Red-state governors are taking the lead in rejecting the idea of new mask mandates or lockdowns. Several, including Kristi Noem in South Dakota, Brian Kemp in Georgia, and Ron DeSantis in Florida, never mandated masks and either stayed open or reopened early with a vengeance. To exit Covistan forever, governors can do a few things to solidify and support their positions.
1. Republican governors should order their state departments of health to do similar studies, as the Delta wave has peaked and is declining
For some reason, our CDC and NIH have no curiosity about the seroprevalence of an immune response to COVID-19 in the population. Oddly, India is far more curious, and following its wave of the Delta variant, the country conducted its fourth national randomized study. It found that nearly 70% of Indians over the age of six have antibodies, despite low vaccination rates.
Republican governors should order the collection of information on vaccination status and recovery from confirmed cases. Public health professionals should test samples for circulating antibodies and T-cell reactivity. The FDA has issued an emergency use authorization for a test to detect the presence of T-cells called T-Detect.
2. Like Governor Ron DeSantis, governors should require labs to report the cycle threshold (Ct) and reference range for every RT-PCR positive test
Florida has done this since December, and other states should do the same. Numerous studies provide insight into what Ct threshold is likely to indicate that the sample contains a replication-competent virus, which is necessary in order to cause an infection or be transmitted. State public health professionals can use this data to make population-level recommendations for governors.
One often-quoted study is Jaafar et al., which evaluated 3,790 positive samples looking for replication-competent viruses. The researchers found that at a Ct of 35, only 3% of samples could grow in culture. They suggested using a Ct of 30 for public health decision-making based on their analysis. Other studies have made similar recommendations, asserting that the time since symptom onset is also a factor in determining a diagnosis of COVID-19. With commercial testing using a Ct as high as 37-40 according to reports, understanding testing trends is important.
3. Like two California counties, the governors should require each county in their state to conduct a review of COVID-19 hospitalizations and deaths to determine whether they were indeed COVID-19 related
Alameda and Santa Clara counties found that the number of deaths fell by about 25% following clinical reviews. Every hospitalized patient is tested for COVID-19 regardless of the admission diagnosis.
Even the CDC distinguishes between being hospitalized “with” COVID-19 and “for” COVID-19 in their analysis of breakthrough cases. Following a breakthrough case investigation, hospitalizations and deaths due to COVID-19 may fall by around 25% as they did in the California counties. Researchers found a similar trend in the hospitalization of children, which fell 40% following a review of California hospital admissions.
An analysis earlier in the pandemic found that 89% of COVID-19 deaths in three New Jersey hospitals occurred in patients with a preexisting Do Not Resuscitate order. Understanding data like this can help state leaders communicate their rationale for public health measures clearly and robustly.
4. Red-state governors should move in the direction of Alberta, Canada, in managing COVID-19
In August, it will discontinue publicly run COVID-19 testing sites and move testing and treatment back into the primary care setting. Public health leaders no longer encourage asymptomatic individuals to be tested and will once again let physicians thoroughly assess and treat patients. In the U.S., this will become necessary as the CDC prompts providers to use tests that differentiate between COVID-19 and the flu.
5. Every Republican governor should ensure that citizens know the treatment options publicized by the Department of Health and Human Services through a public education campaign
The agency published updated clinical guidelines that allow patients to receive monoclonal antibody treatments and have information for patients willing to participate in clinical trials. The media, CDC Director Rochelle Walensky, and Dr. Anthony Fauci of the NIH are not sending this message to the public.
Several governors are doing an excellent job attempting to balance personal liberty and public health. Additional data can help them combat criticism and communicate broadly with their citizens. During every public health crisis to date, the goal of experts and political leaders was to reduce panic. National leaders have abandoned this philosophy during COVID-19, but great leaders can reverse the current trend at the state level.