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Nghe Thomas R. Frieden: Tái khởi động kinh tế - nhưng làm thế nào trong đại dịch?

Subject: Thomas_Frieden: Tái_khởi_động_kinh_tế - nhưng_làm thế nào trong đại dịch?
From: Mike Wilson
Date: Sun, March 29, 2020 8:36 am

Dưới đây là những ý chính của ông Thomas R. Frieden, cựu Giám Đốc Trung Tâm Ngừa Bệnh CDC của Mỹ, cựu Ủy viên Cơ quan Y tế tp New York, Chủ tịch và CEO của cơ quan Giải Quyết Cứu Mạng, Resolve to Save Lives:

1. Chính quyền TT Trump đã uổng phí thời gian đầu chuẩn bị chống dịch

2. Lỗi lầm nữa của Trump là gạt bỏ CDC ra khỏi vai trò quyết định - mà CDC là cơ quan có nhiều kinh nghiệm chuyên gia nhất trong việc chống dịch nội địa và toàn cầu

3. Vấn đề không phải chỉ là bảo vệ lợi nhuận doanh nghiệp, mà bảo vệ sức khỏe toàn dân, các sản phẩm chữa trị cứu mạng vẫn phải đầy đủ trên thị trường, công nhân phải được bảo vệ sức khỏe trong chỗ làm việc

4. Hai việc phải làm song song: (người viết thêm vào) cứu người, giảm thiểu và triệt tiêu số người chết vì dịch đồng thời giảm thiểu độ gia tăng thất nghiệp, ngăn chặn nhịp độ phá sản của các doanh nghiệp vừa và nhỏ

5. Nước Mỹ hiện đang có trên 100 triệu người lớn với một hay hai chứng bệnh kinh niên khó trị, họ cần phải được cách ly trong nhà lâu hơn khi tính đến việc bình thường hóa sinh hoạt thị trường

6. Việc tái khởi động sinh hoạt kinh tế phải từng bước, tùy điều kiện cho phép, tùy sức chịu đựng của hệ thống y tế chống dịch, và sức khỏe của các nhân viên y tế chống dịch

7. Cần rút ngắn thời gian lấy kết quả thử nghiệm, làm nhanh chóng và hiệu quả việc "chài lưới" thanh lọc những người bị nhiễm và những ai có liên hệ đối mặt với họ, phân loại, cách ly theo nhóm.

8. Các doanh nghiệp nào mở cửa hoạt động trở lại phải làm đúng theo qui trình cách ly, giữ khoảng cách, đo thân nhiệt, v.v.

9. Việc tái khởi động sinh hoạt kinh tế phải làm tùy từng địa phương, dựa trên thống kê và chứng nghiệm chính xác

10. Nếu tái khởi động không đúng cách, thì dịch sẽ bùng phát trở lại, và nền kinh tế sẽ èo uột lâu hơn !

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Frieden: When will it be safe to go out again?

There is increasing pressure to resume social and economic activity soon to limit the economic damage from the coronavirus. Suggestions to reopen are emerging that are not informed by thoughtful analysis or public-health expertise. It’s critical that decisions about how, when and what to reopen are based on the best data available, with transparency about how choices are made.

The choice is not between health and economics but about optimizing the public health response to save lives while minimizing economic harm. Economic harm isn’t just about profits: It’s about workers being able to afford essential goods, lifesaving products staying on the market and safeguarding everyone’s well-being. Social restrictions have effects beyond economic and social harms, such as harming patients who go without treatment for conditions unrelated to coronavirus.

In terms of “how” to reopen, the faucet of everyday activities needs to be turned on slowly. We cannot open the floodgates. Even before the pandemic emerged, we were not a healthy society. More than 100 million U.S. adults have two or more chronic health conditions. Medically vulnerable people will need to shelter in place for longer. If there is a large spike in cases, the faucet must be tightened again before cases overwhelm health-care facilities and contacts can’t be tracked.

“When” it will be safe to go out again is the flip side of the question of when social distancing should start. When there are multiple cases for which the source case cannot be identified, indicating that infection is spreading widely, people need to shelter in place. Otherwise, there will be explosive spread as occurred in Wuhan, China, and in Italy, and as is occurring in New York.

Sheltering in place has two benefits. The first is to reduce transmission. It’s wishful thinking to presume that everyone can sequester for two weeks and transmission will end. Spread in health-care facilities, homes and elsewhere will keep embers burning. The other crucial and under-recognized value of sheltering is to buy time to strengthen health-care and public health systems.

Our health-care system needs to be ready to treat large numbers of mildly ill patients, provide safe and effective intensive care for those who would die without it, and maintain care for the millions who need to continue treatment for chronic conditions. And all that needs to be done while protecting our front-line health-care workers. Our public health system needs to scale up the ability to do widespread testing, rapid and effective contact tracing, isolation of patients and quarantine of contacts.

The White House has emphasized high-volume testing, but faster testing turnaround times are much more important. Important advances are rapid-turnaround-time tests, including those provided by hospitals that develop tests locally now that the Food and Drug Administration has allowed them to do so; tests done locally with systems from private diagnostic companies; and, potentially, point-of-care tests that can be used at bedsides.

Note that China is months into the outbreak, responded much more robustly than the United States -- but is only now reopening much of its economy. When it will be safe to come out again depends on how well the country uses this time to prepare health-care and public health systems for a possible (re)surge in cases when activity resumes. The Trump administration squandered the lead time provided by Chinese disease control efforts and its own travel ban. We can’t afford to make that mistake again.

“What” gets restarted first should depend on what would have the biggest benefit for society. We urgently need to understand whether children spread this infection. If they don’t commonly do so, schools may be able to reopen, carefully. This would require enabling staff and students who are medically vulnerable to participate by distance. Day-care facilities are essential so parents can work. Infrastructure projects are a likely priority. Businesses that should go first are those that can open with distancing measures (mandatory hand sanitizer and temperature checks at entry, social distancing, staggered hours, etc.), those that can open with partial staffing to increase productivity of distance work, or those particularly important to a community.

Among the most concerning flaws of this administration’s response has been the virtual absence of our lead public health agency, the Centers for Disease Control and Prevention, from the decision table and the podium. This is dangerous. For example, the CDC issued practical and nuanced guidance about school closings. Without any scientific justification or explanation, the White House overruled that guidance 72 hours later. As a result, many school districts closed that probably didn’t need to, causing avoidable social, economic and educational dislocation.

CDC experts have experience unequaled nationally and globally. We will be safer when the CDC is in a position to provide the kind of expert advice it has dispensed in every other infectious disease emergency since its creation in 1946.

How the virus spreads and how prepared health-care and public-health systems are to fight it will vary by state and community. When to loosen the faucet of social distancing will depend on these three factors. The only reliable approach to decide what, when and how to safely reopen is to base decisions on data and evidence-driven principles as they apply to each community and state. More than the economy will be hurt if we get this wrong. Reopening the floodgates could overwhelm health-care facilities, killing doctors, nurses, patients and others -- and prolonging the need to shutter our economy.
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Thomas Frieden is a former director of the U.S. Centers for Disease Control and Prevention and a former commissioner of the New York City Health Department. He is president and CEO of Resolve to Save Lives, a nonprofit health initiative that is part of the global public health organization Vital Strategies. He wrote this for The Washington Post.

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