It’s time to think about the outside of Maskman Date

The pandemic is different than before, but we are still fighting for masks.

Vaccine to prevent most Covid-19 cases Leads to hospitalization Currently widely available and many of the highest risk people access To Treatment to prevent severe illness.. Nevertheless, public attention and policy still focuses on mask obligations such as: Philadelphia is back April 11th.

Should it be? These types of measures still have a role to play, but they are arguably less important than they used to be. Jennifer NuzzoAn epidemiologist who was recently tasked with establishing a new center for pandemic control and response at Brown University’s Public Health School. The pandemic situation has changed, and Nuzzo argues that public health authorities now have sufficient tools to take a more practical and focused approach, but our policies and public health approaches It’s not catching up with reality.

In our conversation, she outlined four areas where our thoughts on pandemics can use reset. She wants a better understanding of what masks can and cannot do. Clarify what the test really tells you. Pivots for longer-term efforts to ensure fair testing, vaccination, and treatment away from emergency measures. And a new focus was on collecting data related to the region.

Overall, Nuzzo wants Americans to better understand the breadth of tools available to the health sector, institutions, and individuals when a Covid-19 case occurs. .. None of her preferred approaches have compulsory obligations, but she needs to allow the public health department to choose different tools at different times.

This conversation has been edited for length and clarity.

Masking is neither the only preventive approach nor the best preventive approach

Keren Landman

How are public health goals different from the early days of the pandemic?

Jennifer Nuzzo

Our current goal is not to prevent infection, but not necessarily to flatten it. It is to keep people away from the hospital and prevent death. We ensure that hospitals are not overwhelmed so that they can continue to provide life-saving medical care not only for Covid patients, but for everything else that may take someone to the hospital. is needed.

Keren Landman

In order to prevent hospitals from being overwhelmed in the big wave of infectious diseases, the health department needs to carry out many preventive interventions, right?

Jennifer Nuzzo

Yes, but much attention has been paid to whether people need to mask. It’s not the only intervention we have, and it’s not even the best intervention.

Look at South Korea and Hong Kong. Despite their very high compliance with public masking, they still had tremendous Omicron waves. I never oppose the mask. I think they are important tools. But I think we sometimes exaggerate how much they actually affect.

Also, I think public health obligations should be used sparingly and only when there is no alternative. You can make more mask recommendations, not obligatory.

Wang Ying / Xinhua via Getty Images

Some people may have a mental model of “putting out a mask every time there is a surge”. I have no problem with that. It’s hard to imagine that society is trying to accept it.

I’m not sure if masks are our most protective tool for now. Many people who don’t wear masks already have Covid, so “I’ve been vaccinated, I already have it. How long do you want me to do this?” And it’s hard to say, “No, you absolutely must wear it.”

I think there are more important interventions besides masking.

Keren Landman

like what?

Jennifer Nuzzo

See how similar Omicron waves occurred in places with very high mask usage in social environments and public places, such as South Korea and Hong Kong. Both countries were just having this big wave incident. It gives me humility in what we can really do to prevent infection.

However, there was a big difference between Hong Kong and South Korea, and the number of cases of hospitalization and death was increasing rapidly in South Korea. [Hong Kong saw high numbers of deaths among older residents.]

What wasn’t in Hong Kong? High vaccination rate.Only around 50% of the elderly and about 20% of nursing home residents I was vaccinated. It’s a recipe for a severe illness explosion — and that’s why they saw a hospital overwhelming. Because those who are most likely to be hospitalized have not been given the full protection needed to prevent it from happening.

So, for sure, you may need to use the mask again. But above all, you need to make sure that qualified people are vaccinated. Especially a booster for the elderly.

Leicester via Getty Images / Media News Group / Inland Valley Daily Bulletin

Tests no longer provide good snapshots of pandemics

Keren Landman

What positive action should public health authorities take now?

Jennifer Nuzzo

There are many other precautions to take, but it feels like we’re lost in the cultural war we’ve been around the mask.

We have our surveillance [i.e., disease detection system] It’s much worse than ever. This is not necessarily because we are trying to prevent all cases, but because we want to detect changes in transmission dynamics early in case of a surge in hospitalization. And that’s difficult now.

Rapid testing is great, but we don’t see any of those positives in surveillance, so we don’t know how many infections are happening in people’s homes.

There are financial impediments to test [such as having to take off work in the case of a positive result] Unless you are ill enough to be hospitalized. In addition, people in hospital often get accidental Covid-19 infections. As a result, our surveillance data is biased towards serious cases.

One of the things we can do is to perform anonymized population representative sampling to try to understand who is infected. It helps to understand the characteristics of people who infect and catch the virus at any time.

Keren Landman

You haven’t brought up wastewater monitoring or syndrome monitoring [tracking trends in health care seeking for flu-like symptoms].. How do you need to use these tools now?

Jennifer Nuzzo

These tools do not actually provide specific information to identify where cases are increasing and the population at risk. These are very dull indicators that something may be happening.

If you work in the public health department and see these signals increasing, that alone won’t tell you what to do. However, you can use these data to say, “The community is more likely to come into contact with the virus, so take additional precautions.”

Between these waves, we spend quiet time trying to immunize people, engaging with community groups, finding return homes, trying to understand vaccine hesitation, and talking to children’s parents about vaccination. You have to do the difficult thing.

The obligation to block and mask is a short-term emergency measure. Now we need fair testing, vaccines, and treatment.

Keren Landman

Do you think obligations and other temporary measures are a wise approach at this stage?

Jennifer Nuzzo

In my view of the world, these other non-pharmaceutical interventions (masks, cancellations, closures) are really great when we are in an acute emergency and have to buy ourselves for a while. They are pause buttons. It does not eliminate the virus, it only reduces its exposure to the virus. But what do you buy time for when you press the pause button?

Not everyone has access to what they need to follow these rules. The biggest is the ability to work from home. Income is actually an important criterion related to your ability to comply with safety recommendations.

The public health sector has the option of responding in a more targeted way, which is what I really want. At this stage, there are many more tools. Mask obligations and shutdowns are very broad, not specifically targeted at the highest risk populations.

Keren Landman

What are some of those other tools?

Jennifer Nuzzo

It’s important to test your community quickly, especially in areas with low access. We started primarily with government-funded test sites, but the involvement of the private sector in testing created inequality. The emergency medical centers and pharmacies where many of them are located do not exist in any particular community.

Joe Raidle / Getty Images

It’s frustrating to me that our approach to expanding rapid testing was internet based. It also created inequality, as not everyone has the ability and resources to do it.

We haven’t done enough to make the treatment more available — we need to solve the whole thing Nirmatrelville Access problems. Knowing if you are qualified and where you can get it is still really, really difficult, and clinicians don’t know how to give it. Improving it is absolutely what we can and should do. … rapidly increasing, Test-to-treat program It is important.

More reliable sources of pandemic data and more research needed

Keren Landman

Are there other tools that the health department can or isn’t aware of in the list of things to do as rates increase?

Jennifer Nuzzo

First of all, not having a good understanding of where Covid is infected is really, really, really frustrating. I really want you to investigate the case and do a mini-epidemiological study. We will conduct a focused outbreak study to better understand how Covid-19 is currently spreading and how to prevent it from happening.

It’s understandable that contact tracing isn’t universal. The goals are different. Contact tracing also aims to locate the case. You don’t need to do contact tracing in all cases because you want to better understand the dynamics of the transmission rather than trying to stop it.

I want a health department to do a case-control study [which compare characteristics of infected cases and uninfected controls] Understand who is catching Covid and who is not. It may help to understand which types of activity and exposure are most likely to cause infection. Regionally, if we find an increase in cases between the ages of 2 and 5, we will deal with it differently than if we had an increase in cases in a nursing home.

Also, I wish I had done more genomic epidemiology to understand who was giving the virus to whom, but I couldn’t launch it in the midst of a surge because of the resources required.

Keren Landman

I’m not sure if the public health department has the resources for many of these things.

Jennifer Nuzzo

I wouldn’t ask them to do this at the end of December [during the omicron BA.1 surge] But now the system should have more bandwidth so that it can do this. If not, it means that there is no system.