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Former Biden advisers, public health experts release Covid-19 ‘roadmap’ with goal for transitioning out of pandemic phase

By Jacqueline Howard, CNN

Some of the nation’s leading public health experts, including former coronavirus advisers to the Biden administration, detail in a new report when and how the United States can transition out of the Covid-19 pandemic phase and back into “pre-pandemic routines and lives.”

Among the recommendations in the report are for the United States to reach at least 85% Covid-19 vaccination by the end of this year, improve indoor air quality, expand research into long Covid, consider shifting focus from Covid-19 alone to major respiratory viral illnesses, and finance the Covid-19 response as well as preparations for future biosecurity threats.

The push for the nation to follow certain public health steps in its transition out of the pandemic phase comes just days after the White House unveiled its own plan for moving the nation out of the Covid-19 crisis, called the National Covid-19 Preparedness Plan.

That plan will require additional funding from Congress and is more focused on spending for Covid-19 treatments, preparing for new variants, keeping schools and businesses open and continuing vaccination efforts.

The new report from public health experts, titled “Getting to and Sustaining the Next Normal: A Roadmap for Living with Covid,” focuses on vaccinations and keeping schools open too — but also goes into further detail when it comes to indoor air quality, the threat of other respiratory illnesses and providing metrics for when the nation can declare that the pandemic phase has ended and that a transition into the “next normal” can begin.

“The United States’ pandemic phase — with restrictive public health measures — can end when average daily deaths due to Covid and other major respiratory illnesses decline below 0.5 per 1 million Americans, or 165 deaths a day at a national level,” the authors wrote in the 136-page report.

“At that point, the United States can transition into the next normal, although individual regions may be able to make earlier transitions, depending on local Covid metrics,” they wrote, adding that “the nation is not yet at the next normal.”

The United States is now averaging 1,426 new Covid-19 deaths each day, according to data from Johns Hopkins University. More than 6 million people have died of Covid-19 globally. Worldwide, an average of more than 6,200 deaths were reported each day over the past week — about a quarter of them in the United States.

“If you look at the report, I think it’s pretty clear we share many of the same policies and proposals as this outside group — so we’re very encouraged by that,” Dr. Tom Inglesby, senior adviser to the White House’s Covid-19 Response Team, told CNN on Monday. He added that some of the authors of the new report also consulted with the Biden administration in the development of the National Covid-19 Preparedness Plan.

“Not only have we been communicating with outside experts, such as this group that published the report today, but also with governors and businesses and communities as we’ve been developing our plan for the time ahead,” Inglesby said. “We’re heartened by all the work that this group has put into their report and in particular by their call for urgently funding this work by Congress. I think that’s a very important part of this, and we’re we’re encouraged to see their their strong support of that.”

‘COVID will not be eliminated — but we can live with COVID’

The authors of the new report include six former members of President Biden’s coronavirus advisory board: Dr. Luciana Borio, Dr. Zeke Emanuel, Rick Bright, Michael Osterholm, Jill Jim and David Michaels.

Dr. Paul Offit, an adviser to the US Food and Drug Administration; Kizzmekia S. Corbett, scientific lead for coronavirus vaccines at the National Institutes of Health; and R.P. Eddy, former director at the White House National Security Council, also are among the authors of the report.

“COVID will not be eliminated — but we can live with COVID, just like we do with the flu and other diseases — if we prepare now,” Emanuel wrote on Twitter on Monday in announcing the roadmap.

The report seems to put emphasis on improving indoor air quality as a way to limit the spread of other respiratory illnesses, along with the coronavirus.

“Effectively limiting exposure to respiratory pathogens requires following traditional industrial hygiene principles and applying a hierarchical and layered approach. The emphasis must be on providing clean air generally instead of personal protective equipment such as respirators and face masks,” it says.

But when it comes to masks, the report recommends high-quality N95 masks and describes cloth masks as “ineffective.”

“Cloth masks are ineffective at preventing person-to-person transmission of viral respiratory disease,” it says. “The United States must have stockpiles and production capacity of N95 filtering facepiece or similar respirators to ensure adequate supplies for the public and workers during future surges and pandemics.”

‘The next year is not predetermined’

A key attribute of the “next normal,” according to the report, is that there will no longer be a need to wear masks in grocery stores, schools or places of worship or on domestic airplanes, railways, buses and other public transportation.

But the report also warns that if population immunity against Covid-19 declines and variants become more virulent, mitigation measures will be needed.

Continuing to follow certain measures also can affect the likelihood of certain scenarios.

“The scenario that evolves over the next year is not predetermined, however, and will be influenced by actions taken in response to changes in the virus and population immunity,” the report says.

“Effective and rapid reaction to new information can change a potentially pessimistic scenario towards an intermediate outcome or an intermediate scenario to an optimistic outcome. However, the reverse is also true. Inaction or complacency in the setting of an optimistic or intermediate set of variables could lead to more pessimistic outcomes.”

The authors wrote that the federal government — the CDC or another agency — should develop a public communication program to inform communities about when coronavirus transmission is elevated and when people in those communities should wear well-fitting N95 masks or similar respirators indoors.

Currently, the CDC recommends that people living in areas with “high” Covid-19 community levels should still wear masks indoors.

Regarding schools, the report says, “Pandemic school closures cause such significant and enduring harms to children that far more should be done to avoid them. In Omicron’s wake, school-based quarantines should end, masking should soon follow, and a broader appreciation of societal costs should be applied to all infection mitigation measures.”

The report also recommends increasing at-home rapid testing, improving global distribution of vaccines, addressing health disparities, improving communications and building trust between the public and US public health agencies.

“The next normal with Covid can be an improvement over life before the virus emerged. There is likely to be a better work-life balance with more teleworking and less commuting, a reimagining of the education system, a platform for rapid development of highly effective vaccines and therapeutics, better indoor air quality, fewer respiratory infections of all kinds, and more effective surveillance to anticipate and respond to new viral threats,” it says.

“Getting to this better place by creating some of the tools outlined in this report will require Congressional and state legislation, as well as significant resources,” the authors wrote. “Funding is especially critical.”

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