Connecticut Academy of Science and Engineering Provides Guidance for State’s Ongoing Pandemic Response

Connecticut’s success-to-date in knocking down the spread of the coronavirus – particularly when compared to the increasing spread in most of the country – can be attributed to many decisions made by the state’s leaders and individual residents across the state.

Among those efforts which have received less attention, but contributed to the progress, is a special committee of experts from multiple disciplines quickly set up by the little-known but highly regarded Connecticut Academy of Science and Engineering (CASE).  The Academy, a private, nonprofit, public-service institution, “identifies and studies issues and technological advances that are or should be of concern to the people of Connecticut, and provides unbiased, expert advice on science- and technology-related issues to state government and other Connecticut institutions.”

In late April, CASE convened a committee to develop concepts for consideration by the Office of the Governor for addressing the ongoing challenge of the COVID-19 pandemic. The CASE committee met concurrent to the Reopen Connecticut Advisory Group, and produced an 80-page report on May 29.  The focus was not on the initial reopening, but on “concepts that will be needed as part of a sustainable response to the ongoing pandemic challenge,” according to CASE.  The comprehensive report included sections focused on a “targeted approach to testing, contact tracing and mitigation,” the “urgency of reopening the full healthcare system,” the “need for outpatient medical treatment” and recommendations regarding “returning to work and protecting the vulnerable.”

The members of the high-level CASE Paper Committee, with diverse backgrounds from academia and industry, collectively represented the areas of public health, medicine, science, engineering, and technology.  Members included John Kadow, ViiV Healthcare; Bruce Liang, UConn School of Medicine; David Parekh, UTRC (ret.); Krishna Pattipati, UConn School of Engineering; Leon Pintsov, Pitney Bowes (ret.); Harvey Risch, Yale School of Public Health; Ken Rosen, Sikorsky Aircraft (ret.); Jane Snowdon, IBM Corporation; Sten Vermund, Yale School of Public Health; and Elke Weber, Princeton, Psychology & Public Affairs. David Parekh, Ph.D., served as Project Director.

The committee recommendations centered around the acronym COURAGE:  Caution is warranted.  Open the full healthcare system.  Understanding comes from monitoring.  Resources will be needed.  Adaptation is key.  Guard the vulnerable.  Education is Essential.

The report, titled “An Adaptive Risk-Based Strategy for Connecticut’s Ongoing COVID-19 Response,”  stressed that “testing is the means to achieve situation awareness,” calling for an expanded diagnostic testing process (that) should be decentralized at point-of-care,” and noting it would be essential “to build confidence in people so that they can feel safe to reemerge into the economy.” 

The CASE paper also urged state leaders to go “beyond binary thinking,” indicating that “Decisions will have to be made with imperfect information and likely without the benefit of having a perfect treatment or a vaccine. The balance of health and economy will likely require risk-based decision-making to best balance the needs of society…” 

In a subsequent presentation of the CASE Paper last week during the CASE Annual meeting, Parekh noted that education is key to the state’s ongoing efforts.

“So much of this hinges on the policy options being deployed being accepted and followed through by the public, so it’s really important for people to understand the rationale for things being done,” Parekh said.

Among the recommendations, as officials navigate the coronavirus crisis:

·         Expand how we think about risk. Risk exists on multiple issues, and policies that reduce the risk of virus infections increase the risk of economic ruin or the risk of dying of other causes. Even on a single issue, risk is not binary (present or absent) but exists on a continuum, and attempts to reduce a specific risk to zero come at the cost of increasing other risk … It is the perception of risk, rather than the actual risk, that motivates and sustains protective behavior, even if those perceptions are driven by factors that differ from statistical analyses and do not always agree with expert evaluations. Thus, understanding public perceptions of risk is especially important as one seeks to change behavior.

·         Pivot from the current characterization of goods and services as essential versus non- essential and seek to find ways to make all of them safer. Much of what is deemed non-essential significantly impacts people’s lives and livelihoods if closed for extended periods. Other than the obvious essential services, such as food, medical, fire and police, many others are often debated and vary in judged importance from state to state. Instead of engaging in such debates, policies should focus on ways of reducing the risk of virus transmissions for both “essential” and “non-essential” businesses.

·         Be adaptive with a keen sense of the current conditions and trends. As the initial wave of infections has shown, different states and even portions of states can show very different patterns... A state-wide massive shutdown that is appropriate at the beginning when little is known needs to be replaced with more adaptive and targeted approaches that can have the same effectiveness but with much less harm on society on other dimensions. This is enabled by expanded testing coupled with a state specific epidemiological model that includes the interactions with neighboring states in the region.

The report explained that “Decisions in this environment are not either/or, but more nuanced and require a deft touch to adapt to changing levels of risk. These difficult choices involve highly interconnected systems where the direct and unintended outcomes are often uncertain. To this end, CASE looked at this challenge from a risk-based systems perspective.”

As the state reopened the economy, the CASE Paper recommended a “staggered return to work approach, including that “All organizations should establish control and health management procedures governing employee entry and exit from the workplace as well as guidelines for opening and closing specific workspaces. These procedures should be consistent with state guidelines and be in place before the workplace is initially reopened...with a clear understanding about responsibility and authority.”

The report also pointed out that “Poverty is associated with more crowded living. Persons of modest economic means may be more likely to be in “blue collar” jobs that did not permit working from home: custodial services, public transportation, nursing homes and assisted living, home health aide care, retail groceries, and hospital services like nurse aides and orderlies.”  It recommended, therefore, that “Since the minority and low-income populations are disproportionally affected by COVID-19, the state should have a process and a policy for coordinating and aiding non-governmental organizations and volunteers to disinfect low-income buildings, provide masks, disinfectants and soaps, and educate on the benefits of social distancing.”

Also among the recommendations:  “the state’s hospitals should actively participate in clinical trials for therapeutic drugs and vaccines. This has the beneficial effects of making Connecticut a leader in COVID-19 treatment, gaining knowledge of how trials are proceeding, and educating the public on the best therapies and vaccines.”

The Connecticut Academy of Science and Engineering was chartered by the General Assembly in 1976.