care Act (ACA), the rate of uninsured remains much higher than the national average. The data shows that access to health insurance coverage improves health outcomes, because covered people are more likely to get preventive care and earlier interventions when they need acute care. One study found that COVID cases and deaths are higher in non-expansion states, suggesting that Medicaid improves access to health care system and limits both the rates of transmission and death.

In the reconciliation negotiations, lawmakers should prioritize covering the roughly 2.2 million Americans would be eligible for Medicaid save for the fact that they live in one of the 12 states that have elected to forgo Medicaid expansion under the ACA. Congress should work to plug that hole in a cost-effective manner that does not disadvantage the states that elected to expand Medicaid. Medicaid expansion has been linked to fewer bankruptcies and better health outcomes.

We need good paid leave policies.

To limit the spread of infection, the expectation is that people stay home from work when they test positive. This means that people shouldn’t fear losing their job or being unable to pay the bills if they get COVID. To protect workers, we need better sick leave policies. In the U.S., 95% of the highest earning 10% of private employees have paid sick leave, while only 33% of the lowest earning 10% of private employees had paid sick time leave. Given that the virus disproportionately affects low-income people, the U.S. needs to standardize sick leave policies to protect all Americans.

We need to reduce poverty.

Compared to other high-income countries, the U.S. has the worst health outcomes. And while there are many problems with the health care system that make it expensive, difficult to navigate, and otherwise dissuade people from getting needed care, the main reason the U.S. has poor outcomes is because we underinvest in other social determinants of health. If the U.S. invested more in social services for children and working-age adults, it is likely it could close the gap between the U.S. and other high-income countries. More equitable access to good nutrition, education, child care, housing, transportation, and worker benefits helps people live healthier lives that can mitigate the impacts of COVID-19. Poverty rates fell during the early stages of the pandemic because of generous unemployment benefits and stimulus payments. The U.S. should continue efforts to reduce poverty and improve social determinants of health.

With vaccinations, naturally acquired immunity, and other mitigation efforts, COVID-19 is morphing from an acute pandemic to an endemic condition like seasonal flu. But the U.S. can do a much better job reducing infection and death rates. These commonsense steps will protect vulnerable Americans without the need for lockdowns, school closures, and extensive social distancing which made life so difficult over the last 1.5 years.