DURHAM, N.C. -- The United States needs a renewed commitment to social distancing and mask-wearing as well as more testing and contact tracing to make significant progress in the fight against COVID-19, a Duke health policy expert said Tuesday.
And stronger public health messaging to and between young people would help as well, said Mark McClellan, the director of the Duke-Margolis Center for Health Policy.
A former commissioner of the U.S. Food and Drug Administration, McClellan spoke to members of the media Tuesday about the many containment measures still necessary to get ahead of the COVID-19 pandemic in the United States.
Here are excerpts:
ON WHETHER IT WOULD HELP FOR PRESIDENT TRUMP TO WEAR A MASK PUBLICLY
“I think that would help. The president is living in a different environment. He gets tested every day. Everybody who comes into contact with him gets tested frequently. If we could make that kind of support available to everyone, everywhere, maybe we wouldn’t have to wear masks as long.”
“I think you’ve seen some really good leadership examples from Republican governors and other politicians from both parties about the importance of masks. I think it would help if the president did it too.”
ON WHY MANY PEOPLE DON’T WEAR MASKS IN PUBLIC
“It’s people thinking this is about themselves and their choices. Americans, that’s our culture. We’re about independence. We’re about the right to make our own decisions. A lot of people have looked at this and concluded ‘I’m not going to get sick.’ “
“We’re asking people to do something when they feel perfectly well that is a new restriction. But the masks do work when people do adhere to them. Just like spending more time at a distance, not going to big, so-called congregant settings. Those steps do work.”
ON A RISE IN COVID-19 PATIENTS BEING HOSPITALIZED
“Hospitalizations are actually a good benchmark. It’s a sign of hospitals getting strained. The good news with these trends … is we’re seeing fewer people hospitalized out of the new cases, and we’re also seeing better outcomes for the people who are hospitalized. That’s a reflection of more of the cases being in younger individuals. There’s been a shift in who is coming down with COVID-19 infections, with more older Americans clearly taking more steps to be careful, to follow the guidance to avoid infection. Unfortunately, we’re not seeing that among many of the younger communities.”
“It’s even more important than ever not to overwhelm our healthcare systems. Because we can do more to save the lives of people having more serious cases. But of course if we really want to have a safe and stable, reopened economy where people are confident about going out, we’re not worried about our healthcare systems reopening successfully, we’ve got to get these trends in hospital admissions down.”
“The other piece of bad news here is that hospital admissions are a lagging indicator of how the virus is progressing. It reflects activities from 10 days, two weeks ago in terms of how people or businesses are actually transmitting the virus. So it’s going to get worse before it gets better in some parts of the country.”
“I think things are going to be significantly better in terms of treatments we have available in a matter of months. That means we may be able to relax a bit more.”
“For the coming months, in order to contain the outbreak, we’re going to have to do better than we’ve done so far.”
ON GETTING YOUNG PEOPLE TO TAKE COVID SERIOUSLY
“I think the federal government is saying a lot of the right things. I’m just not sure it’s been easy for people to get their heads around. For young Americans, it’s understandably been challenging to be isolated for so long.”
“It’s important to realize there are two challenges here for younger people. They do have serious complications in some cases. A large part of the hospitalizations we’re seeing now … some are very serious cases and deaths involving younger Americans. This is a direct health risk.”
“The other thing we’ve clearly seen is that your behavior is not just about you. We’re all in this together. The models show that unless we get quite high rates of people following basic steps (distancing, using a mask, washing hands, staying home) if we did those things at a high rate for the next six months, we would contain the pandemic.”
“For people who are younger, people who don’t look like me, they probably need to be hearing this, not just from government officials but from people who are in their circles, their influencers, people who they respect. What they do with their actions, for the next few months, for the next six months, really is going to save lives if they take these steps.”
“What’s really tough with this virus is that a lot of the transmission occurs from people who don’t have any symptoms at all or just have really mild symptoms.”
“It is important for everyone to recognize just how much their own behavioral choices … really have an impact on the health of those around them.”
ON NEED FOR MORE TESTING IN VULNERABLE COMMUNITIES
“The evidence over the last couple of weeks has become overwhelming that the virus impact has differed enormously across different racial and socioeconomic groups. If you look around the country, we’re seeing four-fold differences in hospitalization rates. Large differences in mortality rates. If you look around the country, we are not yet even in access to testing.”
ON WHY SOME EUROPEAN COUNTRIES HAVE BEEN MORE SUCCESSFUL STOPPING COVID OUTBREAKS
“Many of their initial shelter-in-place orders were actually stronger than ours. In Italy, you could not go out. They did an even tougher job of really driving down the spread of the virus.”
“And when they opened, they waited until they were seeing significant declines in cases. They put in place the testing, the contact tracing, things we’re doing here, but when they did so they had a declining and lower number of cases that they had to manage.”
“If you’re dealing with only a few leaks in the dam, it’s easier to patch those up, versus if the water level is rising and there are many more leaks. That’s kind of the challenge we’re having now. It’s very hard, even with an increase in testing … if there’s so many more people with positive cases, we’re still overwhelming our testing system.”
You can watch the briefing here: https://www.youtube.com/watch?v=JHDewBVQ1ko
Dr. Mark McClellan is a physician and economist who directs the Duke-Margolis Center for Health Policy, where he works on strategies and policy reforms to improve health care. He was commissioner of the U.S. Food and Drug Administration and administrator of the Centers for Medicare & Medicaid Services. firstname.lastname@example.org
Duke experts on a variety of other topics related the coronavirus pandemic can be found here.