How can the U.S. learn to live with COVID-19? Better diagnostic testing is one of three steps that need to happen to achieve a "new normal," a state characterized by substantially lower transmission and mortality from the SARS-CoV-2 virus, according to a viewpoint published on January 6 in JAMA.
"To reduce COVID-19 transmission, achieve and sustain a 'new normal,' and preempt future emergencies, the nation needs to build and sustain a greatly improved public health infrastructure, including a comprehensive, permanently funded system for testing, surveillance, and mitigation measures that does not currently exist," wrote the authors, led by David Michaels, PhD, of the Milken Institute School of Public Health at George Washington University.
The authors organized their anti-COVID-19 strategy recommendations into three categories:
1. A COVID-19 test for everyone suspected of infection
The authors called for access to free or low-cost testing for all persons in the U.S. to determine if they are infected and infectious. They argued that President Joe Biden's plan to distribute at-home rapid tests, while a good step in the right direction, needs to go further.
"The federal and state governments need to ensure these tests are in plentiful supply, free to individuals with Medicaid coverage, and free or low cost to the rest of the population to help individuals who might be infectious avoid transmitting the virus to others in their homes, workplaces, schools, and other settings and to get prompt medical care if needed," the authors wrote.
The authors also recommended a comprehensive testing and reporting system for all viral respiratory illnesses and suggested that the U.S. Centers for Disease Control and Prevention (CDC) take the lead on implementing the system.
"The CDC needs to collect and disseminate accurate real-time, population-based incidence data on COVID-19 and all viral respiratory illnesses," the authors wrote. "The US should not be reliant on extrapolating cases and outcomes from data collected from a few, underrepresentative sites," Michaels et al wrote.
2. SARS-CoV-2 surveillance
The authors proposed three types of SARS-CoV-2 surveillance: environmental, genomic, and vaccine surveillance. Environmental surveillance includes monitoring wastewater and air sampling.
For genomic surveillance, the authors called on the CDC to establish an organized system.
In the case of vaccine surveillance, the U.S. needs to establish a real-time digital surveillance system to monitor vaccinated individuals using an opt-out rather than an opt-in approach.
"The country needs a system organized by the CDC to sequence a far greater and more geographically representative proportion of positive COVID-19 tests than is currently being sequenced, with the results uploaded into global databases in real-time," they wrote.
3. National strategies to reduce virus transmission
To reduce the spread of SARS-CoV-2, the U.S. should implement several mitigation strategies on a national level that effectively reduce the spread of aerosols. One approach is to implement new enforceable Occupational Safety and Health Administration standards, the authors noted.
"Mitigation strategies should be implemented, including new enforceable Occupational Safety and Health Administration standards, especially requiring workplace masking, distancing, and ventilation," they wrote.
One of the most effective strategies is to take well-established public health measures, such as encouraging individuals who are ill to stay home, by providing paid sick leave, the authors noted.
"This requires systematic access to testing and paid sick and family medical leave for all US workers, especially low-wage, temporary, freelance, contractor, and gig economy workers," they wrote.
In addition, a national initiative is needed to ensure U.S. residents have access to and use high-quality filtering facepiece respirators (FFRs) N95 or KN95 masks, as opposed to cloth or surgical masks, to reduce transmission of the virus in crowded indoor settings, Michaels et al noted.
"There needs to be a national initiative to sustainably produce domestic FFRs and ensure they are readily available to all US residents for free or very low cost," the authors wrote. "The government could mail vouchers to US households to pick up FFRs at pharmacies, grocery stores, schools, and other locations."
Other mitigation strategies include upgrades to ventilation and air filtration systems, such as those in schools in the U.S.
Finally, the authors recommend that a system for clear recommendations from trusted public health authorities be implemented to advise local governments and the public on how to navigate the pandemic.
"Such a system would help reduce confusion and guesswork that many individuals face today as they make daily decisions on how to protect themselves," they concluded.