Alarmed by increasing rates of coronavirus infections and deaths across the country, the AAMC issued a comprehensive “road map” on Wednesday for the nation to follow to help change the course of the pandemic in the United States.
The Way Forward on COVID-19: A Road Map to Reset the Nation’s Approach to the Pandemic calls on federal and state governments, businesses, academic medicine, and local communities to work together to implement a set of 11 evidence-based, short- and long-term actions to address critical testing and supply issues, mitigate the spread of the virus, and ameliorate the health disparities that have further exacerbated the pandemic for vulnerable populations, among other actions.
“If the nation does not change its course — and soon — deaths in the United States could well be in the multiples of hundreds of thousands,” said David J. Skorton, MD, AAMC president and CEO. “The nation urgently needs a decisive, coordinated strategy to save lives, restore the U.S. economy, and return our lives to a sense of normalcy.”
Based on AAMC experts’ understanding of the pandemic as doctors, scientists, and medical educators, the road map includes such immediate actions as ramping up production of testing reagents and tubes, personal protective equipment, and critical medications; increasing the availability of and turnaround time for testing; and establishing national standards for face coverings, stay-at-home orders, and reopening protocols.
The first three action items are urgent, AAMC leaders say. Six additional ones should be addressed immediately and two are longer-term actions. The following is a brief summary of all recommendations in the plan.
- Remedy critical supply and drug shortages. Persistent shortages have marred the U.S. response to the pandemic from the outset. Therefore, the federal government should invoke the Defense Production Act or other powers to issue large contracts to companies producing critical medications, personal protective equipment, and testing supplies. In particular, the plan calls for the domestic production of testing supplies needed to conduct 2.3 million coronavirus tests per day. It further stipulates the need to manufacture enough supplies and equipment so that health care institutions can have a three-day supply on premises, a 14-day supply available within a two- to three-hour drive of the facility, and a 30-day supply warehoused within a geographic region.
- Increase availability and accessibility of testing. The road map recommends a goal of conducting 2.3 million tests per day and urges the Coronavirus Task Force — working with the Department of Health and Human Services, the Federal Emergency Management Agency, and state public health departments — to create a web portal that would allow all laboratories to report shortages of critical testing supplies; assess and manage the supply chain for testing; and communicate supply chain issues with labs, vendors, and the general public.
- Establish national standards on face coverings. The standards should be grounded in scientific knowledge about the spread of the novel coronavirus and should govern local and state decisions about mandatory mask wearing, depending on the level of community spread in a particular area.
- Establish and enforce national criteria for local stay-at-home orders and reopening protocols. Those criteria should be based on the number of current and recent cases, the proportion of positive cases, hospitalizations, deaths, and local health care capacity. State and local governments should order and enforce mandatory stay-at-home orders and progressive reopenings guided by those criteria.
- Establish national criteria for K-12 school reopenings and convene a working group to study different approaches. The National Academies of Science, Engineering, and Medicine have developed a road map for reopening schools, which could be used to guide educators and state and local officials.
- Immediately expand health insurance through COBRA. As an estimated 10 million Americans have lost access to employer-based health insurance since the pandemic began, Congress should expand COBRA and at least partially subsidize premiums for that coverage.
- Begin planning now to prioritize distribution of the SARS-CoV-2 vaccine. Such planning should take into account the disproportionate impact of the virus on health care workers, essential workers, the elderly, and other vulnerable groups.
- Address and resolve health care inequities. Because vulnerable populations are disproportionately impacted by COVID-19, the federal government should develop a national, standardized data collection system that accurately captures race and ethnicity as a starting point for addressing health care inequities.
- Inform, educate, and engage the public. Conflicting messages about how to prevent, treat, and contain the coronavirus have led to widespread confusion among the American public. Therefore, any effort to reset the nation’s response should involve a concerted effort to educate the public. Academic medical center websites could be repositories for this expert information. On a national level, federal, state, and local public health agencies should work to send out daily updates about the virus and local conditions in the area.
- Broaden health insurance. The loss of employer-based insurance during the pandemic has created a second national health crisis. Therefore, policymakers should expand Medicaid in all 50 states, and for those not eligible for Medicaid, a federally subsidized insurance option should be made available to all individuals below a certain annual income.
- Strengthen the nation’s public health infrastructure. As the pandemic has made clear, the nation’s public health infrastructure is woefully underfunded. Therefore, the federal government should prioritize funding for the Centers for Disease Control and Prevention and municipalities should improve funding for state and local public health departments.
“Currently, we have a lot of recommendations from many highly qualified people around the country, but we also have a patchwork of responses at the state and local levels,” Skorton says. “Our road map aggregates the actions that need to happen, adds some specific quantitative targets, and indicates where the responsibility for action lies. Stopping the pandemic is everyone’s responsibility.”