To slow down the spread of COVID-19, we need to bring back the Swiss cheese model of pandemic response

On December 13, 2021, the United States exceeded 800,000 COVID-19 deaths, and more than half of these were under President Biden’s surveillance, mainly due to the Biden administration’s failure to honor its promise to follow science. This is shameful because the country has not been able to leverage the experience of 2020, here and abroad, to deal with the COVID-19 pandemic much more effectively. We have both biomedical and social and behavioral know-how, captured in the Swiss cheese model, to suppress infection and prevent death.

The Swiss cheese model, published twenty years ago to understand why accidents happen and how to prevent them, is a system approach that recognizes human fallibility and builds layers of defense, visualized as multiple stacked cheese slices, to mitigate negative effects . The idea is that each disc has holes or weak spots where errors can occur, but when multiple discs are adjusted, the overall risks are significantly reduced. Applied to the pandemic reaction, the Swiss cheese model is one multilayer access use both vaccines and non-pharmacological interventions (NPIs) to reduce the risk of infection and suppress the spread of COVID-19. These NPIs include vaccine incentives and mandates, improving building ventilation, high-quality masks, available tests, social distancing, and promoting credible and consistent public health communication. Although each intervention alone is deficient in the prevention of COVID-19, the combination of them all is the best way to reduce the risk.

The Biden administration’s national COVID-19 strategy, released in January 2021 before widespread availability of vaccines, embraced many of the NPIs that were crucial in creating the slices of the Swiss COVID-19 cheese model. But when vaccines became available in the United States, government officials quickly relinquished these important NPIs (even vice versa on masked guidance), thus removing many layers of defense, leaving us dependent on a defective layer instead of many, exposing gaps in model and put lives at stake.

Until recently, the Biden administration has opted for a vaccinated-only strategy. Yet, with only 60 percent of the U.S. population fully vaccinated, with large variations by state, this approach proves to be deficient. The violent spread of the Delta variant and the higher number of COVID-19 deaths in 2021 compared to 2020 is strong evidence of that. It is true that at this point in the pandemic, vaccination is the most important layer in the Swiss cheese model. However, due to the risk of breakthrough infections and the transmission of COVID-19 by both the vaccinated and the unvaccinated (where a significant proportion of the latter refuse to be vaccinated), it will fail to promote vaccinations and boosters without restoring other NPI layers to reduce transmission. . to curb increases in cases, hospitalizations and deaths. Even with the advent of the Omicron variant, which could potentially evade much of the protection offered by vaccines, the Biden administration continues to duplicate the same old vaccination and booster messages, clearly disregarding the enforcement of other NPIs. , which has been shown to be effective in reducing infection and reducing the risk of infection. For example, President Bidens “5-step plan to combat COVID-19 this winter‚ÄĚNeglected to emphasize the importance of high-quality masks, ventilation or air filtration.

A recent poll conducted after the emergence of the Omicron variant showed that the vast majority of Americans support a multi-layered strategy for pandemic response – with 70 percent or more supporting vaccination requirements, mask mandates, increased test and contact tracking capacity, and social distancing. The Biden Administration should seize broad public support for other non-pharmacological public health measures to reset its COVID-19 response.

Politicizing public health measures to counter the pandemic has real consequences. Counties that voted for Trump have death rates from COVID-19 nearly three times higher than those who went to Biden, mainly due to lower vaccination rates and limited or no other NPIs in place. But by deliberately neglecting these other documented non-pharmacological public health measures, the Biden administration effectively admits this part of the public health response to reactionary anti-scientific and anti-public health forces that have attacked science-based measures in the fight against the pandemic and spread misinformation and disseminated misinformation. has nourished anti-mask as well as anti-vaccination movements. In addition to trying to discredit science and undermine best practice in response to a public health crisis, these movements have been encouraged to attack frontline public health experts and health professionals, leading to widespread resignation and dismissal of experts and significant workers – to the great detriment of our public health infrastructure.

While the Biden administration is struggling to live up to its promise to “lead with science” in its pandemic response, it must be acknowledged that failure to take a comprehensive scientific response to the pandemic can both result in a strange pandemic control and erode structure in our society that trusts facts and experts. The Biden administration, which consciously chooses to pay attention to the science of vaccine while ignoring the social and behavioral sciences, is playing a dangerous game of devaluing one discipline over another. This could set new standards that allow misinformation and misinformation campaigns to question science-based public health measures.

Given the recent rise in infections and persistent COVID-19 deaths of over 1000 people a day, more coordinated efforts are needed to implement social and behavioral interventions if the administration hopes to reduce to unacceptably high death rates and prevent further increases. There is an urgent need for the Swiss cheese model. In addition to urging Americans to be vaccinated and booster shots in light of the Omicron variant, it is now imperative for the Biden administration to use its federal authority to reintroduce mask mandates, require vaccinations for domestic flights and interstate trains to create incentives for those who want to travel and send high quality masks and home tests to all US households for free. The administration, in collaboration with companies and schools, should continuously improve their ventilation systems. These efforts should be paved with credible messages of public health and principles of justice by prioritizing the needs of marginalized societies, which are disproportionately affected by the pandemic.

President Biden promised “bold action”, so a zero-COVID death strategy should be the goal. It is possible, and the Biden administration must be serious about using all available scientific tools at their disposal.

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