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Bbefore the Covid-19 vaccines, public health officials fought the pandemic with the only tools they had: mask wearing, social distancing, school closures and limits on the size of gatherings.
Now, with cases on the rise again across much of the United States due to the highly transmissible Delta variant, these tools could still make a measurable difference at a critical time – but not if the public is unwilling to use them.
A year and a half after the Covid restrictions were first implemented, people have had it with the pandemic. Other than highly effective vaccines, which have not been accepted by enough people to reverse the spread of the new variant of SARS-CoV-2, there are no new tools in the public health toolkit. , and people have absolutely no interest in reusing whatever it contains.
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These feelings indeed tie the hands of exhausted health officials.
“There’s not a lot of movement left to make, I think, because we’ve gone beyond most of the non-pharmaceutical measures and I don’t think the political appetite is really there to re-implement them.” , Caitlin Rivers, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, told STAT.
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Some jurisdictions, notably in Southern California, have once again made it compulsory to wear masks indoors; some, like New Orleans, advise it. But, in other areas, public hostility to mask wearing and social distancing makes it difficult to know whether these tools would still be effective if health authorities attempted to use them again, a. said Wendy Parmet, director of the Center for Health Policy and Law at North East University School of Law.
“It is also possible that the use of [these] authorities in some places would be ineffective, even counterproductive, because people are so locked up, ”she said.
More transmissible than its predecessor, Delta causes a spike in cases in a number of parts of the United States, largely but not exclusively in unvaccinated people. States with low vaccination rates – Arkansas, Louisiana, Mississippi to name a few – are seeing large increases. On Tuesday, Rochelle Walensky, director of the Centers for Disease Control and Prevention, revealed that 83% of viruses sequenced in the United States are now Delta variant viruses.
Nirav Shah, director of the Maine Center for Disease Control and Prevention, spent the past weekend trying to strategize on how to deal with Delta. Among the “what ifs” he debated with himself was whether the people of his state would agree to wear masks again, if Maine officials made that recommendation.
On the one hand, he thought, it would be mostly about trying to persuade the vaccinated people – people who had already “shown a predilection to take care of themselves and others” – to readopt. masks. On the other hand, these people have already done what they were asked to do; they got vaccinated. Telling them what was supposed to be their Covid exit wasn’t the end of the trip – it might not go well, he thought.
“I was saying to my wife… in public health, we like the belt and suspenders approach,” Shah said. “For people who have been vaccinated, it will be the belt or the suspenders. And in their mind, they have their thing. They have their belt. So, it’s going to be a challenge.
People have come out of the pandemic mentally, Shah said, noting that the virus had not even appeared when he spoke with neighbors recently. Instead, they feared their children would be bitten by ticks while hiking.
“As humans, we only have enough mental bandwidth to be afraid of things. And because Covid is no longer a mystery and a novelty, I think in the minds of a lot of people it’s over, ”he said.
Shah, who is president of the Association of State and Territorial Health Officials, noted that authorities in some states face a structural problem when they now think about measures to control Covid. Some governors have ended the state of emergency in their jurisdictions. As a result, some of the special commands that were used earlier may be out of reach.
And in a number of other states – those with high resistance to Covid control measures – elected officials have banned certain public health tools. North Dakota enacted legislation prohibiting health authorities from requiring anyone to wear a mask, for any reason. Montana has banned the quarantine of people who have come in contact with someone infected with a communicable pathogen, depriving health officials of one of the oldest known disease control techniques.
A report released in late May by the National Association of County and City Health Officials and the Network for Public Health Law found that at least 15 states had taken action to tie the hands of health authorities. Parmet, who worked on the report, said some of these measures, taken in the heat of the moment, will likely have implications for controlling diseases like measles and tuberculosis after Covid is just a bad one. memory.
Courts have also overturned some public health measures, including those that limited the number of people who can attend in-person religious services. In Wisconsin, the state Supreme Court overturned a stay-at-home order – at a time when even the Trump administration was urging people to restrict their movements to slow the spread of SARS-2.
Traditionally, courts and legislatures have supported emergency public health actions, Parmet said. But not so much.
“Now you have to think two, three, four times, ‘Can I do this? Should I start granting religious exemptions? And if I have to get religious exemptions, how can I enforce them for everyone? ‘ She noted. “There is certainly a questioning attitude from public health authorities on the federal bench and in some state courts.”
Rivers believes many of the control measures used earlier in the pandemic are not applicable now, although she believes people could be persuaded to resume wearing masks. She believes, however, that the way to make it acceptable is to link the need for measures to the vaccination of small children, who cannot yet be vaccinated; once children under 12 can be vaccinated, people need to be told that the masks can be put away.
“I think there has to be some sort of exit strategy,” she said. “I think that’s what helps people understand that it’s not forever.”
The use of vaccination mandates by some employers or institutions should also help, Rivers said, although in the absence of a national vaccine mandate – which is not on the cards – the effect will be piecemeal. , benefiting the community in which a business or university, say, is located. “Large institutions can penetrate quite deeply into communities,” she said.
Jeffrey Duchin, head of health for the Seattle and King County Department of Public Health, shares the frustration and concern of others in his field. But he believes communities will take action to try to control Covid – when they reach the point where they believe the threat to them is real.
“I think people can change the way they think as Delta becomes more prevalent and they see more illnesses, hospitalizations and deaths in their immediate personal experience,” said Duchin, who is also a professor of infectious diseases at the University of Washington.
“Regarding the toolkit, we have great vaccines. We have mitigation measures that work like masking, distancing, improving indoor air quality. So you know when people decide they want to do something, we have tools that work, ”he said. “I thinks you have to see long term because it’s not going to go away.
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