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What the White House Covid-19 Global Summit should have spent more time on

World leaders gathered at a virtual global Covid-19 summit on Thursday to discuss the next steps in a pandemic that has killed an estimated 15 million people so far and disrupted the lives of everyone around the world. . The event coincided with the United States officially marking 1 million Covid deaths, underscoring the toll the virus has taken and the need for continued action to reduce health risks at home. coming.

The summit led to a commitment of $3.2 billion in additional funding focused on global access to vaccines, with additional financial commitments to support equitable access to testing and treatment as well as future pandemic preparedness. But it is worth noting what was not a predominant element in the financial commitments: resources and strategies to reduce exposures to the current pandemic.

If we handle exposures in the wrong way, we risk investing a lot of money in unnecessary actions or taking unnecessarily aggressive actions that have harmful societal consequences.

Of course, it is important to provide equitable global access to vaccines and treatments, so that we can reduce the worst consequences of infection. But if we don’t also invest in reducing exposures, we will have many more cases to treat and an increased likelihood of new variants that may elude our available vaccines and treatments. And if we handle exposures in the wrong way, we risk investing a lot of money in unnecessary actions or taking unnecessarily aggressive actions that have harmful societal consequences.

This conversation needs to start with the fact that SARS-CoV-2 (the virus that leads to Covid-19) is airborne. As has been discussed elsewhere, groups like the World Health Organization have been very slow to recognize that Covid-19 is primarily transmitted through smaller aerosols rather than larger droplets or contaminated surfaces (fomites) . While this may seem like a minor distinction, it has profound implications for how you reduce exposure. If droplets and fomites were causing transmission, you would be well protected with a surgical mask and a distance of six feet would be protective. You would also conclude that cleaning surfaces is a key intervention and that measures such as partitions in schools or workplaces are reasonable ideas. But with aerosols, small particles suspended in the air, these strategies do not work. Aerosols can linger in the air indoors for a long time, can squeeze around mask gaps, and plexiglass partitions can actually make matters worse by trapping aerosols. That’s why it’s no surprise that masks reduced Covid in schools, but office screens actually increased the risk.

Even armed with the knowledge of how we are exposed, if we are not going to eliminate Covid-19 from the planet, some might wonder why we should bother to spend global resources on mitigation strategies. the exhibition. A fatalistic mindset seems to have set in, especially with the increasingly infectious variants, where exposure reduction strategies are useless since we’re all going to catch the virus eventually. But that’s not the right way to think about it.

With infectious diseases, if we reduce transmission, fewer people will be infected with a given case, the waves will end faster, and many lives will be saved. An online calculator reinforces how this can work. With a standard set of assumptions, if you put 20 people in a poorly ventilated room with no filtration and no masks, the calculator says seven of them will be infected in an hour. If you improve ventilation (increasing outside air supply to the recommended six air changes per hour), only three are infected. If you add masks that have 50% particle reduction effectiveness (N95s are more effective) to this scenario, only one gets infected. And if you add a good HEPA filter on top, nobody can get infected. The exact numbers will differ by variant and setting, but the idea is clear: if one case quickly leads to seven, things can go wrong quickly. If no one is infected, we can get things under control faster.

The virus doesn’t care if we’re tired of dealing with it.

Even if you as an individual accept the value of reducing exposure, it is useful that a global Covid-19 summit focused on financial commitments focuses on this topic. For starters, this could lead to conversations about current global supply chains for things like respirators (eg, N95 masks) or HEPA filters. Ideally, this could be coupled with financial, manufacturing and distribution commitments to ensure adequate supply worldwide, with surge capacity if needed. World leaders could also emphasize best practices and mechanisms for sharing this knowledge. For example, the United States does not have a federally regulated standard for children’s masks, and the approach used by South Korea to inspect and certify children’s masks could be used as a model. Not all exposure reduction strategies apply everywhere or work in low-resource settings, but wherever people spend time indoors, something can be done to reduce exposure. exhibitions.

Although the rationale for investments in exposure reduction is clear, there are some policy barriers. Many might read this as a call for mandatory masking everywhere or lockdowns to eliminate opportunities for exposure, which is neither politically acceptable nor desirable. But if you talk about exposure reduction in the right way, it can help reduce some of the hostile rhetoric.

Openly discussing effective (and ineffective) exposure reduction strategies reinforces that public health protections are not the same as lockdowns. More broadly, we should recognize the reality that polling data shows that the majority of the American public continues to wear masks at least some of the time in public. We should focus our energy on how to provide people with the most effective masks possible and allow them to be used more purposefully and strategically. Additionally, a more holistic discussion of exposure reduction would include ventilation and filtration, which would reduce the need for masks as the only line of defense in some settings and elevate the important topic of healthier buildings.

We are clearly at a point of national and global exhaustion with the pandemic, exemplified by the lack of committed funding in the United States for future vaccinations and treatments. But the virus doesn’t care if we’re tired of dealing with it. The second Covid-19 World Summit took a step in the right direction by re-engaging world leaders and reaffirming their commitment to bringing the pandemic under control. But we could take a huge step forward by adopting a public health mindset, investing in smart and effective strategies to reduce exposure, and lowering the number of cases as we work to vaccinate the world.

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