May 28, 2020

5 ways to prevent more Covid-19 deaths, according to Tom Frieden

Daily Briefing

    Health experts project that the new coronavirus will cause more than one million deaths worldwide by the end of this year, but former CDC Director Tom Frieden in a piece published by Vox outlines five strategies that could help to avoid an excess of preventable deaths due to the virus.

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    5 ways to prevent more Covid-19 deaths

    To date, officials have reported more than 100,000 deaths linked to the novel coronavirus in the United States alone, and health experts project that the virus will cause more than one million deaths worldwide by the end of 2020. However, Frieden writes that there are five things countries can do to "save as many lives as possible."

    1. Get an accurate death count

    Frieden writes that accurately tracking the mortality rates of Covid-19, the disease caused by the new coronavirus, and other illnesses will help policymakers and health experts better understand the global pandemic's true impact. According to Frieden, every U.S. state and every country should report mortalities from all causes each week—including those that occurred among people who did not test positive for the new coronavirus—in order to get an accurate picture of all deaths that may have occurred because of the virus either directly or indirectly.

    For instance, Frieden writes that, in the United States, health experts expect that more deaths are occurring among people with heart conditions who avoided seeking care out of fear of contracting the new coronavirus in a health care facility. Likewise, declining immunization rates due to such fears could result in preventable deaths, Frieden notes. While those deaths wouldn't be caused by the new coronavirus directly, they could be indirect casualties of the epidemic.

    "Tracking deaths identifies increases from the virus missed by testing and tracking systems and provides an early warning if deaths from other conditions increase," Frieden writes. And, he adds, "What gets measured can be managed."

    But, Frieden writes that the necessary mortality data "isn't readily available" in a lot of countries, including the United States. In some countries, especially those that are lower-income, accurately tracking real-time mortality data week to week will require more training and funding for community health workers, he writes.

    2. Protect health care workers

    According to Frieden, more than 100,000 health care workers have been diagnosed with Covid-19, and the "health and economic consequences of losing health care workers and overwhelming health care facilities are catastrophic."

    But "[t]his does not have to be" the case, Frieden writes. He notes that countries could "make health care much safer" for workers amid the Covid-19 pandemic by implementing strict safety protocols and infection prevention programs. Such programs have proven to be effective in some countries, like Singapore, where few health care workers have contracted the new coronavirus at work, Frieden writes.

    Once health care workers are effectively protected from the virus, countries can "prevent avoidable deaths from people infected with the novel coronavirus," as well as "increases in mortality from other conditions that result from overwhelmed health care systems" Frieden contends.

    3. Continue to address non-coronavirus conditions

    In addition to seeing a rising number of deaths linked to the new coronavirus, health experts also are beginning to see increases in deaths that are not directly linked to the virus—and countries must address the causes of those deaths, as well, according to Frieden.

    Frieden writes that while Covid-19 poses an immediate threat to people's health, a failure by countries to invest in programs that address other chronic or preventable diseases could result in an increase in mortalities due to those diseases, too. Frieden suggests  governments and international organizations focus on maintaining such programs by funding telemedicine and "bolster[ing] primary and preventive care," among other things. If they don't, "the number of people who die from the coronavirus directly might be a small fraction of those killed by other diseases," Frieden warns.

    4. Protect vulnerable groups

    The elderly and people with underlying medical conditions have proven to be particularly vulnerable to the effects of Covid-19, and data shows that one-third of reported Covid-19 deaths in the United States "have occurred in nursing homes, revealing that facilities for the elderly will be coronavirus death traps until we drastically improve efforts to keep the virus out, find it fast when the first staff or residents become infected, and stop outbreaks from spreading," Frieden writes.

    According to Frieden, CMS already has taken steps to protect vulnerable populations at nursing homes by restricting visitors, but stricter policies are needed to prevent deadly outbreaks at the facilities. For instance, Frieden writes that "universal wearing of masks, limited visitors, and extensive testing" should be required at nursing homes and other high-risk facilities, such as homeless shelters, factories, and prisons. Frieden suggests that nursing homes in particular will "need to find the virus fast with rapid and repeated testing, and they need to stop outbreaks before they spread widely with rapid-response teams and test-based strategies."

    5. Find the correct balance between saving lives and preserving livelihoods

    While lockdowns are critical to curbing the spread of the novel coronavirus in areas experiencing significant outbreaks, they also can have negative effects on people's livelihoods, Frieden writes, noting that the pandemic "will cause the first increase in global poverty in more than two decades." As a result, countries may have to allow "economically important activities to begin even before all of the ideal disease control systems are in place," Frieden writes.

    But Frieden contends that, "[i]n most places, most economic disruption from the pandemic isn't from lockdowns, but from fear—much of it rational—that everyday activities could kill us or our loved ones." Therefore, easing lockdowns may not help to rejuvenate the economy until Frieden's first four recommendations are in place, he writes.

    "We can save the most lives and protect our economy most effectively by urgently strengthening public health and emerging as soon and as safely as possible, focusing on the most important societal activities first," according to Frieden. "This means widespread use of face masks, hand-washing, staggered shifts, telework, and prompt contact tracing to prevent cases from becoming clusters, clusters from becoming outbreaks, and outbreaks from forcing another retreat into our homes," he writes (Frieden, Vox, 5/26).

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