23or necessary. Our children, the
demographic group at lowest risk of
serious illness, continue to endure
more hours of uninterrupted masking
than higher-risk adults.
We need to end the policy of school
closures and the cancellation of school
sporting events based on asymptom-
atic testing. While testing and quaran-
tines may have been rationalized
as reasonable strategies prior to the
availability of vaccines, these disrup-
tions can no longer be justified as hav-
ing any direct impact on lowering the
risk of life- threatening illness among
the lives of those subject to the disrup-
tions, namely students, athletes
or even spectators.
Although schools reopened in 2021,
parents and students continue to suffer
from educational loss and work disrup-
tion due to school testing policies and
quarantines. The CDC has finally en-
dorsed “test to stay” as a safe and rea-
sonable policy for keeping kids in school and minimizing
educational disruption. This policy should quickly become
the norm until school-based testing is completely phased
out. Similarly, testing protocols should be updated for all
places of work, shortening the period of isolation following
infection. Returning to work (or school) as soon as a rapid
test is negative, reflecting when COVID-19 is no longer
transmissible, is more appropriate than the outdated lon-
ger periods (with a negative test) of isolation.this updated road map also includes modification
of vaccination policies to better reflect our nuanced un-
derstanding of vaccine efficacy and population risk. Our
widespread promotion of booster vaccination for all in-
dividuals over age 16 should ensure we target those most
vulnerable to serious breakthrough infections first, which
would include mass booster campaigns in nursing homes
and among those in care for chronic diseases. This new
road map will also give recognition to natural immunity
from prior infection when implementing vaccine mandates
(such as recommending one dose after natural infection for
those who have yet to be vaccinated, to increase immunity
but minimize side effects). This policy would increase pub-
lic trust, particularly among more vaccine- hesitant com-
munities, as a more accurate reflection of current evidence.
This new approach reframes our policy toward harm re-
duction and away from zero-COVID policies. Policies like
travel bans are ineffective in decreasing transmission and are
fundamentally inequitable, punishing other countries for
laudable practices such as data sharing. Getting treatments
like Paxlovid authorized tells the unvaccinated we want to
provide compassionate care to this group. And finally, pro-
moting booster doses for young, healthy adults over an equi-
table global distribution of vaccines is counterproductive for
suppressing the emergence of variants and runs contrary to
the notion that all humans are of equal value.
We encourage the Biden Administration to take a ra-
tional approach to the COVID-19 pandemic in 2022.
President Biden said in his speech on Dec. 21 that the Ad-
ministration will renew efforts to increase access to rapid
testing and expand the surge capacity of hospitals in areas
of low vaccination, both important and welcome commit-
ments. In addition to meeting these immediate practical
needs of the pandemic, we hope the Administration will
recognize that it is time to reframe our approach, mov-
ing beyond case counts and community- based restrictions
and to revise policies specifically aimed at protecting vul-
nerable populations and assuring that our nation’s chil-
dren will stay in school. We hope this new way of thinking
will allow a sensible, science-based approach to the next
phase of our response.Dr. Gandhi is professor of medicine and associate division
chief of the Division of HIV, Infectious Diseases, and Global
Medicine at San Francisco General Hospital and director of
the Center for AIDS Research at UCSF; Noble, M.D., M.A.,
is associate professor of emergency medicine and director of
COVID response at UCSF Parnassus Emergency DepartmentPerpetual masking of
entire populations is not
sustainable or necessary
◁
A health care
worker administers
a Pfizer-BioNTech
COVID-19 vaccine
at a drive-through
site in Miami’s
Tropical Park
on Dec. 16