'Metadata" might sound like something that "Star Trek's" Spock would oversee, but it is real and increasingly familiar, as the result of stories about wiretaps and security. The easiest-to-understand example of it is information about the time, duration, originating number, and destination number of a phone call – but without any of the content (i.e. words spoken) of the call. Metadata might also indicate from its format that a field on a form is a date or Social Security number – e.g., "xx/xx/xxxx" or "xxx-xx-xxx," respectively.
We believe it is critical now to establish a set of "metapolicies" – overarching governing actions to deal with the scourge of the COVID-19 pandemic. These metapolicies consist of sets of minimally prescriptive guiding principles, within which specific policies can be crafted.
Most people understand that one size does not fit all, and that that is even true well below the level of a single state, county, or city, much less what can emanate from Washington, D.C. The metapolicies proposed below should transcend these divides and serve as a guide to sensible policies.
We would emphasize, however, that the ultimate "purpose" of the life of infectious agents, like other organisms, is to be fruitful and multiply, to coin a phrase. They are not influenced by our inconvenience or impatience, or by the "happy talk" optimism of politicians. In short, we need to do whatever we need to do in order to confront and control the enemy, however annoying or inconvenient.
One disclaimer: Although we believe our proposed principles comport with currently available knowledge about this pandemic, further research, trials, and data gathering may dictate some alterations, including some additions, to our list.
Individuals' actions designed to prevent exposure to an infectious dose of SARS-CoV-2, the virus that causes COVID-19:
- Handwashing and hygiene measures should continue to be promoted and required where appropriate.
- Persons in highly vulnerable groups – the elderly, and those with underlying morbidities, such as diabetes, pulmonary, cardiovascular or renal disease, or immunodeficiencies – should continue to modulate their exposure to possible sources of infection, and receive whatever assistance is needed to do so.
- High priority should be given to encouraging any individual with a persistent cough, malaise, fever, or sudden loss of smell, to remain in isolation (except when seeking a test for COVID-19). Enforcement with civil penalties by local authorities may be appropriate.
- Masks should become ubiquitous. They are important to prevent an asymptomatic or pre-symptomatic carrier from shedding viral particles, especially indoors and in places with high concentrations of people or where contact will be prolonged, such as supermarkets, indoor athletic events, lectures, etc. In many locales, under certain circumstances, they will likely be mandatory.
- Social distancing remains important but should be context-sensitive. The greater the volume of air and its movement, the less likely viral material sufficient to cause infection will be transmitted across short distances. Context may also include the prevalence of the virus in the relevant area(s).
- Restrictive policies need not be applied to situations where people have passing contact at even a short distance, such as on a trail or bike path, as the time of exposure is generally too short for transmission.
- When larger groupings are permitted to resume, such as in workplaces, policies should encourage and perhaps subsidize self-testing, including temperature-taking and rapid diagnostic tests.
Institutional Guidance – requirements for testing, distancing, and protective measures are important but must be appropriate to the situation:
- All indoor facilities should be encouraged and perhaps subsidized to improve heating, ventilation, air conditioning systems to increase air flow, with filters that will remove viral particles and maximize the throughput of outside air.
- Recognize that infection is a function of the amount of amount of virus and the length of exposure, and tailor requirements accordingly.
- Haste and impatience do not excuse or justify policies based on poor science.
- A life lost to COVID-19 is worth no more or less than one lost to any other cause that results indirectly from policies crafted to avoid infections. This includes suicides, increases in drug overdoses, alcoholism, and untreated, undertreated, and undiagnosed health problems. This is far too often ignored.
- Healthcare facilities should maintain sufficient reserve capacity to deal with possible surges in COVID-19 cases but should otherwise resume the normal delivery of health care.
- All policies should assume that COVID-19 will be with us for the foreseeable future, and that herd immunity cannot be expected without a vaccine or levels of infection unlikely to be acceptable in terms of the accompanying mortality.
- The public's peace of mind is achieved with facts and transparency, not unwarranted restrictive policies.
- While we are in "the fog of war," perfection is impossible, and some errors are unavoidable.
- Balancing public health policy and economic wellbeing is not an either/or choice. Decisions about each carry risks that must be weighed, and the ultimate responsibility belongs to elected officials, not unaccountable bureaucrats. There is no risk-free set of policies, either for those setting the policies or those affected by them.
We hope that each of the constituencies will act on principle and be guided by evidence, rather than unenlightened self-interest. But we are not naïve and know that that will not happen consistently. All parties involved are human, which ensures that motivations and degree of self-discipline will vary and results imperfect. (One need look no further than the irresponsible, dangerous Memorial Day weekend behavior of many young people on boardwalks and beaches around the nation.) But we should strive, as best we can, to base our personal behavior and public policy on science and evidence.
Andrew I. Fillat spent his career in technology venture capital and information technology companies. He is also the co-inventor of relational databases. Henry I. Miller, a physician and molecular biologist, is a senior fellow at the Pacific Research Institute. They were undergraduates together at M.I.T.