As the summer ends and fall begins, COVID-19 continues to thwart the celebrations we had all planned to mark the fading of the pandemic in the United States. Instead, anxiety and foreboding have become more common as we look ahead. And everyone is wondering: What’s next?
President Biden’s new pandemic plan recognizes the urgency and challenges of this moment. Americans seem to have hit a wall on vaccinations, and the Delta variant is sending too many, almost all unvaccinated, to hospitals and deadly illness. Children are returning to schools, workers to their workplaces, and the air is starting to get a bit cooler, signaling that outdoor activities will become harder. It is understandable why so many Americans are feeling a sense of dread and worrying that we are returning to 2020, when the pandemic hit.
We are not. Things are different, and much, much better. We have all the weapons to win this fight against COVID — research, data, experience demonstrating what is effective. We no longer lack the tools. We must begin to deploy them more effectively in ways that avoid another fall and winter surge.
By this point, we had hoped to be at a different stage in the pandemic. With three vaccines made widely available — one of which, Pfizer, now has full FDA approval — and more than 178 million Americans fully vaccinated, expectations were high for a return to normalcy. But the Delta variant is feeding a record surge in cases and hospitalizations, and even in highly vaccinated states like those in New England, cases are rising because of communities that remain largely unvaccinated. And of course, because we all ultimately live in one larger community, the wildfire that is the Delta variant ravaging unvaccinated communities is sending embers and starting small fires in vaccinated ones.
Last year at this time, we were in a far more vulnerable position and the strategy was simple: Protect lives and health until the cavalry (vaccines) arrives. Well, the cavalry is here and we have vaccines. And they are working. Biden is right to mandate vaccinations for federal workers and contractors.
In all six New England states, for instance, at least 60 percent of the entire population is fully vaccinated. Combining immunity gained from vaccinations and prior infections, probably three out of every four New Englanders have some degree of immunity against this virus. Not enough to suppress the virus altogether (a threshold that some refer to as herd immunity), but enough to prevent a run on our hospitals. Vaccines do a great job of reducing severe illness and turning a serious disease into a mild one. But we can do better. We can suppress even the level of mild infections we have, protect the immunocompromised and children who aren’t vaccinated, and get on with our lives.
The first thing we have to do is substantially ramp up testing capacity, as Biden recognizes. Testing during a pandemic should be ubiquitous, fast, and free. We have the technology. Dozens of rapid antigen tests are sitting, awaiting authorization by the Food and Drug Administration. There are high-quality fast tests available on the market. And the American Rescue Plan has allocated billions of dollars to testing so businesses, schools, and individuals can access them without worries about cost.
Yet, it isn’t happening. Tests, both laboratory and at-home tests, are hard to find. People weren’t using them because of lack of clear guidance about their utility and where to find them. And thus, companies weren’t producing them in the quantities we need. We are caught in a vicious cycle that only the government can undo in short order. States are sitting on billions of dollars in federal relief. They should commit to buying millions of these tests and make them widely available. For free. They should also provide guidance on how people should use these tests as we get into the winter and seasonal viruses become more common.
Another tool that gets too little attention is ventilation and filtration. COVID is primarily a problem of contaminated air — air we breathe contaminated by an infected person breathing out infectious aerosols. One way to reduce risk is to clean the air, which will help prevent the spread of COVID-19. Improved ventilation can create healthier environments in offices and schools. Here too, the markets are working too slowly and ineffectively. Companies are selling snake oil — ionzers and other air purifiers that are expensive and largely don’t work. We need buildings upgraded with high-quality filters and air cleaners that are relatively inexpensive to purchase and install. This is a school safety issue. This is a worker safety issue. Public policy makers should be spearheading the effort to make indoor air safe.
Finally, there is a cheap and easy tool that is too often politicized. Masking. Alone, masks are not the solution, but they provide an important layer of protection. When infection rates are high in a community, it’s a good idea to wear masks indoors, regardless of vaccination status. When rates are low, a risk assessment should follow. Are you vaccinated? Do you live or interact with others who are not vaccinated? Are you or those around you immunocompromised? Are you in crowded spaces? The bottom line is that masks are an important tool, and we should use them as needed to get infection numbers low.
We are not done with COVID-19 and, importantly, this virus is not done with us. There is no super cure, or superhero, coming to save the day. As we look to the fall and winter, the numbers, the stories can all feel disheartening. But that would be a misreading of the moment we are in.
We can now finally diminish COVID. The cavalry has arrived. We have all the tools. Vaccines. Testing. Improved ventilation. Masking. It is incumbent on all of us to commit to action on each. Get more people vaccinated by talking to your friends and neighbors who are not, with kindness and understanding. Continue to make vaccines widely available. To businesses: Require vaccines for your employees, to create a safe work environment. To policy makers: Please make sure testing is everywhere, in every venue. And focus on cleaning indoor air. It’s neither that hard nor that expensive. At workplaces and in classrooms. In stores and concert halls. And for all of us: Wear a mask indoors when infection numbers are high, to protect yourself and to protect others.
If we do these things, we can make sure we’ll have a good fall and winter. Our kids can remain in school without outbreaks. Our hospitals can remain open for all the needs of our population. And our economy can come back fully. We can do this. September is here. The air is getting cooler. It’s time to get going.
Dr. Ashish K. Jha is dean of the Brown University School of Public Health and a professor of health services, policy, and practice.