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5 things states must do to curb the spread of COVID-19: ANALYSIS

Cases are on the rise throughout much of the U.S.

The dreaded fall and winter COVID-19 wave has arrived and with a vengeance. Much of the nation is experiencing a viral load of infections unlike those previously seen since the start of the pandemic.

Any one metric by itself doesn't fully relay the significance of the threat, but coupling it with multiple metrics, like the number of daily new cases, percent positivity rate, infection rate, hospitalization rate and deaths, provide a more complete burden of the illness.

There are 50 epidemics playing out in the United States, each state with its own trajectory and prognosis. Only two states, Maine and Vermont, are trending in the right direction, having control on their epidemic, the remaining 48 states are all trending in the wrong direction.

To curb the spread of COVID-19, these are five measures that must be taken to prevent further amplification of cases, illnesses, hospitalizations and death.

1. Mandate face masks

The verdict is in, masks work. In a study published in Health Affairs, mask mandates in 15 states and the District of Columbia led to a slower daily COVID-19 growth rate that was seen over time.

Currently across the nation, 49% of Americans wear a mask in public, with only some states mandating wearing a face covering. If we increase this to 95%, we could save 129,000 lives, the study said.

2. Better risk communication on preventative measures

Communication can make or break any medical response. Countries, like those in Asia, that have been able to curtail the spread of COVID-19 have showcased effective risk communication with the general public -- that is -- telling the public in layman's terms the good, the bad, the ugly and what we don't know yet.

Even more important is saying it with one voice, not mixed messages that erodes trust. During a time when many Americans are experiencing pandemic fatigue, are confused about the evolving science of COVID-19 and want to resume pre-pandemic activities, providing coherent, consistent and reliable guidance has never been more important.

Reliable guidance includes communicating what constitutes low-risk activities (outdoor events) versus high-risk activities (indoors, confined space and poor ventilation), as well as reminding people to stay home when sick, and continue physical distancing and hand-washing.

3. Surveillance at the local level

Early in this pandemic, the nation was blinded by the number of COVID-19 cases that were brewing in our communities. Fast forward 10 months, and we've learned a lot about this disease and the various indicators that can help track and trace where the virus is spreading.

Each jurisdiction should have surveillance systems in place that track levels of SARS-CoV-2 virus circulation and associated illness before they reach alarming levels.

Consistent data should be collected on outpatient and emergency department visits for influenza-like illnesses and COVID-like illnesses, in addition to the number of new daily cases, tests performed, percent positivity rate, hospitalizations and deaths, among other indicators.

4. Hyper-local response and prioritizing low to high-risk activities

Data that's collected through surveillance systems can help inform local decisions and actions to prevent cases from becoming clusters, clusters from becoming outbreaks and outbreaks from becoming epidemics.

Through a hyper-local response model, pre-set benchmarks and associated actions can be established that prioritize curbing activities that pose the highest risk of transmission in order to contain a local outbreak. This includes looking at outdoors or curbside pickup versus indoor dining, limiting gatherings and closing high-risk nonessential businesses.

5. Testing and contact tracing

The mantra has always been "test, isolate, trace and quarantine."

In order to find cases, there must be an adequate testing infrastructure. States should aim for at least 150 new tests per 100,000 population with associated test positivity rate being below 5%.

There must also be an adequate contact tracing workforce to track and trace additional cases and contacts. The aim should be at least 30 contact tracers per 100,000 people in each state and the ability to scale up if the epidemic expands.

Dr. Syra Madad is a pathogen preparedness expert and infectious disease epidemiologist. She is the senior director of the system-wide special pathogens program at NYC Health + Hospitals.