A strategic approach to managing the U.S. COVID pandemic

Last update: Monday 7/25/22 

The Biden administration recently elevated an office within the Department of Health and Human Services (HHS) to the same level of responsibility as the FDA, CDC, and NIAID. Called the "Administration for Strategic Preparedness and Response (ASPR)", its name suggests that the elevated agency will provide the strategic perspective that has been missing from our previous pandemic management efforts. The editor of this blog has repeatedly criticized the Trump and Biden administrations for their failures to manage their efforts within a strategic framework. As consequence, both administrations fumbled and bumbled from surge to surge, and lost the support of America's majority. That's the bad news. The good news is that their inevitable failures make strategic planning a political possibility for the first time. Hopefully, a failed administration led by an infected elderly president will make the most of this opportunity.

The office that is being elevated is the Administration for Strategic Preparedness and Response (ASPR)

• "Officials reorganize HHS to boost pandemic response", Dan Diamond, Washington Post, 7/20/22
• "The Biden administration is elevating a division of H.H.S. to more broadly oversee pandemic", Sheryl Gay Stolberg and Noah Weiland, NY Times, 7/21/22

A view from 20,000 feet

The following bullets sketch thie editor's perception of the current state of the "big picture" facing U.S. pandemic managers:

Most likely COVID victims

• COVID-19 rarely kills children, but its lethality increases with the age of its potential victims. Indeed, on 7/22/22 the CDC's COVID-19 Mortality Overview page reported that COVID-19 had inflicted almost 75% of its deaths on the oldest members of our society, age 65+ In other words, of the 1,018,957 American residents who died since the beginning of the U.S. pandemic 758,958 have been 65 or older.
  
  According to the U.S. Census Bureau (Table S010), the population if the 65+ age group is 52,362,817; the total U.S. population is 326,569,308; so the 65+ group is only 16 percent of the total population. In other words, its 75% share of COVID deaths is almost five times its share of America's population.  
  
  Readers should note that the CDC's COVID-19 Mortality Overview page reported that the 44 to 64 middle age group suffered the second biggest share of COVID deaths, 21 percent, which is less than their 26 percent share of America's population reported by the U.S. Census Bureau.  Least impacted were the youngest age groups, 0 to 43, which represent a solid 58 percent majority of the U.S. population, but only suffered 4 percent of its COVID deaths.

• A second group of COVID victims also incurred disproportionate losses: persons made more vulnerable by certain underlying health conditions, a/k/a/ "comorbidities", most notably those who were diabetic or immunocompromised. CDC data does not provide concise estimates of the COVID deaths among this disparate group. Nevertheless, this group merits special attention because previous pandemic experience has shown that the usual vaccine and booster regimens may not be appropriate for them. For example, the vaccines and boosters may not stimulate effective immune responses in immunocompromised victims, while other health liabilities may require extra booster shots. 

Vaccines and boosters

Two questions must be answered:

• Question 1:  How effective are our vaccines and boosters against the Omicron sub-variants?
  
  Answer: The consensus among experts seems to be that our vaccines and boosters are still highly effective in reducing severe illness and death among people whose vaccinations and booster shots are up-to-date, but don't offer much protection against infection, especially against infection by the highly transmissible Omicron sub-variants 
  
  
• Question 2: How well have we vaccinated and boosted our oldest and most vulnerable potential victims?
  
  Answer: Inadequately. On 7/25/22 the CDC's COVID Data Tracker page reported that 92 percent of persons in the 65+ age group have been vaccinated ... which sounds good, but doesn't bear closer inspection because the same page reported that only 71 percent of the fully vaccinated have received a first booster, i.e., 71% * 92% = 65%. Worse still, only 37% of the first boosted have received a second booster, i.e., 37% * 65% = 24%. In other words, only 24% of the nation's most vulnerable residents are adequately protected against severe illness and death from Omicron's highly transmissible sub-variants.

Treatments

Given our nation's failure to keep its oldest residents up-to-date on their primary and booster shots, for the near term it will have to rely on antiviral medications and other effective treatments to protect its seniors. Unfortunately, this sector of the "Big Picture" is also discouraging. As per the following reports, many doctors are confused as to when they should prescribe antivirals, and the CDC has found that their distribution has been inequitable"

• "Doctors are clamoring for more clarity on Paxlovid prescribing amid Covid-19 rebound concerns", Edward Chen, STAT, 7/7/22
• "Antiviral drugs for Covid are inequitably prescribed, a C.D.C. study finds.", Roni Caryn Rabin, NY Times, 6/21/22

As noted previously, persons who are immunocompromised require special treatments. The good news is that effective regimens for the immunocompromised are readily available; the bad news is that our pandemic managers have not made sufficient efforts to make the existence of these treatments known to doctors or their patients, as per the following report

• "As new variant spreads, a crucial drug to protect the most vulnerable goes vastly underused", Jason Mast, STAT, 7/22/22

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Links to related notes on this blog:  

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