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Nov. 9, 2020, 6:43 a.m. EST

To defeat COVID-19, ‘we need a unified national strategy,’ says public health expert Dr. Howard Koh

Koh served as assistant secretary of health during the H1N1 flu pandemic in 2009

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By Jaimy Lee

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MarketWatch: Earlier this summer, the surge of cases in July seemed to catch a lot of Americans off guard after the lockdown. We’re seeing some leveling now. What do you predict for the fall? What are you looking out for?

Koh: Well, it’s true that the cases have dropped by about a third from the peak in midsummer, but we still have a long way to go. Hospitalizations have declined. Deaths are starting to drop a little bit. That reflects the sacrifices of millions of Americans to adhere to these public health standards, and people should be thanked and supported for following those new norms.

But we’ve got a long way to go. In every step of this pandemic, our country has underestimated the tenacity of this virus and overestimated our ability to contain it. As a result, we’re into month eight of the “first wave” whereas so many countries around the world got through this in two and a half to three months. We opened up too early. We let down our guard. There’s not been a coordinated national strategy. Every state is pursuing their own strategy. And it’s led to this protracted first wave.

People ask me regularly, is this a second wave? And I say, no, you have a second wave by definition only when the first wave comes and goes. The first wave has come and never left. Other countries are having small second waves [and] have aggressively tackled them in a way that our country has not. A second wave of COVID, plus seasonal flu, in the middle of schools and colleges [reopening], are all converging for this fall, and that’s the issue before us.

MarketWatch: If you could set a national coronavirus plan, what do you see as the key pillars of what the U.S. needs to do in terms of its response?

‘The first wave has come and never left [in the U.S.]. Other countries are having small second waves [and] have aggressively tackled them in a way that our country has not.’

Dr. Howard Koh

Koh: We’ve never had a national strategy. It’s always been 50 states. It’s late but still not too late to say we need a unified national strategy going forward: on testing, not just harder but smarter; on supporting contact-tracing efforts, which in too many parts of the country are overwhelmed right now because the case loads are so high; and on making sure that states are cooperating and not competing with each other for supplies and [personal protective equipment], to assure the hospital capacity is ready to go this fall.

There should be a national requirement for masks. We still have only 35 states with requirements.

And then it’d be really important to have a daily briefing from the White House where top health officials, like Dr. Anthony Fauci [the director of the National Institute of Allergy and Infectious Diseases], were allowed to address the press and public directly, every day, starting with the explanation of trends and data and evidence. The president restarted these briefings after a couple of months of hiatus. But we need the highest-level health officials who are trusted, so that people realize there’s a unified response and there’s a system trying to protect everybody.

The messaging has been so mixed. Confusion has been allowed to grow, and that’s just unacceptable, in the worst pandemic that our country has seen this century.

MarketWatch: What do you think have been the biggest issues in this pandemic?

Koh: Well, in the last 10 days, there was not just the FDA announcement [on convalescent plasma], which was then partially walked back by the commissioner, but then the [Centers for Disease Control and Prevention] changed guidelines on the need for asymptomatic contacts to be tested. And that appears to have been walked back, too, although last I heard the written guidance hadn’t been changed back.

What bothered me about the CDC development is that testing guidelines having to be revised is absolutely appropriate in a dynamic situation like this, with more evidence and data coming forward. We need constant revisiting of testing guidelines so we can focus on high-risk populations. But to do it just because the information was discovered on a website — it just creates confusion and questions. In the future, when such guidance needs to be revised, it should be done in a proactive way, with a formal press conference, with the director of the CDC explaining why the change was made, with the evidence and the data to support it. And if that were done, the scientific community would rally around what’s changing. But that did not occur.

MarketWatch: Following up on what you said earlier when we were talking about your national plan ideas, you mentioned testing not just harder but smarter. Can you explain that?

Koh: We now know that there are certain high-risk groups for COVID. Nursing homes, that’s absolutely front and center. Frontline health-care workers. Essential workers in key businesses. And, very importantly, communities of color. Homeless shelters. And now potentially schools and colleges.

They’re trying to send more rapid tests to nursing homes, and there’s more attention to testing for asymptomatic and symptomatic patients and staff in nursing homes. That’s a step forward. It came a little late, but at least it occurred. We want to see that process continue and then similar efforts for those other high-risk groups. The principle is always [to] go for the high-risk populations, and prioritize them. And we haven’t done that in a systematic way in this response at all.

This Q&A has been edited for clarity and length.

Read more A Word from the Experts interviews:

A lung doctor on what she’s learning about coronavirus ‘long haulers’: shortness of breath, fatigue, and depression but also ‘improvement over time’

This Seattle man volunteered to be injected with an experimental COVID-19 vaccine: ‘It was kind of my duty as a healthy individual to step up’

Dr. Osterholm: Americans will be living with the coronavirus for decades

Jaimy Lee is a health-care reporter for MarketWatch. She is based in New York.

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