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Editor's Note: This is a complimentary research note published by Healthcare Policy analyst Emily Evans on 3/7/21. CLICK HERE to get COVID-19 analysis and alerts from our research team and access our related webcasts. |
Politics
As that part of the U.S. economy formerly known as “fun” – concert, parties, dinners – settles into the starting blocks in anticipation of widespread vaccination and better weather, national policy and political leaders are maintaining their c. 2020 embrace of end times.
When Governor Greg Abbott of Texas preempted local laws on business closures and mask mandates last week, followed quickly by fellow Republican, Tate Reeves of Mississippi, President Biden decried their “Neanderthal thinking.” Centers for Disease Control and Prevention Director Rochelle Walensky also criticized the move.
The Biden administration’s posture seems oddly out of step with the national mood and the emerging 2021 politics. The 2020 election was a lot of things but above all it was a referendum on competence and leadership.
Biden’s response to the mandate to set things right and quickly has been, well, more uncertainty with a large side order of helplessness.
Even with a lot of monetary incentives in the form of COVID relief/stimulus, that is a road most Governors facing election in 2022 are not going down. In almost every case their management of the pandemic response will be front and center throughout late 2021 and 2022.
This electoral fact requires them to focus on traditional metrics like unemployment, budgets, state GDP, sales tax collections and all the minutiae of government that point toward resurrection of “fun.”
Hence Democrat Governor Ned Lamont of Connecticut where the first dose of vaccine has been administered to a stellar 28% of eligible populations did pretty much the same things as Abbott and Reeves. He just avoided the name calling.
Policy
To the raging bonfire of the vanities, piled high with a century of learnings on public health, immunity – either through recovery or vaccination - is set to be thrown.
Since the late 18th century when Dr. Edward Jenner concluded that a cowpox infection could ward off the much more deadly and disfiguring smallpox, immunizations have made life safer, more comfortable and a lot longer.
The CDC was preparing to issue guidance on use of nonmedical interventions like mask wearing and gatherings last week. It was delayed without much explanation. According to press reports, the CDC planned to recommend that small gatherings between immunized individuals was appropriate while continuing to discourage large events and promoting continued mask-wearing.
A delay like this usually indicates either a changing situation or a dispute between the agency and the White House. In this case it is probably a dispute.
The political people at the White House have continued to advocate for strong nonmedical interventions in response to concerns about circulating variants, potential for resurgence, etc.
This political theater is not without costs. A vaccination that does not deliver on at least part of the promise of science, like a more comfortable life, is not going to be of much interest. If you are still prevented from returning to work at a bar, restaurant or club, you aren’t going to hurry down to the pharmacy for a shot that might make you uncomfortable for a few days.
The absence of understanding the differing motivations of various demographic groups in the U.S. has been a hallmark of public health policy the last year. It was been replaced with complicated plans to vaccinate under-served communities that slowed vaccine roll-out in many states.
Slowed, that is, until America’s dominant demographic, non-Hispanic whites living in urban areas figured out that an hour drive from home nets them the promise of vaccines, like a more comfortable ski trip this month.
Power
No issue has Joe Biden struggled more with than making good on his promise to return children to classroom learning. His influence is, of course, limited and he has thus far used the one tool he has, CDC guidance poorly.
Like so much of the early days of this administration the official policy continues to look and feel like it is revisiting what it would have done in the spring of 2020 not what is needs to do now.
The CDC guidance on reopening schools relies on many practices adopted in early 2020 but proven now to be marginally effective if at all. Everything you can recall from last spring is there: regular cleaning of high touch surfaces between use; visual signals like tape and barriers to discourage crowding; and modified layouts to encourage physical distancing.
Leaving aside ongoing debate among pediatricians about denying immunological development in children due to obsessive handwashing and limited physical contact, the scientific community has been uniform in its conclusion that school-age children present little risk to adults and each other. The overwhelming consensus if children should be in school.
Yet, the CDC seems to be ignoring the fast accumulating research from around the world in favor of overly prescriptive guidance that grants cover to political forces seeking to exert their own power in the debate.
And they are.
Last week the Los Angeles County teachers’ union voted overwhelmingly to reject Gov. Newsom’s offer to return to the classroom, suggesting many children in California are not likely to see the inside of a classroom until fall.
