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Friday, April 23, 2021

A preview of findings from the Academy’s COVID-19 Task Force

William Arnone, Chief Executive Officer

As the world grapples with three million tragic deaths due to COVID-19 – with over 566,000 deaths in the U.S. – the Academy is helping policymakers and the public understand the pandemic’s impact on our social insurance infrastructure. Here’s an update on the Academy’s COVID-19 Task Force:

Deliberations of the Academy’s COVID-19 Task Force consist of two phases. The first phase is the Epidemiology Working Group. Chaired by Dr. Neil Powe, Professor of Medicine at the University of California - San Francisco, the Epidemiology Working Group began meeting in late 2020.

The second phase of the COVID-19 Task Force is the Policy Translation Working Group. The Policy Translation Working Group is co-chaired by Academy Founding Board Member Henry Aaron of the Brookings Institution and Academy Member Katherine Baicker, Dean of the University of Chicago’s Harris School of Public Policy. Academy Member Louise Sheiner, Senior Fellow and Policy Director at Brookings Hutchins Center on Fiscal and Monetary Policy, will serve as Principal Investigator. This Working Group will be divided into two Subgroups – one on Income Security policy, led by Henry, and another on Health Security policy, led by Kate. The Subgroup’s Members will be announced next month.

(Forthcoming) Report of the Epidemiology Working Group: Scenarios

The main focus of the Epidemiology Working Group’s report is on three pandemic scenarios in the remainder of 2021 and into 2022 that might impact the financing, benefits, and equity of Social Security, Medicare, and other social insurance and related programs. The three scenarios mirror those used by the Social Security and Medicare Trustees in their annual reports: optimistic, pessimistic, and probable. Each scenario incorporates the following key variables that will significantly affect the short- and long-term pandemic outcomes and impacts on social insurance programs:

  • Future mutations of SARS-CoV-2
  • Future transmission of SARS-CoV-2
  • Vaccination efforts
  • Treatment effectiveness
  • Short and long-term COVID-19 effects
  • Testing access and supportive services
  • Public health measures engagement
  • Outbreaks
  • Community protection
  • Economic impacts
  • Social policy
  • Education
  • Other

Probable Scenario

Based on evidence available as of April 2021, the Epidemiology Working Group assessed the following as the probable scenario:

Future mutations of SARS-CoV-2: (COVID-19 is the disease caused by SARS-CoV-2 as the virus/etiologic agent.) As the virus mutates, some strains will be more transmissible and/or have potential for causing more severe illness and death. There is some reduction in natural or acquired immunity to new strains for severe disease or death. Genomic sequencing is improved to enable greater identification and containment of any new variants of concern in the U.S.

Future transmission of SARS-CoV-2: As a result of vaccinations and naturally occurring infections, U.S. achieves reasonable community protection (i.e., “herd immunity”) by end of 2021. Outbreaks continue to occur, but overall case rates and average disease severity levels decline. Like other coronaviruses, SARS CoV-2 becomes endemic and/or persists in some form.

Vaccination Efforts: Effective vaccines are made available in 2021 for all U.S. adults and adolescents and reach 70 percent of that population by fall of 2021. Vaccines are proved to be over 90 percent effective in preventing hospitalizations and death, block 80 percent of non-severe illness, and 70 percent of transmissions. Studies evaluating a "booster shot" show value-added and are incorporated into public health policy. Emergency use authorization is extended to pediatric vaccines (6 months to 11 years) by mid-2022.

Treatment effectiveness: There are better and accessible inpatient and outpatient therapies that moderately reduce hospitalizations, ICU admissions in symptomatic cases, and prevent deaths.

Short and long-term COVID-19 effects: Up to one-third of patients with clinical disease develop long-term sequela (physical or behavioral) that require additional medical care and interfere with employment.

Testing access and supportive services: Accurate and rapid testing is generally available, including home testing. There is some provision of services to support persons during isolation and quarantine, such as paid leave.

Public health measures engagement: Federal agencies release stronger, more uniform national guidance. The federal and many state governments issue strong regulations requiring masks and other precautionary measures. Public compliance with public health measures declines modestly as vaccination rates increase.

Outbreaks: Regional outbreaks persist into 2022 among high-risk populations and in congregate settings (such as incarceration facilities and nursing homes) where community protection is low.

Community protection: Immunity protection levels approach 70 percent of the U.S. population in 2021 and into 2022 through a combination of vaccinations and natural infection.

Economic impacts: Moderate economic growth occurs in 2021 and into 2022, resulting in increased business re-openings, moderate employment increases at somewhat higher wages, some reductions in poverty (especially child poverty) and inequality, moderately increased consumer spending, and moderate increases in inflation.

Education: Most preschools, elementary, middle, and high schools are open for significant periods in 2021 and 2022. Most colleges and universities are open for significant periods in 2021 and 2022.

Other: Incidents of individual and group unrest decrease. U.S. rejoins international virus containment efforts.

Impact on long-term care facilities’ residents and workers

In view of the Academy’s continued focus on Universal Family Care, including long-term services and supports, the Epidemiology Working Group’s report highlights the devastating impact of the pandemic on residents and workers of skilled nursing and other congregate care facilities. The Long-Term Care COVID Tracker found that “less than 1 percent of America’s population lives in long-term care facilities, but, as of March 4,2021, this tiny fraction of the country accounts for 34 percent of U.S. Covid-19 deaths.”

The working group report notes that data, especially on at-risk populations, are key to informing pandemic response. Although all states report COVID-19 data by race and ethnicity to some extent, a large proportion of data are still missing this information. Even more importantly, age-adjusted data on COVID-19 cases and deaths by race and ethnicity are not easily available on the CDC website. There is also little information on sources of COVID-19 transmission in key settings, including long-term care facilities, prisons and jails, through essential work, and in schools. Improving surveillance and contact tracing, as well as data collection and reporting by race, ethnicity, age group, and occupation remains a top policy priority.

Future Considerations

The report concludes by observing:

“Due in part to the existing gaps in our social insurance infrastructure – such as the continued erosion of the Unemployment Insurance program, the lack of adequate coverage for long-term care, and inadequate support for direct care workers – the COVID-19 pandemic has wreaked havoc on the lives of millions of Americans, especially older Americans, people of color, incarcerated individuals, and people with disabilities. Addressing the gaps in social insurance protections – systemic inequities around gender, race, age, and sexual orientation – will improve the economic security and the quality of life for all Americans.”

The Epidemiology Working Group further notes: “This moment offers an opportunity to evaluate the state of our current social insurance infrastructure – including funding, benefit coverage, and equity challenges –  and the degree to which our social insurance systems might better protect large segments of our population from the economic and health risks posed by the COVID-19 pandemic and by future local, regional, national, and global crises that are inevitable.”

The Academy’s new multi-year campaign for economic security

The Academy’s COVID-19 Task Force is one of three vehicles whose work will be integrated into our new multi-year Campaign for Pathways to Economic Security. The other two are our Unemployment Insurance Task Force and our Older Worker’s Retirement Security Task Force. This Campaign was launched at our annual policy conference last month. Conference highlights are available on our website. Stay tuned for more information about the Campaign.

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