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The U.S. should learn from South Africa, not punish it

The Biden administration’s newly announced plans to contain the omicron variant of the coronavirus are broad but noteworthy for what the revamped measures contain — and what they don’t.

President Joe Biden unveiled a regime of stricter testing for international arrivals, required reimbursements from insurance companies for at-home rapid test kits and a public awareness campaign for boosters. Absent from the conversation is when the administration’s punitive and ineffective travel restrictions on countries in southern Africa will be lifted. Also missing is any effort to prioritize a rapid public health research and surveillance network similar to South Africa’s.

The current travel restrictions are entirely out of line with current evidence, which shows the virus was likely already in the Netherlands prior to any known case detected in Africa. Yet the reflexive reactions by dozens of nations was eerily reminiscent of earlier in the pandemic. Travel restrictions against China issued by the Trump administration in January 2020 — lauded mostly by former President Donald Trump himself — did very little to stem the tide of the deadly surge.

In fact, data collected by the Centers for Disease Control and Prevention demonstrated that travelers from Europe were likely responsible for introducing the virus in New York City before the city’s early surge in spring 2020. Restricting flights from China did nothing to prevent the virus from entering from other parts of the world, but in combination with Trump’s inaccurate and racist portrayal of the virus as the “China virus” or “Kung flu,” the restrictions propelled xenophobia and anti-Asian sentiment that has persisted to this day.

So do travel restrictions have any utility? Absolutely: They were considered essential public health tools centuries ago when dealing with highly communicable diseases and limited ports of entry, such as ships arriving in Sicily with rats, sailors and cargo carrying the plague. Such a scenario rarely exists today, a point that was reinforced when, prior to Covid-19, the World Health Organization made painstaking efforts to denounce travel bans or restrictions. Instead, it asked all member countries to adopt a legal framework that would avoid interference with trade and travel unless there was scientific evidence for such measures. Unfortunately, at the beginning of any novel outbreak, such as Covid-19, it is not clear what constitutes “sufficient evidence.”

South African epidemiologists and health officials have long been respected globally for their ability to gather data and quickly translate insights into action.

Given the likelihood of new variants that threaten the public developing in the foreseeable future, the Biden administration must follow the lead of our African colleagues to quickly identify and inform the world of global threats. In a sense, this is a higher priority than anything else, since unlike other nations, the U.S. has plentiful access to vaccines and boosters but lacks a national surveillance network. South African epidemiologists and health officials have long been respected globally for their ability to gather data and quickly translate insights into action. Daily briefings with up-to-the-minute information by region along with integration of clinical sources are a mainstay.

By contrast, what we have in the United States is a clunky patchwork of data sources from labs, clinics and hospitals given to counties, states and, finally, eventually, to the CDC, which usually takes weeks, if not months, to produce a highly edited academic report in the form of the historically lauded Morbidity and Mortality Weekly Report. Some counties have absolutely no public health infrastructure, while many still rely on fax and phone to communicate results. Samples collected and prioritized can still take 28 days for analysis, reporting and data entry.

While preliminary data comes with its own drawbacks, and rushing to judgment can be detrimental, the void of such information can be deadly. Technically, this role could reside within the newly formed Center for Forecasting and Outbreak Analytics at the CDC, but still, to this day, we have blind spots that create significant vulnerabilities in our health and national security.

We still do not have rapid and accurate counts of race/ethnicity and pediatric hospitalizations and deaths due to Covid-19. Some states such as Florida have all but stopped regularly reporting Covid-19 data.

By contrast, California has led the way in data reporting and genomic surveillance. The state has one of the largest genomic surveillance networks in the nation, and thus it was no surprise that California was the first in the U.S. to discover a case of omicron. This kind of lab data needs to be integrated with what we see in the real world: human behavior, clinical presentations and information on how or why people are becoming infected.

What that means is clear: The omicron variant is here.

The first known case of omicron in the San Francisco area was in a traveler who landed Nov. 22, approximately one week prior to when the travel restrictions regarding southern Africa went into effect. The omicron case detected in Minnesota is in a patient with no recent international travel history and who was likely infected while in New York City before Thanksgiving. This indicates community spread among people who have no idea how they were infected.

What that means is clear: The omicron variant is here. Our ability to control it starts with vaccines, stricter testing, treatments and common sense. But the ability to lead as a nation will be tied to our ability to identify global threats and exhibit public health diplomacy. And there we should be taking a page from South Africa’s playbook — not punishing it and its neighbors for finding what was apparently already there.

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