This document is to serve as an ongoing compilation of questions and suggested answers relevant to COVID-19. We’ve paid particular attention to the tough and sometimes politicized questions which public health officials are facing in the current media environment. The document is designed to provide message guidance and framing for project partners and public health officials and is regularly updated to reflect new developments and emerging issues.
Skip ahead to a topic:
When will a COVID-19 vaccine be available?
In early November, Pfizer announced that early analysis of its vaccine suggests it is more than 90 percent effective. A week later a second pharmaceutical company, Moderna, Inc., announced that, also based on interim analysis, its COVID-19 vaccine candidate was 94.5 percent effective. While this is very good news, it is also important to remember that the results are preliminary and a lot more work remains to be done.
Both vaccines are currently in Phase 3 trials, and the FDA has said it will not approve a vaccine for emergency use authorization until it has two months of data on safety issues. On November 18, Pfizer announced it would seek FDA emergency approval for its vaccine “within days.”
Both vaccine candidates are based on a similar approach and one that is true of almost all vaccines currently in use, triggering the body’s immune system to make antibodies to fight the virus without actually causing an active infection. A difference between the two vaccines is that the Pfizer product will be somewhat more complicated to distribute because it requires extremely cold refrigeration (-70 degrees). The Moderna product requires a more routine level of cold storage. (-20 degrees).
Both studies included a higher than usual level of racial diversity among the trial participants. If one or both of these vaccines are proven safe and effective and receive FDA approval, it will be a turning point in the effort to stop the virus but would not mean an immediate end to the pandemic. Complex vaccine distribution and public confidence challenges still have to be addressed.
Because initial supplies of any vaccine will be limited, only those in the top category of at-risk groups will be vaccinated this fall and winter. Experts estimate that a vaccine won’t be widely available to people in lower-risk categories until at least the spring of 2021.
In the meantime, it’s more important than ever for people to do their part to slow the spread of the virus by wearing a mask, practicing social distancing, and washing hands regularly.
How will we know if a COVID-19 vaccine is safe?
The U.S. has a long history of assuring vaccines are safe through the use of specific, detailed, and time-tested protocols. The Food and Drug Administration (FDA) announced on October 6 that before approving a potential COVID-19 vaccine, it will need to see two months of follow-up data after volunteers get their second vaccine doses in a clinical trial. This is a sign that the FDA is taking every precaution to ensure the safety of a COVID-19 vaccine.
Clinical development for vaccines is a three-phase process. During Phase I, small groups of people receive the trial vaccine. In Phase II, the clinical study is expanded and the vaccine is given to people who have characteristics (such as age and physical health) similar to those for whom the new vaccine is intended. In the case of COVID-19 vaccines, Phase II trials in the U.S. should have a demographic makeup similar to that of the country, spanning a wide range of ages, races, ethnicities, and any other factors that would affect risk and efficacy. In Phase III, the vaccine is given to thousands of people and tested for efficacy and safety. During clinical development, a trial vaccine’s effectiveness is determined by comparing outcomes of patients who have received it with outcomes of patients who received the placebo.
In the U.S., the findings from clinical trials are presented to and reviewed by the FDA. The FDA also inspects manufacturing facilities to ensure safety and reviews product labels to ensure clarity. After approving a vaccine, the FDA continues to monitor and oversee its production to ensure that all safety protocols are followed. In addition, many vaccines undergo Phase IV formal, ongoing studies after the vaccine is approved and licensed. The FDA and CDC also collect and analyze information from reports of any side effects that may occur after a vaccine has been licensed.
In summary, before any new vaccine is brought to market, it has been given to thousands of people under stringent monitoring for safety. Sometimes, very rare side effects are recognized only after the vaccine is licensed because they occur so infrequently, but such side effects are very rare and must be weighed against the good the vaccine will do.
Why is it important to have diversity among clinical trial subjects?
Everyone is susceptible to infection by the coronavirus. For that reason, a coronavirus vaccine needs to be safe and effective for all people regardless of their age, race, ethnicity, or gender. Therefore, it’s important to have diversity among participants in clinical trials that measure a potential vaccine’s safety and effectiveness.
Safety and effectiveness for all groups of people is particularly important for a COVID-19 vaccine because of the virus’s disproportionate impact on people of color, people with underlying medical conditions, and the elderly. A vaccine that is not sufficiently tested in a diverse clinical trial pool could lead to unexpected effects that didn’t appear in a trial with a more general population.
In May the FDA “strongly encouraged” the inclusion of diverse populations in COVID-19 clinical vaccine trials, including racial and ethnic minorities, the elderly, people with underlying medical conditions, and pregnant women. However, according to Clinical Research Pathways, a nonprofit that focuses on increasing diversity in clinical research, Black people typically represent only about 5 percent of clinical trial pool participants, even though they make up 13 percent of the U.S. population. Hispanics are typically about 1 percent of clinical trial pool participants but make up 18 percent of the population. Overall, Blacks, Hispanics, American Indians, and Alaska Natives make up approximately 32 percent of the U.S. population; optimally, they should be at least 32 percent of the people participating in the COVID-19 clinical trials.
Moderna, a biotechnology company working with the National Institutes of Health to develop a vaccine, recently announced that its vaccine trial pool is 37 percent minority participants.
How should we be preparing for vaccine distribution once a vaccine is available?
It is essential to have careful and thoughtful planning for the COVID-19 vaccination campaign. Such a process takes months and has begun.
The process of vaccinating hundreds of millions of people — in stages based on risk criteria provided by scientific oversight agencies — will be complicated. The public health sector will have a leading role in conjunction with those in healthcare and other sectors. The effort will need to include accurate estimates of the dates and quantities of vaccine availability, scheduling of populations to be prioritized before sufficient vaccine is available for everyone, identification of vaccine sites and vaccinators, training and authorization for many more people to administer the vaccine, public information campaigns, and careful monitoring of the process and outcome.
Special efforts will be necessary to reach populations at elevated risk and develop trust with people who have concerns about vaccine safety. A process that is transparent and fully grounded in science will be critical to ensuring public confidence in the vaccine.
How will the vaccine be distributed?
The distribution process for the COVID-19 vaccine must be designed so that those people at highest risk of infection are vaccinated first. Even with a global effort to develop and produce a vaccine, initial vaccine supply will be limited, therefore, policymakers must have a plan for equitable allocation of limited doses.
In response to a request from the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC), the National Academy of Medicine formed a committee to produce a consensus study to assist policymakers in the U.S. and global health communities. The committee includes 18 experts from diverse universities and organizations across the country.
On October 2, the committee published its framework for equitable allocation of the vaccine based on this study. The framework recommendations will be one of several factors that ultimately determine how the vaccine availability will be prioritized.
The framework recommends a four-phased approach to allocations:
- Phase 1 prioritizes front-line health workers and people with underlying conditions that put them at a significantly higher risk from COVID-19.
- Phase 2 extends to K-12 teachers and staff, child care workers, critical workers in high-risk settings such as food supply and public transit, people with conditions that put them at moderately higher risk from COVID-19, and people living or working in homeless shelters, group homes, prisons, jails, and detention centers.
- Phase 3 includes young adults, children, and workers in industries such as colleges and universities, hotels, banks, exercise facilities, and factories with a moderately high risk of exposure.
- Phase 4 covers everyone residing in the U.S. who did not previously have access to the vaccine.
updated November 3
With the holiday season approaching, what are some ways to safely celebrate with family and friends?
The fall and winter holiday seasons are traditionally a time to gather with loved ones and celebrate. The CDC has released guidelines that should be used in conjunction with state, local, territorial, and tribal health and safety rules. Please consult these guidelines before planning or attending any sort of celebration, and stay at home if you are experiencing symptoms of any kind. The Public Health Communications Collaborative has created an infographic that quickly summarizes the CDC’s recommendations.
Participating in virtual gatherings or limiting celebrations to with those within your own household pose the lowest risk for COVID-19 spread. If you choose to celebrate with people outside of your household, the CDC recommends holding only small, outdoor gatherings and ensuring that attendees maintain a safe social distance. If you plan to host or attend indoor celebrations, you should wear a mask that covers your nose, mouth, and chin; wash your hands often; and limit the number of people who handle and serve food.
Traveling increases your risk of exposure and the spread of COVID-19, and planes, trains, buses, and cars carry varying degrees of risk. The best way to prevent the spread of COVID-19 this holiday season is to stay home, but if you travel, you should avoid crowds and minimize your use of public transportation.updated November 4
Why should we continue to put our lives on hold when there’s still no agreement on how to end this pandemic?
We understand that people are tired, but public health measures are not the enemy – they are the roadmap for a faster and more sustainable recovery. Because COVID-19 is highly infectious, one infection can quickly grow into an outbreak that could shutter a whole city.
Public health policy measures are in place to prevent crippling surges and make re-opening possible. Scientists and medical professionals are doing everything they can to develop and prepare to distribute a safe and effective vaccine that will help us return to more normal day-to-day activities. Until then (and perhaps even after there is a vaccine), the best way to slow the spread and stay safe is to do three simple things: wear a mask, practice social distancing and wash your hands.added November 3
There have been reports suggesting the CDC’s reputation has been diminished as a result of its role in the COVID-19 response. Is the CDC’s leadership still credible?
For decades, the CDC has put its scientific expertise to work to protect Americans from infectious disease, chronic illness, and preventable injuries. Around the world, the agency is a trusted source for public health and health promotion guidance; the CDC’s career staff remain a respected and credible information source.
The CDC is at its best when its scientists are free to provide public health advice based on the best available data and free of any political or non-scientific considerations.
There’s no avoiding the fact that the COVID-19 pandemic has been extremely challenging for the entire country, including the CDC. There was an early misstep at the CDC with the initial development of a COVID-19 test. However, since then CDC has gathered and shared data on the pandemic’s impact, produced educational materials, distributed billions of dollars in grant funding to local, state, tribal, and territorial agencies, and supported essential services necessary for testing, contact tracing, and protection of the public.
However, the CDC has not had the central and visible roles in coordinating and messaging during the COVID-19 pandemic that it had during past infectious disease outbreaks, including malaria, HIV, H1N1, Ebola, and Zika. This lack of a central, public-facing role for the CDC has impeded the federal response, contributed to mixed messaging on the optimal response to the pandemic, and delayed and sometimes distorted the guidance needed by the American public.
Everyone benefits when the CDC is allowed to do its job without interference and with regular, unfettered science-based messaging offered directly to the public and policymakers.
Thousands of rank-and-file CDC employees are scientists and public health experts, dedicated only to the protection of the public. These career professionals remain at their desks and in the field doing the day in and day out work necessary to fight the virus. Going forward, the nation needs to ensure that science guides public health unfettered by any interference. When statements are made or policies suggested that are not grounded in science, public health experts need to continue to say so.
Why should people trust public health officials?
Public health officials are trained and experienced in responding to infectious disease outbreaks and life-threatening emergencies. They work closely with scientists and researchers to translate the latest findings into action with the express goal of keeping people as safe and healthy as possible.
Public health officials strive to be guided by science and independent of political or partisan considerations. The most effective way to address COVID-19 is to have state, local, and federal officials working in coordination and operating based on scientific guidance.
What is a public health official’s most important role during a health emergency?
As always, the role of public health officials is to follow the science, develop programs and guidelines that protect health, advise elected officials, work with public and private sector partners, and keep the public informed.
updated November 3
What is herd immunity, and is it a viable strategy to combat COVID-19?
Under the current conditions, a herd immunity strategy in response to the COVID-19 pandemic would be irresponsible and dangerous.
Herd immunity is achieved when a virus stops circulating because a large segment of the population has already been infected or has been vaccinated against the virus. Experts believe that 85 to 90 percent of the U.S. population is still susceptible to the COVID-19 virus. A strategy of letting millions more Americans get sick instead of focusing on proven infection control methods would lead to many more deaths. It would likely also increase the disproportionate impact the virus has had within communities of color.
A recently proposed strategy to let children and young adults become infected to achieve herd immunity is unscientific and reckless. Young people don’t live in a vacuum – they interact with family, co-workers and neighbors. Such a strategy would put the entire population at risk.
A herd immunity strategy was attempted in Sweden, only to be quickly ended when COVID-19 deaths sharply increased. See a statement on this topic by Trust for America’s Health, the de Beaumont Foundation, the American Public Health Association, and more than a dozen other public health organizations.
added October 18
Health care providers have had months to build capacity and supplies to manage the COVID-19 outbreak. Why are we hearing about shortages of beds and supplies again?
The most serious potential shortage is for hospital intensive care capacity. The only way to prevent such shortages is to control the spread of COVID-19. During late October there was an unprecedented surge in cases in many communities across the country. In those communities, patients may be at risk if the capacity of local hospitals to provide intensive care is exceeded by the number of patients needing that care. That’s why it is vital for us to work together and follow the latest public health guidance to prevent the spread of the virus.
added November 3
Have public health measures had a negative impact on the national economy?
Public health measures are not an obstacle to a return to normalcy, they are the roadmap to faster and sustained recovery. Americans are coping with job losses, school closures, social isolation, and fears around health and safety. Many people are frightened, angry, and frustrated. As public health officials, we share this frustration. We want the economy and our schools to open. At the same time, we want to protect our families, friends, and neighbors from the virus, and we know that if we don’t, there will be even worse consequences for the economy and for schools.
As we have consistently seen in the United States and around the world, public health measures effectively control the spread of the virus and make re-opening possible. New York’s rebound from the worst in the nation for COVID-19 spread is a one example.
Nobody should have to decide between the health of their family and putting food on the table. The goal is both public health safety and economic security; the two are dependent on each other.
updated November 3
Is rapid testing effective for diagnosing and preventing the spread of COVID-19?
Rapid antigen tests are relatively inexpensive and, with proper interpretation, can be used to quickly confirm a suspected case of COVID-19 in a clinical setting. However, these tests are less sensitive than the recommended RT-PCR tests and more likely to return a false negative. Because they are less sensitive, rapid tests perform best when the person is tested in the early stages of infection, when viral load is generally highest. There is limited evidence to confirm the efficacy of rapid antigen tests to detect or exclude COVID-19 in asymptomatic people accurately or determine whether a previously confirmed case is still infectious.
In short, rapid tests are useful for confirming infection in someone with symptoms. They are less reliable in screening of people who are asymptomatic.
If it’s going to take 12+ days get my results for a COVID-19 test, is it worth getting tested? What should I do between the time of my test and getting the results?
Widespread testing is critical to identifying and forecasting outbreaks, conducting effective contact tracing, and determining how safe it is to re-open the economy and schools, but testing is only meaningful if the results are available quickly—within a few days at the most.
Efforts to increase testing and make the results available quickly are continuing. Anyone experiencing COVID-19 symptoms or with reason to believe they may have been exposed should operate under a “positive until proven negative” mentality, self-quarantining until they receive test results.
updated October 18
What is the difference between “emergency use” and “compassionate use” for drugs and other therapies?
Emergency Use Authorization (EUA) allows the Food and Drug Administration (FDA) to authorize use of unapproved drugs, or unapproved uses of approved drugs, for life-threatening conditions when there are no adequate, approved, and available options and other conditions are met. In the case of COVID-19, the FDA has issued an Emergency Use Authorization for remdesivir, an investigational antiviral drug that is not currently FDA-approved, to treat hospitalized adult and pediatric patients with severe COVID-19.
Compassionate use, also called expanded access, is when a patient with an immediately life-threatening condition or serious disease or condition is given access to an investigational medicine for treatment outside of clinical trials when no comparable or satisfactory alternative therapy options are available. Patients must petition for compassionate use and meet a series of criteria to get expanded access. In the case of COVID-19, patients with life-threatening cases of COVID-19 can petition for expanded access to COVID-19 treatments that are currently in the clinical trial phase.
What is an experimental drug or treatment?
Experimental or investigational drugs and treatments have not yet been approved by the FDA and are currently being studied in clinical trials. During these trials, scientists determine whether a drug is safe and effective, how it should be used, the correct dosage, and the benefits and risks for people taking the drug.added October 18
How can a public health department expect someone who has just been diagnosed with COVID to provide information on possible contacts if those contacts may face hardship by being identified, such as being unable to go to work?
Contact tracing is currently one of the most important tools we have for controlling the spread of the virus. While we understand that no one wants to be the reason someone is unable to work, allowing the virus to spread unchecked will be much more harmful to your community and would have an even greater impact on employment. Cooperating with contact tracers will help prevent people from getting sick. Preventing further spread of the virus is the best strategy we have to protect jobs and livelihoods.
That said, efforts are being made to lessen the impact of going into quarantine. There are both formal and informal ways to assist people who need to quarantine. In some communities, there are services available or volunteers to help – for example, by delivering meals to people who are at home. Hardship can also be lessened when employers offer paid sick leave to employees who need to stay home.
Why aren’t communities prepared to do contact tracing at an effective scale?
Contact tracing is the practice of informing people when they’ve been exposed to a contagious disease. It is an essential part of a comprehensive response to slowing the spread of COVID-19. However, because the scale of contract tracing required by the COVID-19 outbreak is beyond anything we’ve ever experienced, the size of the necessary contract tracing effort was not planned or funded.
There are ways to make contract tracing more manageable and therefore more effective. Health departments need faster COVID testing, funding to hire and train more contact tracers, and sufficient financial and social service support for those who are asked to isolate rather than return to work. We also need the public’s cooperation if they are contacted by a contact tracer.
updated October 18
With guidance from the federal government changing so frequently, where can I go for reliable COVID-19 information?
Safety guidance has changed as more has been learned about the virus and how to prevent its spread. The rate of virus spread in your local community, in addition to your individual health status, will largely determine the safest options for you. Your local health department is an important source of COVID-19 information that’s specific to your community.
What is the meaning and significance of CDC’s recent change of guidance regarding testing of asymptomatic people for COVID-19?
On September 18, CDC reversed its August guidance on who should be tested for the COVID-19 virus. Current guidance now clearly states that regardless of symptoms, people who have had close contact with an infected individual should get tested for COVID-19.
This guidance now aligns with the known science about the best way to identify who has the virus and thereby control its spread. It is critical that COVID-19 cases are detected as early as possible, especially since an estimated 40 percent of infected individuals may lack symptoms but still spread the virus.
Unfortunately, the guidance posted at the end of August was incorrect. The current guidance to test anyone who has been exposed to the virus is the correct directive. State and local health officials have requested that CDC provide more clarity on the reasons for the changed guidance. They have also requested that no further changes to the public guidance be made without prior communication with and involvement of critical public health partners at the state, local, tribal, and territorial levels. But the most important takeaway for all Americans is, if you believe you have had contact with a COVID-19 infected individual, you should be tested for the virus in order to protect your own health and the health of those around you.
How can people trust public officials when guidance has been unclear and is constantly changing?
We understand it is frustrating that guidance continues to change. It’s the job of public health officials to tell you what we know, when we know it, and guidance regarding COVID-19 has evolved as our understanding of the virus evolves.
Public health officials and scientists are continuing to learn about how this virus spreads, how it affects different people, and how best to control it. As knowledge evolves and scientists discover new information about COVID-19, public health officials are committed to providing accurate and timely guidance.
updated September 25
Is it safe to vote this November?
The COVID-19 pandemic should not hinder your ability to vote. However, it is important that individuals and jurisdictions plan ahead to ensure that everyone can vote safely.
Most election officials are working to create as safe a voting environment as possible by ensuring social distancing and mask wearing requirements at polling places. These preparations should also include cleaning surfaces and voting equipment and disinfecting continuously throughout Election Day, as well as ensuring adequate ventilation at voting sites. State election officials should work with public health officials to ensure a safe voting experience for everyone.
In most states, voters also have the option of voting by mail or absentee ballot, voting early, or voting during non-peak hours. Voters should check their local election office website for additional information about specific voting alternatives and precautions. Visit usa.gov/election-office. In addition the American Public Health Association and the National Association of County and City Health Officials have created HealthyVoting.org, a state-by-state guide with the latest guidance from public health experts.
Can my child safely participate in sports?
Providing the opportunity for kids to get exercise is as important as ever. While the best way to limit your child’s risk from the coronavirus is by ensuring they only engage in activities that allow participants to maintain six feet of distance, there are additional ways that leagues, players, and parents can protect families and communities and slow the spread of COVID-19. Participants should stay home if they’re sick, bring their own equipment to practice, maintain six feet of space from others, wear a mask if possible, and ensure proper hygiene. At the same time, leagues can focus on lower-risk activities like outdoor skills-building and conditioning rather than running the risk of contact between players. Certain activities are also safer than others — like tennis, soccer drills rather than scrimmages, and passing and catching football drills.
Is it safe for scholastic sports leagues to play? Professional leagues have been operating.
The risk of activities varies greatly depending on local community spread, so any decision about school sports should be made based upon the virus status locally. What may be considered moderate risk in some areas would be high risk in others.
Professional leagues are different from high school and college athletics in many ways, most notably that they can keep their athletes in a bubble and oversee their other activities. By contrast, student athletes do not occur in a bubble, which means they face increased risk for themselves, their family members, and their school’s students and staff. While many Americans enjoy watching and playing sports, we need to ensure we aren’t putting the health and safety of students, staff, families, and our community at risk.
updated September 17
Are the death tolls for COVID-19 being inflated? The CDC reports that only a small number of COVID deaths were due exclusively to COVID.
The novel coronavirus remains a serious threat to public health, and there is no evidence that the number of COVID-19 deaths has been inflated. In fact, they are probably under-reported because some people have died of COVID without being tested for the virus. The CDC’s report gives a detailed account of something we’ve known since the beginning of the pandemic – having comorbidities like diabetes, heart disease, or obesity greatly increases a person’s risk for life-threatening consequences from the infection. We also know that COVID-19 can cause other illnesses, such as pneumonia or respiratory distress.
The high rate of chronic illness in the U.S. (6 in 10 adults have a chronic disease) has contributed to the high number of COVID-19 deaths, but the cause of these deaths is COVID-19, not some other illness.
Why has data reporting been slow or incomplete under the CDC?
One of the challenges the entire public health system is facing is that most COVID-19 cases go undiagnosed due to asymptomatic infection (people who have the virus but no symptoms).
The CDC relies on local, city, state, and federal reporting systems that have been neglected for decades. CDC is also focused on providing accurate information based on reports from health departments; this means that these reports may sometimes be more delayed than reports from news organizations, which often report unconfirmed information from unofficial sources.
Investing in the data systems at CDC and state and at local health departments is essential to collecting and sharing data across different systems in an automated manner. More efficient data collection is central to controlling any infectious disease outbreak.
How will the new reporting system affect the accuracy and timeliness of data collection and reporting?
Building and implementing theWhite House Coronavirus Task Force data collection system that was announced in July, will take time and resources. The public health sector will do all it can to ensure that accurate and timely information is submitted to this new system. At the same time, it is important to update and strengthen the CDC’s data systems and those at the local, state, tribal, and territorial levels. These are the systems that are at the heart of the COVID response and the responses to all past and future infectious disease outbreaks.
updated September 17
Has the public health response been adequate in communities of color and low-income communities?
Prevention and treatment of infectious and chronic disease for low-income people and communities of color is woefully insufficient in our country, and the COVID-19 pandemic has been no exception to that pattern.
In general, access to affordable health care services for these communities, including testing, has been more challenging than in white communities. Limited economic opportunity and substandard housing have led to higher rates of underlying chronic health conditions, making serious illness and death from COVID more likely among communities of color. In addition, people of color and lower-income Americans have also been disproportionately designated as essential workers during the pandemic, with fewer job protections, placing them at increased risk for exposure. They also tend to live in more densely populated neighborhoods, making social distancing difficult.
These circumstances are the results of our country’s long history of structural racism in housing, jobs, education and healthcare. Addressing this racism is not only critical to protecting communities of color from the impact of COVID, it is critical to address them to allow all people to lead healthy lives.
Because COVID-19 spreads from person to person via respiratory droplets, properly wearing a mask helps prevent the spread of the virus to others, including those at a higher risk of severe illness, especially when paired with other prevention tactics such as proper social distancing and frequent hand washing. At this point, wearing a mask is one of the most important tools we have to fight the spread of the virus.
What type of mask is the most effective for preventing the spread of COVID-19?
Surgical and fitted N95 masks are the most effective for the prevention of spread of COVID-19. In the absence of these, homemade masks should fit tightly against the face and cover the nose, mouth, and chin. Masks that have any exhalation vales or vents are not recommended, as these allow for the escape of respiratory droplets. Research is continuing to determine which types of masks offer the optimal protection.
Why should we trust the CDC on wearing masks when they explicitly told us not to do so at the start of the pandemic?
At the onset of the pandemic, the CDC recommended that those who exhibited COVID-19 symptoms and those who were caring for someone who had COVID-19 wear face masks. Others were dissuaded from wearing surgical masks due to a severe shortage of personal protective equipment (PPE) among health workers treating COVID-19 patients and because, at that time, there wasn’t sufficient evidence of the efficacy of mask-wearing for the general public. As new research demonstrated that the virus could be easily spread by asymptomatic individuals, the CDC updated its recommendations to indicate that everyone should wear face coverings in public settings. Updating guidance is one of the many important roles the CDC plays in protecting public health, and as new scientific evidence becomes available, the agency will continue to update guidance accordingly.
Public health officials are facing unprecedented levels of scrutiny and backlash as the COVID-19 pandemic takes a toll on health systems, the economy, and our nation’s education system. Despite the inevitable challenges of constantly evolving research and evidence, public health officials are the people who are best positioned to help our country emerge from this crisis as safely as possible. Unfortunately, some officials are being harassed and threatened, and have experienced intense, politicized pushback. Public health experts want the economy, schools, and businesses to open as much as anyone else. Data show that the best way to re-open and avoid being shut down repeatedly is to re-open safely while continuing to take precautions. When re-opening isn’t done safely, the economic consequences are much worse. Dismissing or attempting to intimidate the very officials working to ensure the public’s safety is undermining and delaying the full and safe re-opening of our economy and education system.
Re-opening schools and universities is critical for the educational and social development of students of all ages. It is also necessary to re-open these institutions for many parents who need to return to work. At the same time, we want to ensure that schools open in a manner that prioritizes the health and safety of students, teachers, school staff, their families, and the community at large. These are not mutually exclusive goals. If schools open too early or without appropriate measures, there is an increased risk that the virus will spread and cause serious illness and deaths. If that happens, schools will need to be abruptly shut down again, creating additional disruption and even less in-person learning time.
Does COVID-19 need to be eradicated before it’s safe for schools to re-open?
Based on what we know now, COVID-19 will be with us for a while. Our job is to provide the best guidance possible based on the available data. If schools re-open with COVID-19 spreading in the community, there will likely be outbreaks in schools, particularly if schools reopen before community transmission rates are low. Our goal is to reduce, to the greatest extent possible, transmission of disease to students, teachers, and staff in the school setting which will help prevent infection in the wider community. This means taking steps to mitigate spread once in-person learning is reinstated.
What can communities do to safely prepare to open schools?
The keys for safe re-opening is tracking local trends, a strong testing strategy for schools and communities, and compliance with CDC guidelines such as mask-wearing, hand washing, and social distancing. Nationally and locally, infection rates need to get down to a level where contract tracing can be effective, and communities need to adopt mask-wearing as a consistent practice. Schools and universities need systems in place to ensure that mask-wearing, hand washing, social distancing, and daily sanitation guidelines are required and consistently followed by staff, students, and their families on school grounds. For residents who want to help ensure that schools are able to re-open for in-person learning as soon as possible, our best advice is to wear a mask, wash your hands, and practice social distancing to help drive down the infection rate in your community.
What about schools in disadvantaged neighborhoods that serve many needs in addition to education?
Schools are more than places of learning. They provide nutrition, access to mental and behavioral health providers, access to health services, and critical social and emotional learning opportunities. If schools cannot re-open safely, it is important that school districts and local government officials identify alternative ways of providing these supports to children and their families.
Should governments punish schools and universities that refuse to open?
Decisions about school re-opening have to be made based on the community’s COVID-19 status and the school’s ability to have safety protocols in place. These decisions shouldn’t be made by edicts from the state or federal government. Local and state health officials, whose job it is to evaluate the data, are in the best position to advise about the right decision for the community. Unfortunately, we have seen the consequences of communities re-opening schools too quickly and without the necessary safety measures in place. Many have had to close down again as cases and deaths have risen.
Shouldn’t the country follow a unified plan to re-open schools?
Although the principles of safer reopening are the same, school re-openings will look different in different parts of the country. Because the rates of COVID-19 are at varying levels across communities, each region will have a different set of challenges and a different timeline in preparing to re-open. It is vital that school districts are able to listen to the guidance provided by their state and local public health officials, work to fully understand the current situation, and determine how best to keep school faculty, staff, and students safe.
It is more important than ever to protect against influenza, which, like COVID-19, is a respiratory illness. Vaccination for the flu is critical to help reduce the overall impact of respiratory illnesses on the general population and lower the resulting burden on the healthcare system during the pandemic.
National, state, local, tribal, and territorial health officials are all working hard to ensure the safety of their communities and the country as a whole. While federal public health experts can coordinate national response strategies, the impact of COVID-19 varies by state, city, county, village, and town. Local and state health officials have the best understanding of how the virus is impacting their immediate community, the level of community spread, community-specific risks, and who the community will trust to provide public health information. They use that understanding to adapt national guidelines for their communities.
What are your thoughts on the White House Coronavirus Task Force? Is it effective?
The public health experts on the White House Coronavirus Task Force are doing their best to analyze the evidence and advise on a national strategy. Ensuring that America’s response to this pandemic is grounded in science is critically important to managing its impact. The Task Force is at its best when it is guided by science and informed by public health experts. What we hope to see is clear, consistent leadership and messaging from the Administration.
Is the Administration trying to sideline the CDC?
I don’t know what the Administration’s motives are, but I can tell you that the CDC is responsible for promoting and protecting the health of Americans, and it is now more critical than ever that they receive the support and funding necessary to ensure the health and safety of our country. The Administration’s response to the pandemic is at its best when it is guided by the CDC’s experts and informed by data and information-sharing from state and local public health officials.
Is the Administration trying to undermine Dr. Fauci?
I don’t know what the Administration’s motives are, but I can tell you that Dr. Anthony Fauci is a seasoned physician and immunologist who has worked under six presidents from both parties in his 34-year tenure as director of the National Institute of Allergy and Infectious Diseases. He is working hard to inform the American public and respond to the ongoing pandemic. Anyone charged with developing policies and creating guidelines as a part of the COVID-19 response would be wise to heed his expertise and fully embrace his guidance.
The COVID-19 pandemic has exposed the impact of chronic underfunding of America’s public health and emergency preparedness systems. Only five states serve over 50 percent of their populations with a comprehensive public health system. More than 56,000 local public health jobs were eliminated between 2008 and 2017 — nearly one-quarter of the workforce. And in 2018, the White House Office of Global Pandemics was eliminated, leaving the country less prepared for pandemics like COVID-19. This chronic under funding has real consequences, as we’re learning now with health departments struggling to respond to the biggest public health crisis in a century with outdated technologies and inadequate staffing levels. Building and maintaining a public health system capable of effectively protecting and promoting health requires a significant increase in funding. This would be a wise investment considering the much higher costs of responding to uncontrolled epidemics.
How have other countries been able to significantly reduce their COVID-19 cases, and could those tactics be applied in the U.S.?
While COVID-19 has affected some countries more than others, there are places like South Korea and Taiwan that have been able to significantly reduce their surge in cases for a variety of reasons. Those governments took action early; made testing widely available; effectively implemented isolation and quarantine practices, with careful monitoring for compliance and assistance with social and economic supports; and reinforced the importance of social distancing and mask-wearing. In the U.S., some of these steps would be more difficult than others because of cultural and legal differences and resource availability, but many are being advanced here as well. We continue to urge the public to wear face masks and practice social distancing rules outside the home. And we continue to advocate for increased access to reliable testing with quick turn-around time for results and for efficient case finding and contact tracing.