tag:theconversation.com,2011:/institutions/university-of-texas-health-science-center-at-houston-2126/articlesThe University of Texas Health Science Center at Houston2023-05-17T12:41:07Ztag:theconversation.com,2011:article/2057222023-05-17T12:41:07Z2023-05-17T12:41:07ZPivotal points in the COVID-19 pandemic – 5 essential reads<figure><img src="https://images.theconversation.com/files/526612/original/file-20230516-37571-gp5zr6.jpg?ixlib=rb-1.1.0&rect=43%2C28%2C9547%2C5161&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">SARS-CoV-2, the virus that causes COVID-19, has evolved over time into multiple variants and sublineages. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/coronavirus-royalty-free-image/1366654397?phrase=covid+virus&adppopup=true">loops7 / E+ via Getty Images</a></span></figcaption></figure><p>Experts have made it clear that the <a href="https://theconversation.com/what-does-ending-the-emergency-status-of-the-covid-19-pandemic-in-the-us-mean-in-practice-4-questions-answered-205165">end of the COVID-19 national emergency</a>, which was lifted on May 11, 2023, <a href="https://www.statnews.com/2023/05/10/public-health-emergency-ashish-jha/">does not mean an end to the pandemic</a>. But this shift signals a remarkable turning point in a pandemic that is well into its fourth year – something that few could have imagined when the U.S. national emergency went into effect in March 2020. </p>
<p>Likewise, the World Health Organization’s announcement on May 5 that it was <a href="https://www.statnews.com/2023/05/05/who-declares-end-to-covid-global-health-emergency/">ending the COVID-19 public health emergency of international concern</a> that had been in place since January 2020 is indicative that the pandemic has entered a new chapter. </p>
<p>It’s daunting to look back at our coverage and narrow it down to just a handful of standout stories amid all the twists and turns of the pandemic. But here are five stories from The Conversation’s archives that resonated with us, written by scholars who helped to illuminate complex issues at pivotal moments in the pandemic.</p>
<h2>1. A whole new vocabulary</h2>
<p>It’s a little hard to remember the days when words like pandemic, endemic diseases, mRNA, variant and spike proteins were not a part of our vernacular or everyday conversations. But I vividly recall the day that the COVID-19 pandemic was declared and a friend asked me “What exactly is a pandemic?” It turns out a lot of people were asking that question and wondering about the difference between an outbreak of an infectious disease, an epidemic and a pandemic.</p>
<p><a href="https://public-health.tamu.edu/directory/fischer.html">Rebecca S.B. Fischer</a>, an assistant professor of epidemiology at Texas A&M University, <a href="https://theconversation.com/whats-the-difference-between-pandemic-epidemic-and-outbreak-133048">put it in straightforward terms</a>: An outbreak is a small but unusual increase in the expected number of cases of a given disease, while the term epidemic is used when an infectious disease outbreak is getting bigger and spreading over a broader geographic area. A pandemic, on the other hand, is used when a disease is “international and out of control.”</p>
<p>She went on to say that some epidemiologists reserve the term pandemic for when a disease is being sustained in newly affected regions through local transmission – a good characterization of the state of COVID-19 in March 2020.</p>
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<a href="https://theconversation.com/whats-the-difference-between-pandemic-epidemic-and-outbreak-133048">What's the difference between pandemic, epidemic and outbreak?</a>
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<h2>2. Comparisons to the 1918 flu ran rife</h2>
<p>From the earliest days of the COVID-19 pandemic, it was impossible to miss the haunting similarities between it and the 1918 flu pandemic, which led to at least 50 million deaths worldwide between 1918 and 1920. Health care experts and the media made frequent comparisons between the two, pointing to similarities in attitudes about mask-wearing and school closures as well as in the patterns of disease waves, spikes and surges.</p>
<p>But while the two once-in-a-century events have shared plenty of likenesses, the comparison also sometimes <a href="https://theconversation.com/compare-the-flu-pandemic-of-1918-and-covid-19-with-caution-the-past-is-not-a-prediction-138895">led to public misunderstandings about how the COVID-19 pandemic could play out</a>, wrote historian <a href="https://www.history.pitt.edu/people/mari-webel">Mari Webel</a> and pediatric infectious disease specialist <a href="https://www.pediatrics.pitt.edu/people/megan-culler-freeman-md-phd">Megan Culler Freeman</a>, both from the University of Pittsburgh. They explain that key differences in the sociopolitical context of the 1918 flu period, as well as marked differences between the virology behind the two diseases, set the 1918 flu and COVID-19 on different paths.</p>
<p>“People seek answers from the experiences of influenza in 1918-19 for a fundamental reason: It ended.”</p>
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Read more:
<a href="https://theconversation.com/compare-the-flu-pandemic-of-1918-and-covid-19-with-caution-the-past-is-not-a-prediction-138895">Compare the flu pandemic of 1918 and COVID-19 with caution – the past is not a prediction</a>
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<span class="caption">French men in 1919 Paris holding signs urging others to wear masks and to fight the flu. Much like in the COVID-19 era, wearing masks to protect against the deadly influenza was embraced by some, while others resisted and refused.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/two-men-wearing-and-advocating-the-use-of-flu-masks-in-news-photo/3333532">Topical Press Agency / Hulton Archive via Getty Images</a></span>
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<h2>3. How and when pandemics end</h2>
<p>In late 2020, people were naturally wondering when and how the COVID-19 pandemic would end, and how we would know it was over.</p>
<p><a href="https://sasn.rutgers.edu/about-us/faculty-staff/nukhet-varlik">Nükhet Varlik</a>, a historian from Rutgers University who studies disease, medicine and public health, wrote an astute piece in October 2020 about the difficulties of <a href="https://theconversation.com/how-do-pandemics-end-history-suggests-diseases-fade-but-are-almost-never-truly-gone-146066">predicting how the pandemic might play out</a>. She presciently noted that “whether bacterial, viral or parasitic, virtually every disease pathogen that has affected people over the last several thousand years is still with us, because it is nearly impossible to fully eradicate them.” These include diseases like tuberculosis, leprosy, measles and plague.</p>
<p>“Hopefully COVID-19 will not persist for millennia,” Varlik wrote. But she went on to say that politics are crucial, noting how when vaccination programs are weakened, infections can “come roaring back.”</p>
<p>“Given such historical and contemporary precedents, humanity can only hope that the coronavirus that causes COVID-19 will prove to be a tractable and eradicable pathogen. But the history of pandemics teaches us to expect otherwise.”</p>
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<a href="https://theconversation.com/how-do-pandemics-end-history-suggests-diseases-fade-but-are-almost-never-truly-gone-146066">How do pandemics end? History suggests diseases fade but are almost never truly gone</a>
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<h2>4. The midway point</h2>
<p>The summer of 2021 felt like a particularly grueling moment in time – when excitement and optimism over the launch of the first vaccines to protect against COVID-19 had given way to despair over the stronghold of vaccine resistance and general exhaustion with all things COVID. And then came the delta variant. </p>
<p>Epidemiologist <a href="https://scholar.google.com/citations?user=t3nqdNQAAAAJ&hl=en">Katelyn Jetelina</a>, formerly from the University of Texas Health Science Center at Houston, captured <a href="https://theconversation.com/18-months-of-the-covid-19-pandemic-a-retrospective-in-7-charts-166881">18 months of the COVID-19 pandemic in a series of seven retrospective charts</a> that put all of the high and low points into stark relief. “The race between vaccination and variant spread was upon us,” Jetelina wrote. “The fight was far from over.” </p>
<p>The same may still be true today.</p>
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<h2>5. How omicron altered the course of the pandemic</h2>
<p>When the omicron variant arrived on the scene in late 2021 and spread globally in early 2022, it soon became clear that it could bring about a shift in the pandemic. With its ability to spread easily and to also cause milder disease than prior variants, omicron had the potential to act as a natural vaccine of sorts – producing widespread immunity with the help of the existing COVID-19 vaccines.</p>
<p>But the omicron variant had plenty of surprises in store. For one, it gave rise to a family of variants and sublineages that to this day are keeping researchers guessing, with the latest omicron subvariant, XBB.1.16, gaining ground across the U.S. and worldwide as of mid-May 2023.</p>
<p>In January 2022, immunology researchers <a href="https://sc.edu/study/colleges_schools/medicine/about_the_school/faculty-staff/nagarkatti_prakash.php">Prakash Nagarkatti</a> and <a href="https://sc.edu/study/colleges_schools/medicine/about_the_school/faculty-staff/nagarkatti_mitzi.php">Mitzi Nagarkatti</a>, from the University of South Carolina, <a href="https://theconversation.com/is-the-omicron-variant-mother-natures-way-of-vaccinating-the-masses-and-curbing-the-pandemic-175496">explained how the immune system responds to infections</a> and how it remembers those threats through “immunological memory.” </p>
<p>This left room for hope, they wrote, that “when new variants of SARS-CoV-2 inevitably arise, omicron will have left the population better equipped to fight them. So the COVID-19 vaccines combined with the omicron variant could feasibly move the world to a new stage in the pandemic – one where the virus doesn’t dominate our lives and where hospitalization and death are far less common.” </p>
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<a href="https://theconversation.com/is-the-omicron-variant-mother-natures-way-of-vaccinating-the-masses-and-curbing-the-pandemic-175496">Is the omicron variant Mother Nature’s way of vaccinating the masses and curbing the pandemic?</a>
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<p><em>Editor’s note: This story is a roundup of articles from The Conversation’s archives.</em></p><img src="https://counter.theconversation.com/content/205722/count.gif" alt="The Conversation" width="1" height="1" />
With the emergency phase of the COVID-19 pandemic in the rearview mirror, at least for now, we look back on a handful of stories that provided sharp insights at key moments in the pandemic.Amanda Mascarelli, Senior Health and Medicine EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1804882022-04-13T12:15:43Z2022-04-13T12:15:43ZDo you need a second booster shot? An epidemiologist scoured the latest research and has some answers<figure><img src="https://images.theconversation.com/files/456233/original/file-20220404-30995-ylbsxy.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5382%2C3591&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The CDC recommends the second booster for those over 50 who received their initial booster shot at least four months earlier.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/shana-alesi-administers-a-second-covid-19-booster-shot-to-news-photo/1388972345?adppopup=true">Scott Olson via Getty Images News</a></span></figcaption></figure><p>In late March 2022, the U.S. Food and Drug Administration <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-second-booster-dose-two-covid-19-vaccines-older-and">authorized a second booster shot</a> of COVID-19 vaccines for vulnerable populations in the U.S., a move that was <a href="https://www.cdc.gov/media/releases/2022/s0328-covid-19-boosters.html#">soon after endorsed</a> by the Centers for Disease Control and Prevention. People ages 50 years and older and certain immunocompromised individuals who are at higher risk for severe disease, hospitalization and death are eligible four months after receiving the initial booster shot.</p>
<p>A second booster shot is equivalent to a fourth dose for people who received a <a href="https://theconversation.com/how-effective-is-the-first-shot-of-the-pfizer-or-moderna-vaccine-156615">Pfizer-BioNTech or Moderna mRNA series</a> or a third dose for those who received the <a href="https://theconversation.com/new-johnson-and-johnson-data-shows-second-shot-boosts-antibodies-and-protection-against-covid-19-but-one-dose-is-still-strong-against-delta-variant-168463">single-shot Johnson & Johnson vaccine</a>.</p>
<p>In Israel, people in these same vulnerable categories <a href="https://doi.org/10.1038/d41586-022-00200-9">began receiving fourth doses</a> in January 2022. The U.K. recently started administering a fourth dose for people <a href="https://www.bbc.com/news/health-55045639">75 years and older</a> and coined it a “<a href="https://www.gov.uk/government/publications/covid-19-vaccination-spring-booster-resources/a-guide-to-the-spring-booster-for-those-aged-75-years-and-older-residents-in-care-homes">spring booster</a>.” In Germany, those <a href="https://www.dw.com/en/coronavirus-german-health-minister-calls-for-4th-covid-19-shot/a-61294978">over 60 years old</a> are now eligible for a fourth shot of the mRNA series. </p>
<p>I am an epidemiologist at the <a href="https://scholar.google.com/citations?user=t3nqdNQAAAAJ">University of Texas Health Science Center</a> School of Public Health and founder and author of <a href="https://yourlocalepidemiologist.substack.com/">Your Local Epidemiologist</a>, a newsletter translating the latest public health science for everyday use. </p>
<p>The latest recommendations have left many wondering about the importance of boosters for protection against COVID-19. Does the third shot wane over time? Is a fourth dose necessary? What if you’ve had a previous infection? </p>
<p>After reviewing the mounting body of research on how the immune system shifts over time following each dose, it is clear that another booster for vulnerable populations has meaningful benefit with very little risk. </p>
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<figcaption><span class="caption">The FDA’s authorization provides the option of a second booster shot for vulnerable populations, but the agency stopped short of making it a broad recommendation.</span></figcaption>
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<h2>Vaccine effectiveness following the first booster dose</h2>
<p><a href="https://doi.org/10.1038/s41591-022-01727-0">There is clear evidence</a> that a third dose of the mRNA series – or the first booster dose – was and still is critical for ensuring a robust immune response against <a href="https://theconversation.com/will-omicron-the-new-coronavirus-variant-of-concern-be-more-contagious-than-delta-a-virus-evolution-expert-explains-what-researchers-know-and-what-they-dont-169020">the omicron variant</a> for all age groups. This is in part because the immune response <a href="https://doi.org/10.1038/s41591-022-01727-0">wanes over time</a> and also in part because omicron has proved to be partially effective at evading immunity from the existing COVID-19 vaccines and from prior infections.</p>
<p>But then the question becomes: How well is immunity from the first booster holding up over time? </p>
<p>The best real-time data to follow on vaccine effectiveness over time is in the U.K. The U.K. Health Security Agency currently has follow-up data for 15 weeks after the third dose, or first booster shot. <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1063023/Vaccine-surveillance-report-week-12.pdf">In its latest report</a>, the effectiveness of vaccines against infection wanes significantly after a third dose. In the U.K. report, vaccine effectiveness against hospitalization is holding up much better compared to effectiveness against infection. But even protection against hospitalization is slightly decreasing over time. While this data is insightful, 15 weeks of follow-up data isn’t very helpful in the U.S. because many Americans got their third dose up to 24 weeks ago.</p>
<p>A <a href="https://doi.org/10.1056/NEJMc2119912">recent study</a> assessed the durability of a Moderna third dose after six months. Researchers found waning levels of neutralizing antibodies six months after the booster. The CDC <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7107e2.htm?s_cid=mm7107e2_w">also found significant waning protection</a> against emergency department and urgent care visits five months after the first booster. Vaccine effectiveness against hospitalization decreased a little but largely held up five months after the booster.</p>
<p>The studies mentioned above pooled all age groups. But researchers know that older adults don’t mount as durable an immune response as younger people. This explains why breakthrough infections have occurred at a much <a href="https://www.kff.org/coronavirus-covid-19/press-release/breakthrough-covid-19-hospitalizations-among-fully-vaccinated-patients-occur-most-often-among-older-adults-and-involve-people-with-chronic-health-conditions/">higher rate</a> among people ages 65 and up. A recent study in the Lancet <a href="https://doi.org/10.1016/S1473-3099(22)00135-9">assessed the durability of a third dose</a> among people ages 76 to 96 years old. Researchers found that the third dose improved neutralizing antibodies, but in the face of omicron, antibodies still dropped substantially following a booster.</p>
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<figcaption><span class="caption">President Biden gets his second booster shot on camera, and Dr. Anthony Fauci discusses the benefits of a booster.</span></figcaption>
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<h2>Data on the second booster dose/fourth shot</h2>
<p>Now that Israel has been delivering a fourth dose for several months, researchers have some data to rely on to assess its effectiveness. There are three studies that have been released so far, one which has not yet been peer-reviewed. </p>
<p>In one study published in the New England Journal of Medicine, scientists assessed the <a href="https://doi.org/10.1056/NEJMoa2201570">rates of infection and severe illness after a fourth dose</a> – or second booster – among more than a million people ages 60 and older in Israel. The researchers found that after a fourth dose, the rate of COVID-19 infection was two times lower than after a third dose. However, this protection quickly waned after six weeks. They also found the rate of severe disease was four times lower compared to those who received only three doses. It’s important to note, though, that hospitalizations among both groups were very low. </p>
<p>Importantly, <a href="https://doi.org/10.1056/NEJMc2202542">another study</a> assessed the effectiveness of a fourth dose among younger health care workers in Israel. The results confirmed that antibody levels dropped significantly five months after the third dose. Unfortunately, the effectiveness of the fourth dose was no different from the effectiveness of a third dose in this population of younger health care workers. In other words, there may not be meaningful benefit of a second booster of the same formula for young, healthy populations. </p>
<p>Researchers carried out a third study, <a href="https://doi.org/10.21203/rs.3.rs-1478439/v1">one that has not yet been peer-reviewed</a>, at a large health care system in Israel among people aged 60 to 100 years. Among 563,465 patients in the health care system, 58% received a second booster. During the study period, 92 people who received the second booster died compared to 232 people who had only the first booster. In other words, the second booster equated to a 78% reduction in death compared to the first booster alone. </p>
<h2>What if you had a COVID-19 infection with omicron?</h2>
<p>The combination of being both vaccinated and having experienced a COVID-19 infection is called “<a href="https://theconversation.com/how-long-does-protective-immunity-against-covid-19-last-after-infection-or-vaccination-two-immunologists-explain-177309">hybrid immunity</a>.” More than <a href="https://doi.org/10.1126/science.abj2258">35 studies</a> have shown that hybrid immunity offers complimentary and broad protection. This is because immunity from the vaccines targets the spike protein – after which the <a href="https://theconversation.com/how-can-scientists-update-coronavirus-vaccines-for-omicron-a-microbiologist-answers-5-questions-about-how-moderna-and-pfizer-could-rapidly-adjust-mrna-vaccines-172943">COVID-19 vaccines were designed</a> – and infection-induced immunity aims more broadly at the whole virus. </p>
<p>[<em>Over 150,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-150ksignup">Sign up today</a>.]</p>
<p>So, it is not unreasonable to skip a second booster with a confirmed infection of omicron. This doesn’t mean that people should purposefully get SARS-CoV-2, the virus that causes COVID-19. But it is clear that hybrid immunity is a viable path to protection.</p>
<p>In short, there is strong evidence that a fourth dose – or second booster – provides meaningful protection among vulnerable populations, including people over 60. So another booster is reasonable for some groups. And while a fourth dose may benefit a select group, it is far more important that people receive their first, second and third doses.</p><img src="https://counter.theconversation.com/content/180488/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katelyn Jetelina receives research funding from the NIH, CDC, DOJ, NIOSH, and several non-profit organizations. She sole founder, owner, and author of Your Local Epidemiologist newsletter. She is senior scientific advisor to Judge Lina Hidalgo in Harris County. </span></em></p>New data on the second booster suggests the older you are, the more you need it.Katelyn Jetelina, Assistant Professor of Epidemiology, University of Texas Health Science Center at HoustonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1668812021-09-09T18:55:30Z2021-09-09T18:55:30Z18 months of the COVID-19 pandemic – a retrospective in 7 charts<figure><img src="https://images.theconversation.com/files/420094/original/file-20210908-23-8ctbwx.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2355%2C1269&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">September 11, 2021 marks the 18 month anniversary of the WHO declaring the COVID-19 outbreak a pandemic</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/coronavirus-covid-19-2019-ncov-on-calendar-april-royalty-free-image/1216610197">summerphotos/Stock via Getty Images Plus</a></span></figcaption></figure><p>A year and a half into what the <a href="https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020">World Health Organization officially declared a pandemic</a> on March 11, 2020, it’s an understatement to say that Americans are exhausted.</p>
<p>I’m an <a href="https://scholar.google.com/citations?user=t3nqdNQAAAAJ&hl=en">epidemiologist</a> and an internationally recognized <a href="https://yourlocalepidemiologist.substack.com/about">science communicator</a>, and I’ve often found myself running between COVID-19 meetings asking “how did we get here?” </p>
<p>Figuring out the “how” is essential to preparing for the future. In trying to make sense of these past 18 months, I’ve found it helpful to broadly categorize the U.S. pandemic journey thus far into five phases: Scramble, Learn, Respond, Test and Hope.</p>
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<h2>Scramble: What’s going on?</h2>
<p>In early 2020, SARS-CoV-2, the virus that causes COVID-19, hit the United States. The first documented case was a traveler who landed in Seattle from Wuhan, China on <a href="https://www.history.com/this-day-in-history/first-confirmed-case-of-coronavirus-found-in-us-washington-state">Jan. 15</a>. Only later did public health officials find that SARS-CoV-2 was already <a href="http://dx.doi.org/10.15585/mmwr.mm6922e1">spreading throughout the community</a>. </p>
<p>It wasn’t until March that Americans were forced to take the pandemic seriously, as states began to implement <a href="https://www.nytimes.com/interactive/2020/us/coronavirus-stay-at-home-order.html">stay-at-home orders</a>. While civilians were struggling to figure out <a href="https://www.nytimes.com/2020/06/10/parenting/virus-day-care-bright-horizons.html">child care</a>, <a href="https://theconversation.com/telecommuting-could-curb-the-coronavirus-epidemic-133308">working from home</a> and <a href="https://theconversation.com/declining-antibodies-and-immunity-to-covid-19-why-the-worry-143323">Immunology 101</a>, epidemiologists started to react.</p>
<p>But maybe a better word is “scramble.” The U.S. did not have the public health infrastructure in place to effectively respond. A <a href="https://www.tfah.org/report-details/publichealthfunding2020/">chronically underfunded</a> and <a href="https://theconversation.com/theres-a-name-for-trump-playing-down-the-threat-and-failing-to-take-action-against-the-virus-institutional-betrayal-133909">politicized public health system</a> hampered the nation’s real-time response.</p>
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<p>Epidemiologists were scrambling, left to <a href="https://covidtracking.com/thank-you">rely on volunteers</a> to report national level public health data because there was <a href="https://www.politico.com/news/2021/08/15/inside-americas-covid-data-gap-502565">no centralized public health data system</a> in the U.S. Public health officials were scrambling to enact safety recommendations and contact trace because of <a href="https://www.ama-assn.org/about/leadership/pandemic-exposes-dire-need-rebuild-public-health-infrastructure">limited resources</a>. Data scientists, like those at <a href="https://coronavirus.jhu.edu/about">Johns Hopkins University</a>, were scrambling to share accessible data for decision-making. Scientists were scrambling to <a href="https://theconversation.com/there-are-many-covid-19-tests-in-the-us-how-are-they-being-regulated-134783">develop COVID-19 tests</a>. And everyone was scrambling to figure out <a href="https://theconversation.com/covid-19-public-health-messages-have-been-all-over-the-place-but-researchers-know-how-to-do-better-150584">how to communicate</a> the evolving threat of the virus to American lives. From the beginning, the seeds were sown for a reactive, rather than proactive, approach. </p>
<h2>Learn: Are we doing anything right?</h2>
<p>Once the Northeast started to get <a href="https://covid.cdc.gov/covid-data-tracker/#datatracker-home">under control</a>, June 2020 was fairly quiet across the nation. Is this done? Maybe the decrease is <a href="https://theconversation.com/coronavirus-may-wane-this-summer-but-dont-count-on-any-seasonal-variation-to-end-the-pandemic-136218">due to weather</a>? People started relaxing. </p>
<p>Then July hit. In one month, cases in the South <a href="https://covid.cdc.gov/covid-data-tracker/#datatracker-home">were as high</a> as they had been in the Northeast months earlier. The West started creeping up, too. The game of whack-a-mole began as there still wasn’t a coordinated, national response. </p>
<p>Health departments were <a href="https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/rtt-management-introduction.html">expanding capacity</a> for testing, tracing and surveillance. A multitude of multidisciplinary, academic teams were forming to understand COVID-19 from <a href="https://theconversation.com/how-virus-detectives-trace-the-origins-of-an-outbreak-and-why-its-so-tricky-161387">microscopic-level virology</a> all the way to <a href="https://theconversation.com/the-coronavirus-could-be-generation-zs-9-11-133740">population-level social implications</a>.</p>
<p>This is when published, peer-reviewed data on COVID-19 started coming through. In fewer than five months, scientific literature database Scopus indexed <a href="https://doi.org/10.1007/s11192-020-03706-z">more than 12,000</a> publications. Researchers started discovering <a href="https://theconversation.com/deciphering-the-symptoms-of-long-covid-19-is-slow-and-painstaking-for-both-sufferers-and-their-physicians-164754">long COVID-19 symptoms</a> and figuring out effective protective measures like <a href="https://doi.org/10.1016/S0140-6736(20)31142-9">social distancing and wearing a mask</a>. Researchers also learned more about <a href="http://dx.doi.org/10.15585/mmwr.mm6945a5">superspreader events</a> and how COVID-19 is <a href="https://doi.org/10.1093/cid/ciaa939">transmitted through the air</a> – although this wasn’t officially recognized by the <a href="https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-how-is-it-transmitted">WHO</a> or the <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/sars-cov-2-transmission.html">Centers for Disease Control and Prevention</a> until about a year later.</p>
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<p>While the <a href="https://doi.org/10.1126/science.abc7839">flood of evidence</a> provided scientists and clinicians with critical information, a <a href="https://retractionwatch.com/retracted-coronavirus-covid-19-papers/">wave of retractions</a> pulling papers with erroneous or unreliable data began to appear. This, coupled with lack of <a href="https://doi.org/10.1056/NEJMp2103798">accurate scientific communication</a> from unbiased sources, fueled a <a href="https://www.who.int/health-topics/infodemic#tab=tab_1">concurrent infodemic</a> – an epidemic of misinformation and public health threats that researchers, social media companies and public health officials are still learning how to identify, mitigate and treat.</p>
<h2>Respond: Bring it on, virus!</h2>
<p>Then came winter, which proved to be a perfect storm of <a href="https://theconversation.com/sick-of-covid-19-heres-why-you-might-have-pandemic-fatigue-148294">pandemic fatigue</a> and holiday travel. This resulted in our biggest pandemic wave yet. <a href="https://usafacts.org/articles/the-us-has-averaged-more-than-3000-deaths-per-day-in-2021/">More than 3,000 people were dying per day</a> in the U.S.</p>
<p>Thankfully, help was on its way: vaccines. And not just pretty good vaccines – vaccines that blew efficacy out of the water. The Pfizer-BioNTech vaccine proved to have an <a href="https://www.fda.gov/media/144245/download?fbclid=IwAR3RqVgP7tAcHKj5-oWhrPqhkkDPvDekJZ60UXCisFlJb5iOoY6uil9hBRI">efficacy of 95%</a>, significantly above the <a href="https://www.afro.who.int/news/what-covid-19-vaccine-efficacy">threshold target of 50%</a>. Thanks to <a href="https://time.com/5894798/need-volunteers-covid-19-vaccine-trials/">over 500,000</a> clinical trial volunteers, <a href="https://doi.org/10.1038/s41578-021-00358-0">decades of mRNA research</a>, an estimated <a href="https://www.healthaffairs.org/do/10.1377/hblog20210512.191448/">US$39.5 billion</a> and fast-moving scientists, the vaccines got to the public in <a href="https://www.ifpma.org/wp-content/uploads/2019/07/IFPMA-ComplexJourney-2019_FINAL.pdf">record time</a>. And, while the <a href="https://www.vox.com/future-perfect/22213208/covid-19-vaccine-rollout-coronavirus-distribution">vaccine rollout was rough</a>, <a href="https://covid.cdc.gov/covid-data-tracker/#vaccination-trends_vacctrends-total-cum">more than 260 million</a> doses were administered by May 2021 in the U.S.</p>
<p>With vaccines, though, came new challenges: a new fight against disinformation (no, <a href="https://doi.org/10.1038/d41586-020-01221-y">mRNA does not change your DNA</a>) and a struggle to understand <a href="https://theconversation.com/what-is-a-breakthrough-infection-6-questions-answered-about-catching-covid-19-after-vaccination-164909">breakthrough infections</a>.</p>
<p>In the meanwhile, <a href="https://covid.cdc.gov/covid-data-tracker/#variant-proportions">new COVID-19 variants</a> arrived on the scene. <a href="https://doi.org/10.1038/d41586-020-02478-z">Suboptimal genomic surveillance</a> made it <a href="https://theconversation.com/genomic-surveillance-what-it-is-and-why-we-need-more-of-it-to-track-coronavirus-variants-and-help-end-the-covid-19-pandemic-157540">difficult to identify where and what variants</a> were spreading. The race between vaccination and variant spread was upon us. The fight was far from over.</p>
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<h2>Test: We’re tired</h2>
<p>Early summer 2021 for Americans was blissful. The U.S. reached an <a href="https://www.usatoday.com/story/news/health/2021/06/08/covid-vaccine-variant-lab-leak-cdc/7594625002/">all-time pandemic low in terms of COVID-19 cases</a>. People who were vaccinated were told they could <a href="https://www.washingtonpost.com/health/2021/07/19/mask-mandates-returning/">take off their masks</a>, while some unvaccinated people took this carte blanche. More Americans started <a href="https://www.tsa.gov/coronavirus/passenger-throughput">traveling again</a> and getting back to <a href="https://theconversation.com/covid-19-as-offices-reopen-heres-what-to-expect-if-youre-worried-about-getting-sick-on-the-job-142154">working in person</a>. </p>
<p>But then the delta variant knocked on the door. Significantly <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/991135/3_June_2021_Risk_assessment_for_SARS-CoV-2_variant_DELTA.pdf">more transmissible</a> and <a href="https://doi.org/10.1016/S0140-6736(21)01358-1">severe</a> than the original strain of the coronavirus, it first created a <a href="https://www.usnews.com/news/best-states/articles/2021-09-02/delta-surge-hits-southern-states-the-hardest">tsunami of cases in the South</a> that then spread to every corner of the United States.</p>
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<p>Unfortunately, <a href="https://www.scientificamerican.com/article/how-we-can-deal-with-pandemic-fatigue/">pandemic fatigue</a> has settled in. And the pandemic is pushing the U.S. response to its limits. It’s testing the amount of pressure <a href="https://doi.org/10.1038/d41586-021-02261-8">vaccines can withstand</a>. It’s testing <a href="https://www.npr.org/sections/health-shots/2021/09/05/1034210487/covid-surge-overwhelming-hospitals-raising-fears-rationed-care">health care system capacity</a>. It’s testing the <a href="https://www.newschannel10.com/2021/08/30/healthcare-workers-dealing-with-post-traumatic-stress-delta-variant-takes-hold/">resilience of public health and health care workers</a>. It’s testing the ability of scientists to effectively communicate <a href="https://doi.org/10.1001/jama.2020.12535">ever-evolving research findings</a>. And it’s testing the public’s patience as <a href="https://theconversation.com/kids-arent-just-littler-adults-heres-why-they-need-their-own-clinical-trials-for-a-covid-19-vaccine-162821">pediatric vaccines undergo clinical trials</a>.</p>
<h2>Hope: This will end</h2>
<p>Every <a href="https://www.cdc.gov/training/quicklearns/epimode/">epidemic curve comes down</a>. And this one will too. But even after it comes down, the pandemic will still be far from over.</p>
<p>There’s still <a href="https://www.theatlantic.com/health/archive/2021/05/pandemic-trauma-summer/618934/">trauma to be addressed</a>. Families were robbed of <a href="https://www.chicagotribune.com/coronavirus/ct-coronavirus-funerals-20201202-q52w5txzyvbuxio2rxucaxm5r4-story.html">proper funerals and goodbyes</a>. <a href="https://www.theguardian.com/world/2021/feb/13/i-dont-want-friends-who-put-others-at-risk-has-lockdown-wrecked-friendships">Friendships were ripped apart</a> by politically charged misinformation and disinformation. Millions of people <a href="https://theconversation.com/pandemic-hardship-is-about-to-get-a-lot-worse-for-millions-of-out-of-work-americans-167165">lost their jobs</a>. And <a href="https://khn.org/morning-breakout/health-care-workers-may-suffer-more-ptsd-trauma-during-pandemic/">frontline workers</a> are still not OK. A survey of public health workers across the U.S. found that <a href="http://dx.doi.org/10.15585/mmwr.mm7026e1">more than half</a> reported symptoms of at least one mental health condition from March to April 2021.</p>
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<p>The U.S. will also need to self-reflect as a nation. In order to deal effectively with the next infectious disease crisis, the U.S. will need to create centralized public health systems and expand genomic surveillance, hospital networks and testing capabilities. Scientists need to revamp how they accessibly communicate science and research so the CDC can build public trust again. And by removing politics from public health, science might be able to infiltrate echo chambers instead of <a href="https://doi.org/10.1038/s41586-020-2281-1">feeding them</a>. </p>
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<p>Americans need to prepare so <a href="https://www.statnews.com/2021/05/18/luck-is-not-a-strategy-the-world-needs-to-start-preparing-now-for-the-next-pandemic/">when the next pandemic hits</a>, everyone will be ready to mount a proactive, effective fight against a common enemy: the virus.</p>
<p>[<em><a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-corona-important">Get The Conversation’s most important coronavirus headlines, weekly in a science newsletter</a></em>]</p><img src="https://counter.theconversation.com/content/166881/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katelyn Jetelina receive(s/d) research funding from NIH, CDC, DOJ, DHHS, Merck, and several non-profits (THR, HABRI, MMHPI, Arnold Foundation, HOGG). She is the sole founder and owner of Your Local Epidemiologist. She is the Senior Scientific Advisor to Judge Lina Hidalgo in Harris County.</span></em></p>A lot has happened since the WHO declared the coronavirus outbreak a pandemic. A portrait in data highlights trends in everything from case counts, to research publications, to variant spread.Katelyn Jetelina, Assistant Professor of Epidemiology, University of Texas Health Science Center at HoustonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1499062020-11-13T13:43:16Z2020-11-13T13:43:16ZPresident-elect Biden’s new COVID-19 task force gives the US a fresh chance to turn around a public health disaster<figure><img src="https://images.theconversation.com/files/369202/original/file-20201113-23-1lak1g3.jpg?ixlib=rb-1.1.0&rect=194%2C423%2C5458%2C3119&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Biden and Harris meet with their COVID-19 advisers virtually on Nov. 9.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/Biden/f405d19e6f394a169f039583fb2bfc8d/photo?Query=Biden%20AND%20COVID&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=1907&currentItemNo=26">AP Photo/Carolyn Kaster</a></span></figcaption></figure><p>A change in administration in January will bring a new pandemic strategy for the United States. President-elect Joe Biden has <a href="https://buildbackbetter.com/press-releases/biden-harris-transition-announces-covid-19-advisory-board/">announced his transition COVID-19 advisory council</a>, and there are high expectations that its recommendations to combat the pandemic will be backed by science and reflect public health best practices.</p>
<p><a href="https://scholar.google.com/citations?user=T8sw5R0AAAAJ&hl=en&oi=sra">As an infectious disease epidemiologist</a>, I’m looking forward to research-based guidance at the federal level that I hope will help get the coronavirus under control. </p>
<p>The United States is currently experiencing a <a href="https://apnews.com/article/doctors-better-equipped-virus-surge-743c0448c3ada001d327d73a6f2ed9d7">major increase in COVID-19 cases</a>, with over 1 million new cases logged in just the first 10 days of November. <a href="https://coronavirus.jhu.edu">Over 240,000 people with COVID-19 have died</a> in the U.S. to date. The Trump administration’s tactics of <a href="https://www.theatlantic.com/politics/archive/2020/11/trumps-lies-about-coronavirus/608647/">pretending this upsurge is not happening</a>, <a href="https://www.nytimes.com/2020/10/02/us/politics/donald-trump-masks.html">dismissing the benefits of mask-wearing and physical distancing</a> and <a href="https://www.cnn.com/2020/10/26/politics/fact-check-testing-cases-october/index.html">blaming increases in case counts on increased testing</a> are not viable methods to control the pandemic.</p>
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<p>The United States has <a href="https://coronavirus.jhu.edu/map.html">4.4% of the world’s population and 20% of the COVID-19 cases</a>. Clearly, the U.S. has not done an adequate job of controlling the pandemic within its shores. A change in administration and coronavirus-fighting strategy will hopefully help the U.S. change course.</p>
<h2>Experts at the helm reflect the US</h2>
<p>Biden’s advisory board is headed by three eminently qualified co-chairs: the former director of the Centers for Disease Control and Prevention, David Kessler; former Surgeon General Vivek Murthy; and researcher-scientist Marcella Nunez-Smith, an expert in health equity issues.</p>
<p>The other committee members are all experienced public health experts and physicians with years of experience in combating infectious diseases; among them are Michael Osterholm from the University of Minnesota’s <a href="https://www.cidrap.umn.edu/">Center for Infectious Disease Research and Policy</a> and <a href="http://atulgawande.com/">Atul Gawande</a>, noted author and physician at Harvard Medical School.</p>
<p>Not only do these task force members bring a high level of expertise to the table, but the group itself mirrors the country – there are five women and nine persons of color among the 13 members. This gender and racial/ethnic diversity will <a href="https://doi.org/10.1016/j.jnma.2019.01.006">likely result in better decision-making</a> and lend greater credence to the task force’s decisions and recommendations. </p>
<p>The demographic diversity of the task force is particularly important because many communities of color distrust the government and <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html">its handling of the coronavirus</a>. Unfortunately, these are the <a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html">same communities that are being affected the most by the pandemic</a>, with high rates of infection, hospitalization and death compared with non-Hispanic whites. Cultural competence will be necessary to convey messages that all Americans will believe and adhere to.</p>
<h2>Planning now to hit the ground running Jan. 20</h2>
<p><a href="https://buildbackbetter.com/priorities/covid-19/">Priorities for the task force have been set</a>, and they read like a public health expert’s wish list. Top concerns include:</p>
<ul>
<li>Managing the surge in cases that is affecting most of the U.S.</li>
<li>Protecting at-risk populations.</li>
<li>Increasing the manufacturing of PPE, including N95 masks.</li>
<li>Increasing availability of testing.</li>
<li>Working with governors and mayors on mask mandates.</li>
</ul>
<p>These are all matters that have not yet been dealt with adequately, contributing to the current surge in cases nationwide.</p>
<p>Another top priority is equitable distribution of an effective, safe and free COVID-19 vaccine once readily available. A vaccine will be crucial to protect people and <a href="https://theconversation.com/herd-immunity-wont-solve-americas-covid-19-problem-139724">achieve herd immunity</a>. Developing a realistic plan now, based on these guidelines, is absolutely necessary for the success of an eventual vaccine rollout.</p>
<p>There’s already good <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-vaccine-candidate-against">preliminary news about an effective vaccine</a>, but the logistics of distributing future vaccines are formidable. The Pfizer vaccine must be <a href="https://www.fiercepharma.com/manufacturing/pfizer-moderna-s-covid-19-shot-rollouts-could-be-ice-as-analysts-question-cold">transported and stored at an ultralow temperature</a>, something never previously attempted. <a href="https://www.theatlantic.com/health/archive/2020/09/covid-19-most-complicated-vaccine-campaign-ever/616521/">Record keeping for a two-dose vaccine</a> will be a nightmare. <a href="https://www.beckershospitalreview.com/pharmacy/covid-19-vaccine-likely-won-t-be-widely-available-in-rural-areas-early-cdc-says.html">Reaching rural populations and those without regular access to health care</a> will be difficult. Planning for effective vaccine distribution must begin now.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/369201/original/file-20201113-23-3erafi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Biden taking notes" src="https://images.theconversation.com/files/369201/original/file-20201113-23-3erafi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/369201/original/file-20201113-23-3erafi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/369201/original/file-20201113-23-3erafi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/369201/original/file-20201113-23-3erafi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/369201/original/file-20201113-23-3erafi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/369201/original/file-20201113-23-3erafi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/369201/original/file-20201113-23-3erafi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">President-elect Biden is already taking guidance from his COVID-19 advisers.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/Biden/b255a24a4d30462b8d505a0920200f65/photo?Query=Biden%20AND%20COVID&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=1907&currentItemNo=27">AP Photo/Carolyn Kaster</a></span>
</figcaption>
</figure>
<h2>A cohesive message, from the top</h2>
<p>I anticipate that the guidance coming out of Biden’s task force will represent the best known science. The committee will keep abreast of new scientific findings and revise messages to reflect emerging information. Biden’s communications will be consistent with his task force’s recommendations, which, by cutting confusion, should lead to better public compliance with prevention recommendations.</p>
<p>I also expect the Biden administration’s COVID-19 advisory board will work with the CDC to develop consistent guidelines for state and local health departments to follow. Most public health efforts happen at the state and local levels. While not every health department will fully embrace all recommendations, a unified national strategy will improve on the whack-a-mole approach seen to date as cases pop up in one area of the country and then another. States and municipalities do not exist in a vacuum, and community transmission in one area can affect other jurisdictions.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p><a href="https://theconversation.com/sick-of-covid-19-heres-why-you-might-have-pandemic-fatigue-148294">Pandemic fatigue is real</a> – everyone’s tired of this pandemic, and we want our lives to get back to normal. Unfortunately, the virus doesn’t care, and the U.S. is <a href="https://www.washingtonpost.com/politics/fauci-covid-winter-forecast/2020/10/31/e3970eb0-1b8b-11eb-bb35-2dcfdab0a345_story.html">in for a hard winter</a>. SARS-CoV-2 is still out there, and it’s an infectious, sometimes deadly virus. The new Biden administration will be taking over the reins during a public health disaster in January. But I’m optimistic that while the COVID-19 task force will have its hands full, it has the people and tools necessary to get the coronavirus under control.</p><img src="https://counter.theconversation.com/content/149906/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Lynne Troisi does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Biden will begin his presidency in the midst of a global public health crisis that’s already killed over 240,000 people in the US alone. His team is already planning how to get COVID-19 under control.Catherine Lynne Troisi, Associate Professor of Management, Policy, and Community Health and Epidemiology, University of Texas Health Science Center at HoustonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1452362020-08-31T12:38:28Z2020-08-31T12:38:28ZI’m a public health researcher, and I’m dismayed that the CDC’s missteps are causing people to lose trust in a great institution<figure><img src="https://images.theconversation.com/files/355397/original/file-20200829-20-1195wxl.JPG?ixlib=rb-1.1.0&rect=11%2C36%2C613%2C403&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Workers on Saturday, Aug. 29, 2020 removed the main sign to the visitors' entrance to the CDC, leaving instead a temporary one made of cardboard-like material.</span> <span class="attribution"><span class="source">Lynne Anderson</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><a href="https://www.cdc.gov/coronavirus/2019-ncov/about/steps-when-sick.html">The Centers for Disease Control and Prevention</a> has been the premier U.S. public health agency since its founding on <a href="https://www.cdc.gov/about/history/index.html">July 1, 1946</a>. </p>
<p>The CDC is responsible for assuring the health of all Americans and promoting evidence-based public health practice. It also is responsible for researching the causes of death and illness as well as working on ways to prevent them. Americans have come to trust it for <a href="https://fivethirtyeight.com/features/americans-trust-the-cdc-on-covid-19-trump-not-so-much/">accurate information</a>. </p>
<p>However, recent actions by the CDC have led many in public health to call into question the <a href="https://thehill.com/opinion/healthcare/509227-we-need-an-independent-public-health-agency">integrity</a> of the CDC’s leadership as they ignore the science and bow to <a href="https://www.cnn.com/2020/08/26/politics/cdc-coronavirus-testing-guidance/index.html">political pressure</a>. Their actions have hurt public health efforts and led to confusion and mistrust by the public at large. </p>
<p>As an <a href="https://scholar.google.com/citations?user=T8sw5R0AAAAJ&hl=en">infectious disease epidemiologist</a>, I have spent my career both in academia and in public health practice studying how viruses infect people and testing populations to determine current infection and immunity. I find the politicization of advice coming out of the CDC disturbing, to say the least. </p>
<p>The latest, most egregious non-science-based advice is a change in recommendation for who should get tested for COVID-19. Here’s what happened and why it matters so much – not just to public health experts, but to the public. </p>
<figure class="align-center ">
<img alt="A big digital sign by a road that directs people to a testing site." src="https://images.theconversation.com/files/355394/original/file-20200829-21-ynfi78.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/355394/original/file-20200829-21-ynfi78.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/355394/original/file-20200829-21-ynfi78.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/355394/original/file-20200829-21-ynfi78.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/355394/original/file-20200829-21-ynfi78.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/355394/original/file-20200829-21-ynfi78.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/355394/original/file-20200829-21-ynfi78.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A digital sign in Stony Brook, New York, directs patients to the drive-thru coronavirus test site at Stony Brook University on March 28, 2020.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/digital-sign-on-stony-brook-road-in-stony-brook-new-york-on-news-photo/1215580919?adppopup=true">John Paraskevas/Newsday via Getty Images</a></span>
</figcaption>
</figure>
<h2>Testing is key to containing the virus</h2>
<p>Public health experts have learned a great deal about the novel coronavirus and COVID-19 since the coronavirus first appeared. </p>
<p>They have learned, for example, that an <a href="https://www.acpjournals.org/doi/10.7326/M20-3012">estimated 4 out of 10 infected people</a> will never show symptoms – but can unknowingly infect others. </p>
<p>In addition, infected persons who will go on to develop symptoms can spread the disease <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2765641">one to two days</a> before those symptoms occur. These are two of the reasons the virus is so hard to contain.</p>
<p>Evidence suggests that widespread testing of people without symptoms would <a href="https://theconversation.com/rapid-screening-tests-that-prioritize-speed-over-accuracy-could-be-key-to-ending-the-coronavirus-pandemic-143882">greatly reduce the spread of the virus</a> by allowing people to know they’re infected and self-quarantine. Contacts of those asymptomatic cases can be identified and tested for the same reasons. This has been the CDC’s recommendation since studies first began to show asymptomatic transmission.</p>
<p>Then, the CDC on Aug. 24, 2020 changed course and recommended to <a href="https://www.nytimes.com/2020/08/26/us/politics/coronavirus-testing-trump-cdc.html?action=click&module=RelatedLinks&pgtype=Article">test only those people who have symptoms for COVID-19</a>. </p>
<p>Many <a href="https://www.usatoday.com/story/news/2020/08/27/cdc-walks-back-surprise-coronavirus-asymptomatic-testing-guidelines/5645630002/">public health experts were shocked</a>. Testing only those who have symptoms will miss close to half of those who are infected.</p>
<p>Two days after the revised guidelines had been quietly changed on the CDC website, <a href="https://www.statnews.com/2020/08/27/redfield-clarify-controversial-testing-guidelines/">Director Robert Redfield clarified</a> that those who come into contact with confirmed or probable COVID-19 patients could be tested even in the absence of symptoms. </p>
<p>That has always been the case, though. </p>
<p>In the meantime, the altered guidelines on the CDC website promote confusion and remain unchanged as of Aug. 31, 2020. <a href="https://www.reuters.com/article/us-health-coronavirus-usa-testing/california-florida-new-york-texas-will-not-follow-new-us-covid-19-testing-plan-idUSKBN25N31H">Arizona, California, Connecticut, Florida, Illinois, Texas, New Jersey and New York have already announced</a> they will not follow the new CDC testing guidelines, showing more understanding of the benefits of testing than our national public health institution.</p>
<figure class="align-center ">
<img alt="Dr. Anthony Fauci sits at the White House." src="https://images.theconversation.com/files/355426/original/file-20200830-21-1p3fhdy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/355426/original/file-20200830-21-1p3fhdy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/355426/original/file-20200830-21-1p3fhdy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/355426/original/file-20200830-21-1p3fhdy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/355426/original/file-20200830-21-1p3fhdy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=514&fit=crop&dpr=1 754w, https://images.theconversation.com/files/355426/original/file-20200830-21-1p3fhdy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=514&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/355426/original/file-20200830-21-1p3fhdy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=514&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, listens during a briefing on the pandemic in the press briefing room of the White House.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/national-institute-of-allergy-and-infectious-diseases-news-photo/1215224972?adppopup=true">Drew Angerer/Getty Images</a></span>
</figcaption>
</figure>
<h2>Fauci had no voice in the matter</h2>
<p>This new recommendation came from the <a href="https://www.cnn.com/2020/08/26/politics/fauci-coronavirus-cdc-testing/index.html">White House Coronavirus Task Force</a>, and the CDC fell in line. Dr. Anthony Fauci, a task force member and head of the National Institute of Allergy and Infectious Diseases, <a href="https://www.cnn.com/2020/08/26/politics/fauci-coronavirus-cdc-testing/index.html">was undergoing surgery</a> on his vocal cords when the task force met Aug. 20 and decided on the change. </p>
<p>The <a href="https://www.apha.org/news-and-media/news-releases/apha-news-releases/2020/new-covid-19-testing-guidance">American Public Health Association has pointed out</a> that the change was made without effective consultation with public health professionals working on the ground to control the pandemic. The World Health Organization continues to support testing of asymptomatic persons. Nearly every public health organization has called for a <a href="https://www.washingtonpost.com/nation/2020/08/28/coronavirus-covid-live-updates-us/?utm_campaign=wp_post_most&utm_medium=email&utm_source=newsletter&wpisrc=nl_most">reversal</a>. </p>
<p>It is a particularly confusing decision given that <a href="https://www.nytimes.com/interactive/2020/04/17/us/coronavirus-testing-states.html">lack of access to adequate testing</a> has been an ongoing issue and has led to serious barriers in getting control of the pandemic.</p>
<figure class="align-center ">
<img alt="Trump, wearing khaki pants and a MAGA hat, surrounded by health officials at the CDC." src="https://images.theconversation.com/files/355393/original/file-20200829-14-ka8s7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/355393/original/file-20200829-14-ka8s7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/355393/original/file-20200829-14-ka8s7a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/355393/original/file-20200829-14-ka8s7a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/355393/original/file-20200829-14-ka8s7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/355393/original/file-20200829-14-ka8s7a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/355393/original/file-20200829-14-ka8s7a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Alex Azar, head of the Department of Health and Human Services, President Trump, CDC Director Robert Redfield and Associate Director Steve Monroe at the CDC in March 2020.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/president-donald-trump-speaks-next-to-us-health-and-human-news-photo/1205520815?adppopup=true">Jim Watson/AFP via Getty Images</a></span>
</figcaption>
</figure>
<h2>See no virus, have no virus?</h2>
<p>Without test data, epidemiologists are flying blind. Not knowing who is infected, we do not have a picture of how many infected persons are in the community and how the virus is being transmitted.</p>
<p>Identifying those who may have been exposed to the virus is the whole rationale for <a href="https://www.who.int/news-room/q-a-detail/contact-tracing">contact tracing</a> – find cases, identify contacts who may have been infected, ask them to self-quarantine, and test them for the virus. Testing is at the core of controlling infectious disease spread. </p>
<p>The thinking seems to be that if you don’t test, the number of cases will go down. </p>
<p>Clearly, this is true only in the political sense. Yes, the number of reported cases will decrease, but the number of infected persons will not. By not identifying those who are infected but don’t have symptoms, spread of the virus will increase as those who don’t know they are infected, infect others. </p>
<p>Trump has said that he “likes the numbers where they are” and said at a campaign rally in Tulsa that he would tell his people to <a href="https://nymag.com/intelligencer/2020/06/trump-slow-down-coronavirus-testing-confession-joking.html">“slow the testing down.”</a></p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<h2>A series of tussles</h2>
<p>The CDC has been in the midst of a political struggle many times during this pandemic. </p>
<p>In May, it was revealed that CDC had been <a href="https://www.theatlantic.com/health/archive/2020/05/cdc-and-states-are-misreporting-covid-19-test-data-pennsylvania-georgia-texas/611935/">adding antibody tests, a marker of previous infection, to the number of PCR tests</a>, a marker of current infection, performed. This made it appear that more tests to detect current infection had been performed than actually had.</p>
<p>In July, hospitalization data, historically reported to CDC and used by health departments and researchers throughout the country to understand the pandemic, <a href="https://www.statnews.com/2020/07/16/hospital-data-reporting-covid-19/">disappeared from the CDC website</a> as reporting switched to a private contractor. It reappeared a few days later, but this raised <a href="https://www.npr.org/sections/health-shots/2020/07/15/891351706/white-house-strips-cdc-of-data-collection-role-for-covid-19-hospitalizations">concerns this would hurt the ability of CDC to gather and analyze these data</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1280857657365200902"}"></div></p>
<p>In another instance, the administration pressured CDC to rewrite its guidelines for <a href="https://www.washingtonpost.com/health/trump-sidelines-public-health-advisers-in-growing-rift-over-coronavirus-response/2020/07/09/ad803218-c12a-11ea-9fdd-b7ac6b051dc8_story.html">safely reopening schools</a>. It did this, even though once again, the guidelines did not reflect current scientific knowledge. </p>
<p>The world is now in the midst of the worst pandemic in over a century. The United States has 4.4% of the world’s population but <a href="https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6">24%</a> of COVID-19 cases. Plainly, we are not doing well, and lack of trust in CDC’s guidance as well as contantly changing messaging is hampering our efforts to control the virus. No wonder the public is confused about what they should be doing.</p>
<p>It does not bode well if we Americans can no longer trust the advice and guidelines emanating from our national public health entity, not just for control efforts in this pandemic but for future health concerns as well. </p>
<p>I answer questions about COVID-19 weekly on a <a href="https://tunein.com/podcasts/News/Houston-Matters-p517987/">radio call in</a> show. A few weeks ago a caller asked me if we could trust the information coming out of the CDC. I never thought I would be in a position where I couldn’t give an unequivocal “yes.” When politics overcomes science, public health cannot fulfill its mission, and everyone will all suffer. </p>
<p><em>Editor’s note: Any views in this article reflect the opinion of the author and not of the University of Texas Health Science Center.</em></p><img src="https://counter.theconversation.com/content/145236/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Lynne Troisi is an executive board member of the American Public Health Association. </span></em></p>The CDC has long been a trusted source of health information, keeping the public not only safe but calm in times of disease outbreaks. Public health officials fear now for its reputation.Catherine Lynne Troisi, Associate Professor of Management, Policy, and Community Health and Epidemiology, University of Texas Health Science Center at HoustonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1426242020-07-21T12:36:00Z2020-07-21T12:36:00ZCoronavirus numbers confusing you? Here’s how to make sense of them<figure><img src="https://images.theconversation.com/files/347791/original/file-20200715-37-1dol1ig.jpg?ixlib=rb-1.1.0&rect=49%2C0%2C5472%2C3612&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In Irvine, Calif., a COVID-19 test is retrieved from a drive-in patient at Orange County Great Park. For four weeks, the testing station will see 520 patients per day. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/curogram-health-care-specialist-mari-cruz-and-dr-ali-news-photo/1227111595?adppopup=true">Getty Images / Allen J. Schaben</a></span></figcaption></figure><p>Turn on the TV news, or look at a news website, and you’ll see charts, graphics, and dashboards that supposedly <a href="https://www.covidexitstrategy.org/">indicate the latest</a> with COVID-19 – statistics revealing the number of tests, cases, hospitalizations and deaths, along with where they happened and whether they are rising or falling. </p>
<p>Different stories are told depending on the dashboard. But one thing is certain: These indicators lag behind the actions we take, or don’t take, on COVID-19. <a href="https://www.purdue.edu/hhs/nur/directory/faculty/aaltonen_pamela.html">As researchers</a> <a href="https://sph.uth.edu/faculty/index.htm#ZVgAnD5x/7T/svjJzdP7wQ==">who focus</a> on public health, we can tell you that a fully accurate, real-time snapshot of the progress of the virus isn’t possible. </p>
<h2>Some don’t get tested</h2>
<p>There are many reasons for this. Here’s one: <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html">diagnostic testing data</a> are incomplete. Someone infected with COVID-19 must first come in contact with the virus either through the air or (less likely) environmental surfaces. <a href="https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html">Symptoms show</a> between two and 14 days later. But <a href="https://doi.org/10.7326/M20-3012">at least 40% of those infected will never manifest </a>symptoms, or show such mild ones they don’t even suspect they have COVID-19. So they may never get tested, which means they won’t show up in the total number of tests, or the total number of cases.</p>
<p>Another example: because of the <a href="https://www.theatlantic.com/science/archive/2020/06/us-coronavirus-testing-could-fail-again/613675/">lack of testing availability</a> – a widespread problem in the U.S. since the start of the pandemic – not everyone who should be tested gets a test.</p>
<p><a href="https://www.acpjournals.org/doi/10.7326/M20-1495">And another</a>: the tests themselves are not perfect. Up to <a href="https://doi.org/10.7326/M20-1495">one-third who get a negative result may actually be infected</a>. This happens because they are tested before they have a viral load sufficient enough for detection. Or maybe the sampling is not adequate. Or perhaps the test itself simply failed. </p>
<figure class="align-center ">
<img alt="In Florida, people wait outside a COVID-19 testing station." src="https://images.theconversation.com/files/348042/original/file-20200716-21-1pr0zak.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/348042/original/file-20200716-21-1pr0zak.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/348042/original/file-20200716-21-1pr0zak.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/348042/original/file-20200716-21-1pr0zak.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/348042/original/file-20200716-21-1pr0zak.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/348042/original/file-20200716-21-1pr0zak.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/348042/original/file-20200716-21-1pr0zak.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Florida is now the epicenter of the U.S. pandemic. In Opa-locka, people wait in line outside a COVID-19 testing site.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/Search?query=Florida+covid-19+&ss=10&st=kw&entitysearch=&toItem=18&orderBy=Newest&searchMediaType=allmedia">AP Photo/Lynne Sladky</a></span>
</figcaption>
</figure>
<h2>Case numbers don’t tell the full story</h2>
<p>This is why problems arise when we use case numbers to determine disease levels in a community. Case counts actually reflect what was happening in a community weeks earlier. Four weeks, for instance, could elapse between the time a person is exposed to the virus and when they are <a href="https://www.health.harvard.edu/diseases-and-conditions/covid-19-basics#:%7E:text=Recently%20published%20research%20found%20that,as%2013%20days%20later.">reported as a case</a>. Even the best testing results often take a week to report to public health authorities, and longer to appear on dashboards. Some testing results, seriously delayed, may take ten days or more.</p>
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<p>Other factors impact the metrics. Laboratory results, often released in batches, may introduce artificial variation in case numbers. Someone who tested two days ago, then got a result back immediately, might be added on the same day as someone who was sick two weeks ago, but whose test results were delayed. To smooth out these variations, it helps to look at a rolling <a href="https://coronavirus.jhu.edu/testing/individual-states">seven-day case average</a>.</p>
<p>Hospitalization <a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html#hospitalizations">is a clearer metric</a> for assessing the level of community disease. Those who are seriously ill, in most cases, will be hospitalized whether previously tested or not. Data suggests roughly one in five infected persons are hospitalized. Individuals seem to do okay for the first week, with more life-threatening symptoms showing in the second. That means hospitalizations represent exposures that happened three or four weeks earlier. </p>
<p>Again, a seven-day rolling average evens out artificial variations. There is one caveat for this: Though hospitalization is a useful metric, only about <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm">20% of infected people</a> need it. That means hospitalization numbers alone underestimate the number of people infected and what age groups they represent.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/R4EpauHw61I?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">This animation shows COVID-19 case increases in 15 U.S. states.</span></figcaption>
</figure>
<h2>States vary on cause of death</h2>
<p>The death numbers are not a reliable indicator either. <a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/purpose-methods.html#hospitalization">In some states</a>, to count as a COVID-19 death, the deceased must have had a test reporting positive. In other states, probable cases are reported.</p>
<p>As clinicians learn how to better treat COVID-19, <a href="https://doi.org/10.1111/anae.15201">fatality rates are dropping</a>. Deaths, the longest lagging indicator, reflect people who were infected six or eight weeks earlier. When comparing one region to another, deaths are best expressed as rates – a ratio of deaths to population. </p>
<p>Another issue: News reports do not always clearly distinguish between diagnostic testing, which shows if you currently have COVID-19, and antibody testing, which shows if you had it in the past, and now harbor antibodies that can fight it. So far, however, <a href="https://doi.org/10.1002/14651858.CD013652">antibody testing has not provided a useful picture</a> of who has been infected and who has not. Once that happens, it could provide researchers and clinicians with some indicators on how widely the virus has spread. </p>
<p>Though the dashboards are ubiquitous on television, none of these frequently used indicators they feature is perfect. Still, taken together, they provide a reasonable approximation of COVID-19 transmission in communities. But as authorities make decisions, they should take into account the numbers are weeks old. </p>
<p>What does this mean to you? Understanding these limitations may help you understand your risk. We are still in the midst of a pandemic that is not under control. Being educated will help all of us from becoming a part of tomorrow’s lagging indicators.</p><img src="https://counter.theconversation.com/content/142624/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There’s more to the numbers than what you see on TV.Pamela M. Aaltonen, Professor Emerita; Immediate Past President, APHA, Purdue UniversityCatherine Lynne Troisi, Associate professor, Management, Policy, and Community Health and Epidemiology, University of Texas Health Science Center at HoustonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/456282016-01-19T08:47:58Z2016-01-19T08:47:58ZMental health care for prisoners could prevent rearrest, but prisons aren’t designed for rehabilitation<p>Mental health conditions are <a href="http://dx.doi.org/10.1093/epirev/mxn011">more common</a> among <a href="http://www.bjs.gov/content/pub/pdf/cpus12.pdf">prisoners</a> than in the general population. Estimates suggest that as many as <a href="https://dx.doi.org/10.2105/AJPH.2014.302043">26 percent of state and federal prisoners</a> suffer from at least one mental illness, compared with nine percent or less in the general population. And prisoners with untreated mental illness <a href="http://heinonline.org/HOL/LandingPage?handle=hein.journals/jpsych19&div=12&id=&page=">are more likely to be arrested again</a> after they are released. </p>
<p>But prisoners’ access to health care, including mental health care, varies from prison to prison. This is partly because funding varies annually due to budget restrictions and changing policies requiring use of funds for other purposes. And public support for rehabilitation is constantly fluctuating. As you can imagine, many people consider mental health treatment among prisoners to be a low funding priority compared to other federal programs, such as college student financial aid.</p>
<p>As a researcher in the emerging field of correctional health, I have spent many hours with inmates and the physicians who treat them. With mental illness so prevalent in U.S. prisoners, the ability to access quality mental health care is critical. It can help inmates regain control over their lives, and may lead to better individual and public safety outcomes upon release from prison.</p>
<p>But even though mental illness is consistently associated with criminal behavior, these conditions are largely undertreated in our prison system. Prisons were designed to incapacitate inmates, not to rehabilitate them. They are underfunded, and they provide poor working conditions for health care providers and environments that can exacerbate (or perhaps even lead to) mental illnesses. </p>
<h2>Health care is a right for prisoners</h2>
<p>In the 1970s, the Supreme Court supported the rights of prisoners to receive <a href="http://ir.lawnet.fordham.edu/cgi/viewcontent.cgi?article=1117&context=ulj">physical health and mental health care</a>. In fact, this right is now law, and denial of care would be considered “cruel and unusual punishment,” which is prohibited under the Eighth Amendment.</p>
<p>This law came about because prisoners were contracting contagious and communicable diseases <a href="http://openjurist.org/611/f2d/1050/smith-v-sullivan">from one another</a>. Infectious disease screenings are now commonplace in prisons. While prisoners have access to basic health care, treatment for mental health conditions is less broadly provided. The quality of treatment that is available in the penal system, including counseling and medication for chronic mental illnesses, <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2008.144279">remains poor</a>.</p>
<p>Unfortunately, the screening and treatment procedures that should constitute minimal provision of “mental health care” are not clear and tremendous variation exists from <a href="http://static.prisonpolicy.org/scans/bjs/mhtsp00.pdf">one prison to another</a>.</p>
<h2>How big a difference can good mental health care make?</h2>
<p>Imagine that you are a prisoner housed in a relatively well-funded state-run facility. You have a mental illness, and have regular counseling sessions and receive antipsychotic medications that help you function in your day-to-day routine. When you are released, you will likely receive comprehensive discharge plans and direct links to services in the community to make sure you can continue therapy and get access to medication. Your ability to control your condition might lead to better employment prospects, not to mention less involvement in criminal behavior. As a result, you aren’t rearrested. </p>
<p>But, if you are transferred to a poorly funded institution, you may be immediately taken off your medication and receive very limited counseling or none at all for your condition. </p>
<p>Transfers from one institution to another <a href="http://www.truth-out.org/news/item/31858-on-the-draft-how-prisoners-suffer-during-and-after-prison-transfers">are common</a> and may explain why there is <a href="http://dx.doi.org/10.2105/AJPH.2014.302043">such inconsistency</a> in treatment nationwide. According a national survey of department of corrections staff across 48 states, medical treatment was identified anecdotally as <a href="https://s3.amazonaws.com/static.nicic.gov/Library/021242.pdf">a reason for transfer</a>, but no percentages were reported to shed light on the number of prison transfers that occur for medical or psychological reasons. </p>
<p>And this explains why prisoners with mental health conditions return to prison 50-230 percent more frequently than those <a href="http://www.antoniocasella.eu/archipsy/Baillargeon_revolving_2009.PDF">without mental health conditions</a>. Given the high cost of the average prison stay (<a href="http://www.vera.org/sites/default/files/resources/downloads/price-of-prisons-updated-version-021914.pdf">US$31,286</a> per person per year), an ounce of mental health treatment may result in pounds of cost savings.</p>
<h2>For physicians in prisons, low morale and high turnover</h2>
<p>As you can imagine, recruiting quality physicians to work in prisons can be challenging given the work environment. Although prison physicians <a href="http://www.businessinsider.com/what-its-like-to-be-a-doctor-in-prison-2013-3">are relatively well-paid</a>), they are exposed to infectious diseases like tuberculosis or influenza more so than the general population. Threats or fear of physical violence are ever-present in the prison setting. This is not to say that the doctors employed by prisons are not highly qualified – they are. However, in my anecdotal experience, there is high turnover and low morale. And many prisons employ only one primary care doctor who is responsible for treating all inmates’ physical and mental health conditions, a challenge in a facility that houses hundreds or thousands.</p>
<p>The absence of mental health care sets prisoners up for failure when they reenter their communities and social circles. They may leave prison unequipped to handle their mental health condition and continue through the “revolving door” of incarceration for much of their life. This costly cycle is difficult to stop, as is exceedingly clear from decades of research in criminal justice. To make mental health care in state and federal prisons a national priority, a transformation in how we view the role of prisons is needed. </p>
<p>Given the investment that taxpayers make in the criminal justice system, it is reasonable for the public to expect a return on their investment in the form of lower repeat criminal activity. One step in this direction would be using time spent in prison to address as many risk factors for crime as possible, including mental health conditions.</p><img src="https://counter.theconversation.com/content/45628/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer Reingle Gonzalez does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even though mental illness is consistently associated with criminal behavior, these conditions are largely undertreated in our prison system.Jennifer Reingle Gonzalez, Assistant Professor of Epidemiolgy, University of Texas Health Science Center at HoustonLicensed as Creative Commons – attribution, no derivatives.