Open Letter to Pence Seeks Science-Based COVID-19 Response

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MARCH 03, 2020 -- Almost 700 clinicians, public health, legal, and ethical experts have signed on to an open letter outlining to Vice President Mike Pence and other federal, state, and local health leaders what they believe are necessary and appropriate steps to ensure that the response to the novel coronavirus is handled in a scientific and humane fashion.

Mandatory quarantines are likely not the answer, especially given that evidence now exists that the virus is transmitted in its presymptomatic or early symptomatic stages, they write. Voluntary quarantines, social distancing, and compliance with public health instructions will become more important, which, in turn, brings up a host of other issues.

"Whether individuals can comply will be determined by the degree of support provided, particularly for low-wage workers and other vulnerable communities," the letter writers say.

The six-page letter — addressed to Vice President Mike Pence, who is leading the White House coronavirus response team, and to federal, state, and local health leaders — was put together by clinicians, researchers, and legal experts at Yale, Harvard, Northeastern, and Temple University, along with representatives from health and human rights organizations such as the American Public Health Association.

It includes multiple recommendations, from ensuring adequate funding and resources, to proper protection for both healthcare workers and patients, to the need to "manage public fear" with honest, clear, evidence-based communication.

"People feel very, very strongly that the response to coronavirus in the US needs to be based in science and human rights principles," said Gregg Gonsalves, PhD, assistant professor of epidemiology at Yale University School of Medicine in New Haven, Connecticut. "We wanted to make sure that was appreciated by people at the federal, state and local levels," he told Medscape Medical News.

Among the other recommendations in the letter: "Science needs to guide messaging to the public, and no government official should make misleading or unfounded statements, nor pressure others to do so."

"There's some sense that the administration wants to keep a lid on information about the extent of the epidemic, and about any missteps," Gonsalves said.

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And, he added, withholding information "just makes things worse," because the public does not know whom or what to trust.

"Open, transparent information sharing is really important," Gonsalves said. "You're not going to handle the epidemic like a political crisis; you're going to handle the epidemic like an epidemic."

"Best Public Health Advice"

The letter calls for an influx of new government funding to ensure that health and safety net programs are not cannibalized, and also urges special protections for health facilities and health workers. That includes giving workers adequate protective equipment, reasonable respite, and protection from discrimination that might arise due to their work with infected patients.

Prisons, nursing homes, and other institutions with congregate living also need to take special preventive measures to protect against rapid spread, the letter states.

It also says that health facilities should be immigration enforcement-free zones, so that those who are potentially infected are not discouraged from seeking care.

That recommendation ties in with several others aimed at encouraging individuals to comply with quarantine, self-isolation, and social distancing.

The authors of the letter note that many individuals might have difficulty meeting such requests due to a lack of paid sick leave or jobs that don't have an option to work at home.

It might come down to choosing between rent or complying, Gonsalves said. "If you don't feel sick, the emergency for you is am I going to get paid on Friday," he said. "You want to create a climate that makes it easy for people to comply with the best public health advice."

The letter calls on employers and governments to provide incentives — including making up for lost compensation — as motivation. It may be without precedent in the United States, but the government of Hong Kong has set aside $10 billion in its current budget to offer permanent residents $1280 each to cover the financial fallout of the coronavirus, according to a Financial Times report.

Gonsalves and colleagues are also recommending that insurers be required to minimize out-of-pocket costs, including copays and out-of-network fees, to ensure that people aren't dissuaded from seeking care.

One state has already taken that step. New York Governor Andrew M. Cuomo (D) announced that his administration is requiring insurers in the state to waive cost-sharing associated with testing for novel coronavirus including emergency room, urgent care, and office visits. Medicaid recipients also will not have copays for any testing related to COVID-19.

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