公共卫生专家已经提出了一个全国性的新冠肺炎(新型冠状病毒肺炎)基于奥巴马政府艾滋病毒/艾滋病战略的战略。
在一个艾滋病和行为杂志上新发表的论文来自美国多所大学的专家利用2010年和2015年国家艾滋病毒/艾滋病战略文件的结构，提出了一项战略对抗新冠肺炎应该看起来像。这些专家包括公共卫生和流行病学的杰出教授，他们都曾在疾病预防控制中心工作过。
他们说，国家战略应该是透明的、全面的和科学驱动的。
冠状病毒颗粒的特写图像，它是包括SARS、普通感冒和MERS冠状病毒在内的病毒家族的一部分。
国家艾滋病毒/艾滋病战略是由奥巴马政府在2010年发起的，根据疾病预防控制中心的说法，是有史以来第一次全面的协调艾滋病毒/艾滋病路线图;五年计划详细说明了指导国家应对气候变化的原则、优先事项和行动艾滋病毒流行病。该战略在2015年进行了更新，纳入了治疗、暴露前预防、实施《平价医疗法》和其他更新。
这项研究的作者之一，纽约州立大学奥尔巴尼分校公共卫生学院院长大卫·霍尔特格雷夫博士说，鉴于目前公共卫生的风险如此之高，“尽快为国家制定一项全面的计划非常重要。这个计划应该是全面的，也应该植根于我们可能使用的最好的证据和科学。”
《艾滋病毒/艾滋病战略》是起草一份新冠肺炎(新型冠状病毒肺炎)他说，计划是因为“它把预防和治疗计划放在一个地方，解决不平等，并协调联邦政府、州和地方政府以及私营部门之间的服务。”。
值得注意的是，特朗普总统承诺结束艾滋病在他2019年的国情咨文中。然而，霍尔特格雷夫说:“本届政府的‘结束艾滋病毒流行’计划解决了重要的核心要素，但该战略不如早期的国家艾滋病毒/艾滋病战略全面。”"因此，我们在2010年和2015年NHAS更新的基础上进行了建设."
为在全国范围内管理艾滋病毒/艾滋病而提出的战略以科学证据为基础，并包括经过彻底研究的疾病预防措施和被证明对艾滋病毒/艾滋病有效的药物。此外，这些战略还解决了健康差距问题，如受艾滋病毒/艾滋病影响过大的社会和种族群体。
“不受限制地获得”高质量治疗
然而，艾滋病毒/艾滋病和COVID并不是完全一样的。“艾滋病毒与COVID非常不同，所以显然你不能采用完全相同的干预措施，”美国广播公司新闻撰稿人、首席创新官兼哈佛医学院教授约翰·布朗斯坦博士说。“但类似的非药物干预可以(通过COVID)发挥重要作用。与艾滋病毒类似，差异在谁受到影响方面发挥着如此大的作用，教育也是一个重要组成部分。”
拟议的新冠肺炎战略甚至包括一项受《国家艾滋病毒/艾滋病战略宣言》启发的任务声明:“美国将成为一个新的SARS-CoV-2感染很少发生的地方，当它们发生时，每个人，无论年龄、性别、种族/族裔、性取向、性别认同或社会经济状况如何，都将不受阻碍地获得高质量、延长生命的护理，免受耻辱和歧视。”
霍尔特格雷夫详细说明了在制定战略时需要真正全面的内容:研究COVID的模式，利用循证治疗和预防措施(不仅针对急性感染，也针对长期影响)，协调各级政府的服务，解决种族和族裔差异，建立透明的进展指标。
“我认为，现在当我们听到关于我们作为一个国家要去哪里解决COVID的讨论时，讨论往往是零碎的，”他说。“他们要么专注于疫苗，要么专注于治疗，或者专注于口罩。我们需要真正做到全面。”
霍尔特格雷夫补充说，“联邦政府在制定全面的国家COVID战略方面有着明确的作用。如果那不是来自联邦政府，那么我们需要有一些其他的能量中心。一个挑战是找到能够走到一起的人，进一步发展这一点，并推动它向前发展。”
目前的策略是“打地鼠”
虽然还不确定哪个框架是理想的，但随着这种流行病继续影响美国社区，一个基于证据的治疗、预防和管理新冠肺炎的国家战略似乎越来越有必要。布朗斯坦博士说:“缺乏国家战略造成了如此多的混乱，造成了拼凑的反应，并导致了这种‘打地鼠’和不均衡的控制战略。”
“建立一个透明的过程，引入正确的声音来帮助确定战略，这是我们一直需要的概念。所以，如果我们能利用这个例子，以前做过，让我们领先几步，那就太好了，”布朗斯坦说。
医学博士莉亚·克罗尔是NYU·兰贡健康中心的神经病学居民，医学博士亚历克西斯·卡林顿是加州大学戴维斯分校的皮肤病学研究员。两人都是美国广播公司新闻医疗组的撰稿人。
Health experts call for a national COVID-19 strategy rather than current 'whack-a-mole' approach
Public health experts have proposed a nationalCOVID-19strategy based on the Obama administration's HIV/AIDS strategy.
In anewly published paper in the AIDS and Behavior journal, experts from multiple universities in the United States used the structure of the 2010 and 2015 National HIV/AIDS Strategy documents to suggest what a strategy forfighting COVID-19should look like. These experts include prominent professors of public health and epidemiology, all of whom have worked with the CDC on prior epidemics.
A national strategy, they say, should be transparent, comprehensive and science-driven.
A close-up image of a coronavirus particle, which is part of a family of viruses that include the SARS, common-cold and MERS coronavirus.
The National HIV/AIDS Strategywas launched by the Obama administration in 2010 and according to the CDC was the first-ever comprehensive coordinatedHIV/AIDSroadmap; the five-year plan detailed principles, priorities and actions to guide a national response to theHIV epidemic. The strategy was updated in 2015 to include the emergence of treatments, pre-exposure prophylaxis, the implementation of the Affordable Care Act and other updates.
One of the study's authors, Dr. David Holtgrave, Dean of the School of Public Health of the University at Albany, State University of New York, said that with public health stakes so high right now, “it is really important to have a comprehensive plan for the nation in place as quickly as possible. And that plan should be one that’s comprehensive and also rooted in the best evidence and science that we possibly can use.”
The HIV/AIDS Strategy was a good starting point for drafting aCOVID-19plan because “it put in one place plans for prevention and treatment and addressing disparities and also coordinating services between the federal government, the state and local governments, and the private sector too,” he said.
Notably,President Trump pledged to end AIDSin the U.S. by 2030 in his 2019 State of the Union Address. However, “the current administration's plan to ‘End the HIV Epidemic’ addresses important core elements, but the strategy is less comprehensive than the early National HIV/AIDS Strategy,” said Holtgrave. “For that reason, we built upon the 2010 and 2015 update of the NHAS.”
A copy of the National HIV/AIDS Strategy (NHAS) is held by a member of the audience during its introduction by President Barak Obama in Washington, July 13, 2010
The strategies presented for nationwide management of HIV/AIDS were rooted in scientific evidence and included thoroughly studied measures for disease prevention and medications proven to be efficacious for HIV/AIDS. In addition, the strategies addressed health disparities such as social and racial groups disproportionately affected by HIV/AIDS.
"Unfettered access" to high-quality treatment
However, HIV/AIDS and COVID aren’t totally torn from the same cloth. “HIV is very different than COVID, so clearly you can’t apply exactly the same interventions,” says Dr. John Brownstein, ABC News Contributor, Chief Innovation Officer and Professor at Harvard Medical School. “But similar non-pharmaceutical interventions can play a big role [with COVID]. Similar to HIV, disparities are playing such a big role in who is impacted, and education is a big component as well.”
The proposed COVID-19 strategy even includes a mission statement inspired by the National HIV/AIDS Strategy manifesto: “The United States will become a place where new SARS-CoV-2 infections are rare, and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity, or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.”
Holtgrave details what is needed to be truly comprehensive in strategizing: looking into the patterns of COVID, utilizing evidence-based treatment and preventive measures (not only for acute infections, but for long-term effects too), coordinating services on multiple levels of government, addressing racial and ethnic disparities, establishing transparent metrics for progress.
“I think now when we hear discussions about where we’re going as a nation to address COVID, the discussions tend to be kind of piecemeal," he said. "They’re either focused on vaccines or maybe treatment or a bit on masks. We need to really be truly comprehensive.”
Holtgrave added that "there’s a clear role here for the federal government to develop a comprehensive national COVID strategy. If that doesn’t come from the federal government, then we need to have some other locus of energy around that. One challenge is finding who the group of people is that could come together, develop this further, and move it forward.”
Currently strategy is a "whack-a-mole" approach
Although it isn’t certain which framework would be ideal, as the pandemic continues to affect American communities, an evidenced-based national strategy to treat, prevent and manage COVID-19 seems more and more necessary. “The lack of a national strategy has created so much confusion, has created a patchwork of response and led to this ‘whack-a-mole’ and uneven control strategy,” said Dr. Brownstein.
“The concept of creating a transparent process which brings in the right voices to help determine a strategy is what we needed all along. So, if we can leverage an example of this, having done it before, to get us a few steps ahead, then that’s fantastic,” says Brownstein.
Leah Croll, M.D., is a neurology resident at NYU Langone Health and Alexis E. Carrington, M.D., is a dermatology research fellow at the University of California, Davis. Both are contributors to the ABC News Medical Unit.
