On January 12, while driving, I listened to the Maine CDC’s weekly COVID-19 briefing conducted by Maine DHHS Commissioner Jeanne Lambrew and Dr. Nirav Shah. These briefings are informative in content and civil in tone. They are a good example of the government explaining itself in a difficult, fast moving and sometimes controversial context. I applaud them even though I don’t always agree with them. They also have the advantage of occurring before a friendly audience.
At the outset of the briefing, Dr. Shah announced a change in guidance regarding contact tracing and isolation in schools. Contact tracing is conducted to reduce the spread of an infectious disease by testing and identifying carriers who are infected and can transmit the disease to others, notifying those who test positive and their close contacts, and having them isolate and quarantine while infectious.
In general, the Maine CDC has been following the U.S. CDC guidance regarding COVID-19, even though it has been less than a model of consistency and coherence. The guidance had been that schools should test and trace their staff and students. As of the Senate committee hearing on January 11, the federal government was still very much emphasizing testing.
However, Dr. Shah and his epidemiology team had been interacting with school administrators around the state. They heard about the challenges that schools were experiencing in their efforts to follow the guidance, including difficulty obtaining tests.
Dr. Shah explained that the biology of the omicron variant reduces the effectiveness of tracing. That’s because omicron is significantly more contagious than previous variants, and its contagiousness is “front-loaded.” It has a shorter latency period before an individual becomes symptomatic. It is most transmissible immediately before and after a person becomes symptomatic.
Even rapid testing and tracing is not fast enough to catch carriers before they infect others, because people aren’t likely to test until they are symptomatic, and by then, it’s too late. In addition, at this point, COVID-19’s spread is so great that there aren’t enough resources to trace and notify all close contacts.
Meanwhile, it had become impossible to deny that isolation and quarantine was having serious detrimental effects on students. Dr. Shah spoke of the lost benefits of in-person teaching, its educational value, its value for the development of social skills, as well as the fact that some students get their only regular meals at school.
As a result, the new guidance is that schools that practice universal masking can suspend contact tracing. Dr. Shah advised that parents who were surprised and worried about their children’s safety should vaccinate their children, keep them home if they are sick, and improve air filtration at home.
The new state policy doesn’t seem entirely consistent with its rationales. If omicron’s spread is so fast and wide, and resources are so scarce that it can’t be caught, then why trace at all? Alternatively, if tracing still has value in suppressing spread, why not use what limited resources are available to trace in schools with mask mandates where the number of positives requiring tracing should be more manageable?
That evening, I watched BBC World News America and the PBS Newshour. Amongst numerous other news outlets, both reported that in addition to the $10 billion devoted to school-based testing in the COVID-19 relief law, the Biden administration was sending millions more tests to schools to promote their reopening.
The state and federal positions seem inconsistent as well. If the virus is too fast to catch in Maine, it’s probably too fast to catch in other states too, and maybe the federal CDC should be providing the type of guidance that Maine is. It seems unfortunate that the federal and state government aren’t on the same page two years into the pandemic.
But omicron seems to be a game-changer that requires half-time adjustment, and the state-federal inconsistency is consistent with the general plan of our government. That plan is to govern locally before nationally, for each component of our federated, tripartite government to perform the function to which it is suited, using the power it has been delegated.
States develop and implement policies to address conditions within their borders because every state is different. Each knows their situation better than the politicians in Washington. What works for one may or may not work for another, even with respect to infectious diseases.
But Washington does have a role to play. If a state and its neighbors’ resources get exhausted, the federal government can provide assistance. State policies that prove to have wider benefits can be scaled up. If international travel should be restricted, DC is the one to do it. But given the speed and interconnectedness of our world, infectious diseases that emerge elsewhere are likely to be here before we know it.
In general, infectious disease is always going to be one step ahead of the central planners. We are always going to be catching up. It will emerge and mutate before we detect it, implement policies to curtail its spread, develop tests to identify it, vaccines to prevent it, and therapeutics to treat it.
In this area as in others, overreacting can be wasteful and detrimental. It can result in an ineffective or counterproductive response: too many ventilators, too much hand sanitizer, not enough tests and masks, vaccine failures and too much collateral damage.
That’s not to say that we shouldn’t be on alert, thinking about the possibilities, anticipating and preparing to meet them; only that one of the things we need to guard against is our tendency to overreact. And to remember that our government is designed to respond in a federated manner.
