No one thought it safe to dine outside before the pandemic. Fast forward to today, and it is normal to wonder if there is a city, state or federation policy on whether you need a mask or vaccination certificate to eat at a restaurant. Public policies on food and many other activities have changed many times during the pandemic. These rules are also often different from place to place. For millions of parents like my wife and I, the guidelines for children can be very frustrating, as they seem to be constantly changing. I am a former director of the University of Virginia Center for Health Policy and a current surgeon. I have watched both the development and the rapid implementation of public policy in response to COVID-19 and, like many people, I have struggled to stay informed. Usually, significant changes in federal health policy occur at a glacial pace. But the modern world has never faced a public health crisis that changed as quickly as the pandemic. The constant back and forth of the rules can be frustrating, but policy changes are not usually a sign of error. On the contrary, they show that for the most part, policymakers are correcting things over and over again.
Quick changes require quick answers
The ongoing evolution of the coronavirus and the consequent changes in public policy do not look like a normal public health crisis. It happens like a hurricane. The risk of a hurricane depends to a large extent on the strength and course of the storm, and these things can and do change unexpectedly. Government officials use the best available information to provide general information or instructions for taking specific precautions, housing or evacuating an area, all within a very short period of time. Evacuation orders are sometimes issued for a city or area, only to be hit by the hurricane elsewhere. This virus changed in a similar way – and continues to change – very quickly. In just over two years, researchers have found dozens of variants of COVID-19. Many of them have clinically significant differences in their contagiousness, the severity of the disease they cause, and the extent to which they can be prevented and treated with existing treatments. When the coronavirus first appeared, health officials knew very little about it and did not have systems in place to monitor or predict its behavior. a hurricane was approaching and the world had neither satellites nor weather models. But as epidemiologists and public health officials gained a greater understanding of the virus, they quickly gained the ability to take effective countermeasures and adapt as the virus changed. Researchers at the university and the pharmaceutical industry have developed rapid COVID-19 tests. The mask test started immediately. And as soon as scientists mapped the coronavirus genome, work began on rapidly using existing mRNA vaccine technologies to develop a vaccine in record time.
Public health was done fast
With science and the situation evolving rapidly, policymakers had no choice but to be just as agile. This has been manifested in two unique ways. First is the use of executive power. Both President Trump and Biden – as well as a number of coast-to-coast governors – have used executive mandates to shorten the time between policy development and implementation. Enforcement orders are also much easier to overturn or restore, as coronavirus outbreaks recede and flow over time, and states in particular rely on their ability to do so. Second is the rapid monitoring of drug and vaccine approvals. The normal process by which the US Food and Drug Administration approves new drugs is slow – usually about 10 years, depending on the treatment. Pharmaceutical companies can use the FDA’s emergency authorization process to speed it up slightly, but not too much. To further speed up this process, the FDA has established a rapid monitoring program specifically designed to expedite the approval of treatments and vaccines for COVID-19. As a result, it took less than a year for the vaccines to receive emergency authorization from the discovery of the coronavirus. Just as a hurricane response must adapt to soil conditions and apply the best information available at a time, so does a pandemic. Densely populated areas like New York will apply very different guidelines on very different schedules from rural areas, where the virus spreads very differently. Fred Hsu via WikimediaCommons, CC BY-SA
Different places, different policies
Hurricanes are highly local and relatively short-lived. The pandemic is like dozens of different hurricanes hitting the US all at once. This has created a complex network of policies that can and should be different depending on where you are and the governing bodies there. The US Congress, state governors, city mayors, health departments, and even local school councils must each develop and implement policies for their own hurricanes at their own levels of control. Despite its complexity, this approach to public policy is another example to be corrected over and over again. New York public health workers must respond to the unique situation in New York at all times. These actions may be very different from the issues facing the mayor of Barstow, California – a much smaller, much more rural city. Local conditions require local solutions, which can evolve over time. This is very different from most other public health problems in the US During the flu season, for example, the right response tends to be relatively similar from place to place.
Do it right again and again
I and many others have been guilty of thinking that policymakers back down when instructions change back and forth, or that we are inconsistent when one state makes a particular decision while another does something else. But I understand that this is not the right framing. As variations emerge, targeted policies to address the new reality quickly follow. Restoring mask requirements after discarding or recommending additional vaccine doses between waves may seem like 180-degree course corrections. But in reality, these policy changes are the right reactions to the hurricane of COVID-19 that continues its helical course around the world. When the next change comes, I argue that you should not be disappointed or angry. Instead, we should all applaud the fact that researchers and public health experts are doing it again and again. [Research into coronavirus and other news from science Subscribe to The Conversation’s new science newsletter.] Michael Williams, Associate Professor of Surgery and Public Policy, University of Virginia This article is republished by The Conversation under a Creative Commons license. Read the original article.
