How We Move Forward, Even If It’s Not Straightforward

After four weeks of increasing COVID-19 cases, Colorado officials are dialing back many of the more optimistic reopening plans they proposed earlier this summer.

Jefferson County and Denver schools postponed plans to return to school buildings in person, opting to start the school year virtually. Gov. Jared Polis ordered bars to have an earlier last call and, after weeks of hesitation, implemented a statewide mask mandate. Polis said this week that 15 counties are at risk of being required to reverse their reopening plans if cases don’t decline.

Why hasn’t progress been more straightforward?

Managing a pandemic requires decisive, research-based action. People’s lives are on the line. Yet we are still learning about the virus and about how policies can work to control it. Even where the research is clear, politics and public opinion play major roles in how plans can be put into action.

It is frustrating, to say the least.

At the Colorado Health Institute, we’ve been thinking how policymaking tracks with the scientific method. You might remember the steps laid out in science textbooks: Make an observation. Ask a question. Form a hypothesis. Make a prediction based on the hypothesis. Test the prediction. See what you learn, and then start again.

In reality, the way scientists work is more dynamic then a five-step list would lead you to imagine. Your first hypothesized solution — say, “the general public should not wear masks” — may not prove to be accurate, and you may not learn what you hoped to learn. With each prediction that’s tested, new questions and new nuances emerge.

But revisiting the basic process — and remembering that gaining knowledge and solving problems is a process — can offer an alternative to frustration.

The process we’ve been engaged in so far — testing actions we believe will reduce the spread of the disease — means we know more in July than we did in March. For example:

  • Countries and regions that took more decisive action and made testing widely available saw drops in cases and deaths that appear to be lasting.
  • Cases in Colorado dropped after the state stay-at-home order took effect.
  • Masks help reduce the spread of the disease, and mandates encourage mask-wearing.
  • The burden of disease is not spread equally, and Indigenous, Black, and Hispanic/Latinx Coloradans have been particularly affected.

So even if we are not following a straight line, we at least have gained knowledge that can inform the next set of policy decisions.

But What About...

Even the relatively minor question of how to reopen our medium-sized office at CHI has required consistent iteration, flexibility, and learning. We planned for a phased reopening: Several CHIers (well under the 50% permitted by state regulation) returned to our building in late June and early July. More would return in August, and more in September, as cases — we hoped — declined. We offered a few guidelines about how to return to the office: Masks were required in shared spaces; quarantining was required after trips, time spent indoors with large groups or without masks, or exposure to someone with COVID-19. 

But real life immediately challenged the initial set of guidelines. Should employees quarantine if they live with essential workers who may have been exposed? For how long? Do Colorado’s rising infection rates mean fewer employees should return in August? What we are learning suggests that our plans and guidance may need to change to reflect our community’s needs and context.

Many other organizations are experiencing this kind of difficulty at a larger scale — most notably schools. Public health guidelines for schools are predicated on the idea that opening school buildings is a healthier choice for many students. But real-world implementation has introduced an almost-infinite number of what-ifs and concerns. The needs and context are complex — and fast-changing.

Involving the Community in Policy Decisions Pays Off

Nearly four months after the pandemic took hold in Colorado, we now have the experience to anticipate some of these fast-changing needs. One approach: connecting with the people immediately affected by decisions and using their insights to inform plans.

Our hypotheses and predictions are better informed when we collect as much information as we can about context and needs ahead of time. Policies that are developed with the input of those affected are more likely to reflect nuances that might be otherwise overlooked.

Engaging with people outside the typical policymaking process can take time. But while COVID-19-related decisions often need to be made quickly, making more informed decisions early on can help prevent backtracking later. It would be powerful to see school district decisions informed early on by teachers, janitors, students, and parents; decisions about venues and restaurants made and shared along with input from staff and owners; decisions about grocery stores and other essential business informed by those workers; decisions about how to serve the growing number of Medicaid patients informed by those enrolled in the program.

It is worth noting that involving communities and reflecting their needs in decision-making is not the same as creating policies that please everyone. Keeping restaurants open could make it harder to open schools, for example. And there is an important role for the evidence and judgment of those with deep knowledge of COVID-19 and public health. But creating spaces and processes for involving more stakeholders can pay off in better policy.

Use What We Know — and Keep Learning

Of course, all of this is predicated on our ability to understand how all these decisions really are affecting the spread of COVID-19. People, organizations, and governments need reliable and accessible data about test results, outbreak information, hospital usage, and, unfortunately, death rates. A strong national strategy for collecting this information has been lacking. And Colorado has been lagging in testing in recent weeks. Gov. Polis said in a press conference Thursday that more and more timely tests are on their way.

Let’s hope that’s true. Clearer data and information about the spread of the disease will help us make more informed, effective policy decisions — and will help us understand how the steps we’ve already taken have affected the health of Coloradans. Our learning depends on it.

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