Let’s Lead with a Science-First Approach to Opening the Country
Finally, some good news.
by Lindsey Leininger, Ph.D., MA and Eve Bloomgarden, MD
COVID cases, deaths, and hospitalizations are on the decline in many states, including Illinois. As health care professionals we honor what the declines represent: fewer long, scary battles with this devastating virus among our chronically ill patients; lives saved. But as scientists, we simultaneously fear the rising drumbeat of voices calling for a complete and immediate “re-opening” of society. While we’d certainly prefer it to suggest otherwise, the evidence clearly indicates the need for caution. We urge leaders to adopt a “science-first” approach in phasing out social distancing measures.
What does a science-first approach look like?
In our most recent letter to Governor Pritzker, we emphasized that a plan to relax social distancing required testing, contact tracing with isolation of positive cases, and of course treatment. Indeed, in Tuesday’s press conference, he emphasized that a science-first approach requires the ability to “test, trace, and treat.” It also requires humility in the face of the virus – University of Wisconsin-Madison epidemiologist and science communicator Malia Jones explains having scaled this first COVID “peak” does not mean we are safely down the mountain. We must also learn from the hard lessons of history – the second wave of the Spanish flu was the deadliest, and the behavior of earlier coronaviruses suggests that we’re in for a long, hard slog, likely requiring repeated periods of difficult social sacrifices.” Harvard’s Mark Lipsitch – perhaps the preeminent academic infectious disease epidemiologist -- warns that social-distancing measures of some degree will be required through at least 2022. It’s a bracing message, to be sure, with difficult economic and social consequences. Unfortunately the economic experts’ recommendations are similarly pessimistic with respect to the need for continued short-term sacrifice. The International Monetary Fund recommends aggressive near-term social distancing as the least-bad of current economic policy options. CEOs advising the President are also urging caution. They rightly argue that a prolonged battle against multiple COVID waves would lead to deepening economic woes.
Additionally, we need to buy time for scientists to build up an arsenal of available treatments and to test candidate vaccines. Simply put, science cannot be sped up. We cannot afford to make mistakes. It takes time and sufficient numbers of patient populations to understand drug effectiveness and safety. While we live through this painful waiting game, we must resist the temptation to follow advice guided by political “instinct.” We must continue to listen to the experts who understand and interpret real-time data on health system capacity. Their experiences will remain a key sentinel indicator as broader population testing ramps up.
A science-first approach also requires strategies to reduce the uncanny ability of SARs-CoV-2 to exploit the vulnerable. Demographers and epidemiologists continue to produce rigorous empirical estimates highlighting the unevenness of COVID’s impact. Their initial findings have been widely disseminated and are now well-known: frail elders are the most susceptible to dying from COVID; individuals with preexisting conditions have elevated risk for bad outcomes; African-Americans are experiencing a disproportionate share of deaths and serious illness relative to other groups. Millions of people have lost their jobs, translating into levels of economic vulnerability our society hasn’t experienced since the Great Depression. A large body of scientific work demonstrates that unemployment is both an economic and a psychological devastation. Importantly, fighting economic fragility will protect all of society: Economists have demonstrated a link between weak labor markets and crime rates.
The country is united in wanting to reopen, the question is when and how. A science-first approach is key to ensuring that our decisions are informed and will not result in a path that leads to more deaths and prolonged economic depression. Therefore, we must come together and commit to a science-first approach, starting with a plan to test, trace, and treat that is partnered with a focus on supporting the most vulnerable. We strongly support the actions of policymakers, including Governor Pritzker, whose approaches to date have exhibited these principles.