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May 28, 2020

Using Controlled Trials to Resolve Key Unknowns About Policy During the COVID-19 Pandemic

Author Affiliations
  • 1Princeton University, Princeton, New Jersey
JAMA. 2020;323(23):2369-2370. doi:10.1001/jama.2020.8573

In an all-too-familiar pattern, US politics have become polarized around whether to maintain lockdowns and physical distancing. Many conservatives denounce public health restrictions as limits on individual freedom and push for reopening, whereas liberals tend to oppose those demands as premature and favor continued restrictions to protect health.

The trouble with this debate is that too little is still known about coronavirus disease 2019 (COVID-19) to take any position with certainty. In particular, too little is known about the alternatives to lockdowns that could enable the US to reopen institutions while minimizing the risk of new waves of the pandemic.

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    1 Comment for this article
    Resolving Key Unknowns About Public Policy on COVID-19
    Michael McAleer, PhD (Econometrics), Queen's | Asia University, Taiwan
    The perceptive and prescriptive Viewpoint is concerned with providing factual evidence through controlled trials for effective minimization of the spread of COVID-19.

    Such controlled trials would clearly be preferable to the current arbitrary policies based on preconceived and prejudicial ideas, frequently of a political nature.

    The key unknown effects of policies that need resolution for the desired control and mitigation of COVID-19, where the alternative is the status quo, include:

    (1) continuing general government mandated lock downs;
    (2) physical social distancing;
    (3) tightening public health restrictions;
    (4) control groups receiving a prescribed vaccine versus random placebo recipients; /> (5) quarantining of patients who test positive;
    (6) reopening of schools;
    (7) increased testing of asymptomatic or presymptomatic patients;
    (8) isolation within private homes;
    (9) protection of the elderly within their homes;
    (10) pro-active testing of pets for infection;
    (11) centralized relocation of patients to hotels or college dormitories;
    (12) effective redistribution of health care professionals to alternative housing.

    Before reopening the economy, it is essential to obtain reliable data on:

    (1) patients who test positive and:

    (i) accepted;
    (ii) declined; or
    (iii) were not offered alternative housing.

    The reasons for declining alternative housing would provide useful information to policy makers.

    (2) reopening schools for school-aged children who could infect others:

    (i) controlled experiments involving children, in particular, face numerous ethical hurdles;
    (ii) voluntary summer programs involving children, though not ideal, could provide alternative trial programs.

    Although public policy decisions based on arbitrary political priorities should not dominate scientific controlled data-based outcomes regarding the reopening of the economy and of schools, informed policy requires accurate information on infections, for which the data are sadly lacking.