We have previously written about the challenge public health faces in balancing the — sometimes — competing demands of equity and efficiency. Health equity, one of the core principles that animates public health, suggests that we should implement any health-related effort such that those who are most vulnerable are protected first. Efficiency refers to the success of our efforts in promoting the health of populations. These two goals can be aligned much, if not most of the time. We can promote population health while leading, first, with promoting the health of those who are most vulnerable. And when the two principles are in conflict, it is probably generally right to privilege health equity, to help push against injustice that has left some groups lagging on health.
With that in mind, we applaud the principles that have been widely articulated and that have been informing the rollout of the Covid-19 vaccine in the United States. Broadly speaking, these guidelines prioritize vaccination of health care providers and persons who are at high risk of contracting Covid-19, ensuring that those groups are vaccinated before others. This approach correctly recognizes that those at higher risk need to be protected first, and, reassuringly, most states have embraced these principles and have been implementing their vaccination plans accordingly, even establishing fines for any vaccine providers who do not comply with these guidelines.
Decision-making in an age of Covid and social media | The Healthiest Goldfish
Lately, I have been thinking a fair bit about decision-making. Covid-19 has confronted us with a range of significant choices: about whether, and to what degree, to embrace lockdowns, about closing and reopening elementary schools, about who should get the vaccine first, and so on. As we have engaged with these choices, there have been people on both sides making good-faith cases for their point of view. There are some who passionately think we should reopen elementary schools, and there are some who passionately wish to keep them remote-only. There are some who feel lockdowns should remain in place until vaccines are widely distributed, there are others who feel a phased reopening is both feasible and necessary for countering the economic consequences of the pandemic. There are some who think vaccine priority should be guided exclusively by who is likeliest to die from the virus and there are some who favor an equity-based approach which accounts for the historic disadvantage that creates health gaps.
These choices have in common their deep ramifications for health, and the quality of being difficult to get completely right. Indeed, I have yet to see anyone suggest a resolution to any of the issues I have just mentioned that both elides costly health and economic tradeoffs and manages to satisfy everyone. (If you, the reader, can name an instance where this needle has been successfully threaded, please do let me know in the comments section below. I am interested to hear about it.)
Read the full article on The Healthiest Goldfish.
Should We Be More Upset by This? | The Turning Point
The world was upended during 2020 by Covid-19. As we struggled with the pandemic, much of life as we knew it ground to a halt. We watched case numbers, anguished over severe cases, and waited for a vaccine. We started talking about the potential for a vaccine as early as March, giving us what turned out to be more than eight months of lead time to be ready for the rollout once we had vaccines approved.
Vaccines finally arrived in December, and the rapid distribution that could save lives, more or less, did not happen. And we all fretted again and wrung our hands in frustration. But have we been upset enough that a vaccine rollout that we knew was going to be needed, and we knew would be happening soon enough, has essentially been sub-par at best, botched at worst? Has there been enough vaccine activism to try to fix this?
We suggest that this has not upset us as much as it should have, and we have not seen outraged calls for fixing the problems, for a number of reasons.
Read the full piece here.
A case against moralism in public health | The Healthiest Goldfish
Covid-19 has been, in many ways, a high watermark moment for public health. Over the last year, health authorities have engaged with the public, with the goal of influencing behavior in order to save lives. And the public has largely listened, making drastic changes to their lives in the name of health.
A key reason, perhaps, that public health advice has so resonated is that it has tried to offer clarity in the midst of a disorienting moment. This clarity comes largely from our data. Throughout Covid-19, public health recommendations have largely been supported by our growing knowledge of the disease. For example, the data reliably show that the virus spreads through the air, via person-to-person contact. This allows us to clearly say that masks and physical distancing are an effective means of slowing the disease’s spread. This clarity has led to the widespread embrace of these measures, which have come to define our response to Covid-19.
How Federal Dollars Can Incentivize a Stronger Response to Covid-19 | Barron's
Authored by: Efthimios Parasidis, Amy Lauren Fairchild, Sandro Galea, Cheryl Healton, and James W. Curran
A year into the pandemic, Covid-19 continues to spread. In large part this is due to widespread failure to institute and enforce evidence-based public health measures, including protocols for testing, universal masking, distancing, and isolation and quarantine. The Biden administration issued an order requiring masking in all federal buildings, a testing program for federal employees, and masking on all forms of transportation. While these are smart, swift moves, more is required for the United States to be a world leader in pandemic response and prevention.
The spread of new variants of concern—that are more transmissible, possibly more lethal, and potentially reduce the efficacy of our current menu of vaccines—makes it important to shore up layers of prevention that we know work. While vaccinations are safe and effective in preventing symptomatic Covid-19, strong efforts will be required to maintain additional public health policies as vaccine roll-out picks up speed. Vaccination, at this stage, is another protective layer in a comprehensive strategy, not a panacea that will end the pandemic.
What's most important | The Turning Point
The degree of protection afforded by any vaccine can be understood in terms of its efficacy and its effectiveness. The distinction between the two terms is important. Efficacy refers to the reduction in biologically proven illness (detected serologically or via culture of the virus from the patient), whereas effectiveness refers to the reduction in clinical consequences, which, for infectious disease like influenza or Covid-19, includes pneumonia, hospitalization, and death.
The influenza vaccine has a variable efficacy; it is not terrific at preventing infections (50%) in years where the vaccine is not well matched to circulating strains of the virus, better (90%) when it is. But the more important purpose of getting vaccinated is in preventing hospitalizations and death. The flu vaccine reduces hospitalization by 90% in healthy adults. More importantly, it decreases the risk of death in the elderly, where most deaths occur, by 20-50%.
The stimulus is necessary medicine | The Healthiest Goldfish
Imagine the day you, the reader, get the COVID-19 vaccine. Think about what that day will look like. You will wake up in your home or apartment. You will shower. You will eat breakfast. You will get in your car, perhaps using your smartphone for directions to the vaccination site. Then you will go get the vaccine. Which of these activities will be most supportive of health? You might say getting the vaccine. But imagine what your day would be like if you got the vaccine, but took none of the other actions. Imagine you do not wake up in a home because you do not have one, or perhaps you have one but it lacks the reliable water and heating that allow you to shower and stay warm in winter. Imagine you skip breakfast because you have no food. Imagine you walk to the vaccination site (say, three or four miles) because you have no car. Imagine you spend an extra hour outside because you get lost without a smartphone to help you navigate. You get the shot, but how healthy can you really be, if you get it in such a context? Important as the vaccine is for you, it is clear that if your life continues to unfold amid such deprivation, it will not be healthy, and may not even continue very long.
Political Decisions and Science | The Turning Point
The Boston Globe, our local newspaper, led with a story last month entitled “A warning on relaxing too soon," subtitled “Epidemiologists say take it slow after Baker eases some pandemic restrictions." The article noted that, citing an improvement in the pandemic curve, Massachusetts Governor Baker announced an overnight advisory for residents and that he would relax rules requiring many restaurants to close at 9:30 PM. The article went on to quote several experts about this, all of whom warned that this adjustment came too soon. Tellingly to our mind, one of the experts quoted was “not privy to all the data the Baker administration has and acknowledged that there are economic and psychological factors to consider when it comes to assessing restrictions.”
We could not agree more and argue strongly that fundamentally decisions about societal actions — including around Covid-19 — have to be political decisions that include the science but also must balance a range of other considerations. In the same weekend for example, we saw stories about surges in suicides among school-age children in Las Vegas, resulting in school re-opening, a scenario long anticipated by the CDC. Surely such reports should be a consideration in decisions made to maintain or relax restrictions.