October 14, 2020
In this week’s briefing for the public about the coronavirus pandemic, the governor and state health officials announced a revised plan to help bring the current spike in COVID-19 cases and hospitalizations under control. But how effective will the new system be? The answer to that question will be driven by public awareness of the plan, a willingness to follow it, and our knowledge of COVID-19.
The new plan creates a COVID-19 Transmission Index that is transparent and data-driven. It labels counties as having high, moderate or low rates of COVID-19 transmission based on three COVID metrics:
- The 7-day average COVID test positivity rate in the county,
- the 14-day COVID case rates per 100,000 people in the county, and
- the percentage of ICU beds currently being used, both for COVID patients and in total.
There are currently six high-transmission counties, 15 moderate-transmission counties, and eight low-transmission counties. Each transmission category has different public health guidelines or restrictions regarding masks, casual social gatherings, business operations and large public gatherings (e.g., sporting events, musical performances, weddings, etc.).
The immediate policy question about the new plan is: Will it be effective? The answer will depend on several factors:
- Utahns’ knowledge of the actions required by the index,
- Utahns’ willingness to take those actions, and
- the current level of understanding about COVID-19.
For the index to be effective, people must understand it and know what they need to do because of it. Utah’s air quality index offers an illustration of how to be effective in this regard. It is commonly understood that a red air day means it is best to stay inside (to avoid breathing polluted air) and drive less (to avoid making bad air worse).
Will Utahns understand that when their county has a high level of COVID-19 transmission, it means they need to wear a mask in public and avoid social gatherings of more than 10 people? Will businesses understand that it means they need to keep separate groups of customers six feet apart at all times? If this does not become common knowledge, it will limit the impact that the new plan will have on staving off the pandemic.
Willingness to follow
If Utahns come to understand what is being asked of them at varying levels of transmission, they must be willing to follow requirements and guidelines on masking, social distancing, gatherings and business operations in order for the index to be an effective tool. This has been an issue in many parts of Utah, with some people or groups refusing to abide by mask policies and guidelines.
If Utahns can be persuaded that the requirements and guidelines of the index are reasonable and beneficial for themselves and for others, then knowledge of the index will translate into action. Such action is necessary for the new plan to be effective, but it still may not be sufficient.
If Utahns know what they must do under the guidelines of the index and are willing to do it, the new plan may still prove ineffective if it is based on an insufficient understanding of the virus. This factor is less about knowing what we should about how the virus is spreading, and more about what we don’t know that we don’t know.
A hypothetical example, based on one piece of research, may illustrate the point. There is published evidence that COVID-19 can be transmitted through young children who spread the virus asymptomatically, like in a child care setting. Hypothetically, what if part of the reason for the current spike in COVID cases and hospitalizations in Utah was asymptomatic transmission of the virus between younger children in schools (where mask requirements can be difficult to consistently maintain) who then bring the virus home and spread it among older family members? This would mean that masking in public and avoiding large social gatherings would have some positive effect, but it might be limited.
This hypothetical is not used to assert that this is indeed what’s happening, but rather to suggest that our knowledge and understanding of the virus and how it spreads is still somewhat limited. It is still a relatively new virus. There has simply not been enough time to establish the proper record of rigorous, replicated and peer-reviewed research required to have a high level of public confidence that our policy approaches to containing the virus will not be undermined by something we do not yet have the evidence to understand.
This does not mean, of course, that the COVID-19 Transmission Index and associated guidelines will not work. Rather, it means that if the new plan does not have the level of effectiveness that we all hope that it will, we should not be surprised. In that scenario, it is likely that there was an obstacle to the plan’s effectiveness that could not be known at the time of its announcement. That is the difficulty of novel pandemic disease: We have a moral imperative to act but lack the practical understanding necessary to know that our actions will lead to broad solutions. So, while public officials must take and encourage action, they must do so with the proper level of humility about what they can promise about the effect that our actions will have.
Utah’s elected leaders and public health officials should be commended for attempting to adapt their approach to current circumstances and information. They should also be commended for anchoring that approach in transparency and data. But how effective the new plan will be remains a question that we can only answer in time. Neither the supporters nor the critics of the new plan should pretend otherwise.
In the end, the effectiveness of the plan will depend on what we know and what we’re willing to do, combined with what we do not yet understand.
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