Elected leaders should still consider data when making these decisions. They should start by asking public health officials: Is the overall burden of disease rising, and if so, could it overwhelm the health care system? Even if it’s not rising, are there gross inequities in disease burden by place or race that can be addressed, such as specific communities or facilities that require a targeted response?
To answer, health officials will need to use an approach similar to how they measure flu activity. For the flu, public health officials acknowledge they cannot accurately count all community and hospitalized cases, so they monitor samples of the population for flulike symptoms, flu strains circulating and vaccine effectiveness. They make a composite estimate of flu activity and compare it with historical data. We can shift to this approach for Covid-19 and complement it with other promising approaches, such as wastewater monitoring.
In most situations, however, elected officials need to operate in the far grayer area of interventions narrowly tailored to specific settings, like schools, nursing homes and jails. For each setting, officials need to consider whether the people in those places are vaccinated or are medically vulnerable, whether the building has optimized ventilation and whether there are high-quality masks and rapid tests available to all who want them — similar to the expectation that a building has abundant soap, water and paper towels for hand hygiene.
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