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January 19, 2022

Carroll: America should 'think less like doctors' in fighting Covid-19

Daily Briefing

    Writing for the New York Times, Aaron Carroll, chief health officer at Indiana University, argues that health officials should shift pandemic response strategies from current individual-level mitigation to a population-level approach.

    Q&A: Aaron Carroll on medicine's 'dirty secrets,' how to fight coronavirus myths, and more

    Current Covid-19 response focuses too much on the individual

    According to Carroll, the United States' Covid-19 response has so far largely focused on what is best for individual people instead of what is best for the population as a whole, similarly to how physicians focus their care on individual patients.

    For example, Indiana recently limited the use of rapid antigen tests, which are currently in short supply, at state-run sites to symptomatic patients under 18 or over 50. And while this decision makes sense from a clinical and individual perspective by restricting the tests to those at highest risk, it is the "absolutely wrong choice" from a population perspective, Carroll writes.

    Young people may be at low risk of severe disease individually, but they play a large role in transmitting the virus because they are more likely to go out and interact with others. This means that rapid tests may be better used for younger people, who would be able to adjust their behavior and reduce the spread of infection.

    In addition, Carroll writes that focusing too much on individuals can lead to "excessive fears of bad outcomes, even if they're rare." For instance, many leaders have implemented pandemic-related school closure policies, even though the risk of coronavirus transmission in schools appears to be relatively low.

    A population-level view is needed to fight the pandemic

    Instead of approaching the pandemic from an individual perspective, Carroll argues that a population-level view is necessary.

    In particular, Carroll recommends that the United States have more repeated and regular testing with rapid antigen tests. Although these tests are less sensitive than PCR tests, they are usually more accessible and can be done at home, which means more people will be able to test themselves and potentially reduce viral transmission.

    "More frequent imperfect [rapid] testing may pick up more cases, even if we miss a few we might have caught with perfect [PCR] tests," Carroll writes. "Getting people to be somewhat safer might achieve more than getting fewer people to be really safe."

    Carroll also notes that CDC's "any mask is better than no mask" recommendation was helpful during the beginning of the pandemic when N95 masks were in short supply, but that is not the case now. By not recommending better masks now that they are more readily available, CDC "misses a chance to potentially raise overall safety" over the possibility that someone may choose to not wear a mask at all, he writes.

    In addition, Carroll suggests Covid-19 vaccination campaigns should encourage people to get vaccinated to protect others, not only just themselves. "[O]nly with herd immunity, or something close to it, can we begin to see an end to this pandemic—and that requires near-universal vaccination," he writes.

    Overall, if the country wants to prevent Covid-19 surges and end the pandemic, it needs to make the population the center of its thinking, Carroll writes. To do this, health authorities need to get rapid tests and better masks to as many people as possible, especially those who are most likely to spread the virus, and people should be incentivized to get vaccinated to protect others.

    "If you are sick, even with severe Covid, you want someone with a doctor's viewpoint caring for you," Carroll writes. "America, however, is not a patient. And we'd all be better off, as a society and as individuals, if those in control of our country's health stopped thinking of it that way." (Carroll, New York Times, 1/14)

    Aaron Carroll on how clinicians can combat medical misinformation

    Listen to the Radio Advisory episode

    Radio Advisory, a podcast for busy health care leaders.

    Medical misinformation has been a significant problem for a long time, but amid the Covid-19 pandemic, the problem has become even more widespread. In this episode, host Rachel Woods sits down with Dr. Aaron Carroll, author, professor, and Indiana University chief health officer—to discuss what all clinicians should do to combat medical misinformation.

    Plus, Advisory Board experts Solomon Banjo and Pam Divack offer their take on clinician’s role in online spaces (with patients and with each other) and translate those same principles for the rest of the industry.

    Listen now

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