We are a physician-led grassroots coalition and we are gravely concerned. We stare at the Massachusetts daily public health indicators in disbelief. We are witnessing uncontrolled community spread, despite ample warning, after enduring the first surge in the spring. And this time, it may be even worse. The number of new daily COVID-19 cases, patients in the hospital, and deaths are about twice as high as last month. The most reliable indicator of infection rates, wastewater levels, is much higher now than in April, and levels are still heading straight up. Elective inpatient procedures have been canceled to free up hospital beds. We cannot overstate the direness of the situation.

On December 4, 2020, the CDC (Centers for Disease Control and Prevention) published steps to curb the spread of COVID-19. As detailed below, Massachusetts is doing well in implementing some of these steps but is failing in others. Current Massachusetts regulations are not enough. We urge Governor Baker to immediately adopt the CDC guidelines and act to stop the spread. We are at risk of our healthcare system becoming overwhelmed. We need to do better immediately.

1. Avoiding nonessential indoor spaces and crowded outdoor settings. The CDC states, "Indoor venues, where distancing is not maintained and consistent use of face masks is not possible (e.g., restaurant dining), have been identified as particularly high-risk scenarios.” Massachusetts is failing in this area. We must immediately close casinos and bars, and limit dining and restaurant service to outdoor or takeout only. All gym patrons must be required to wear masks at all times. Allowing indoor entertainment to continue while hospitals restrict medical services is unacceptable. Support must be in place to ensure that workers are able to feed their families and maintain their housing while businesses are limited or closed for safety. Even with limited federal funds, Massachusetts can take actions that will benefit both public health and the economy.

2. Increased testing, diagnosis, and isolation. Our current test positivity rate is greater than 5%. Although test capacity is increasing, we need to do much more to contain the virus. Workers from temporarily shuttered industries could be retrained to serve in roles supporting public health. Paid sick leave is needed to incentivize testing and staying home when ill.

3. Prompt case investigation and contact tracing to identify, quarantine, and test close contacts. Massachusetts has an excellent contact tracing system, but it is over capacity. Additional contact tracers could be hired from within hard-hit communities, and should include people of diverse backgrounds with fluency in languages other than English.

4. Safeguarding persons most at risk for severe illness or death. Ensuring regular testing and robust personal protective equipment (PPE) for workers and residents in congregate living facilities is paramount. Nursing homes are a particularly important setting, because outbreaks and deaths continue despite current regulations.

5. Protecting essential workers. Access to regular testing, robust PPE supplies, and paid sick leave are needed for essential workers.

6. Postponing travel. Massachusetts’ current travel rules are difficult to enforce. Our student population of over 100,000 young adults-- the age group with the most infections and an extremely high rate of asymptomatic transmission—have traveled or will soon travel home for the winter holidays. For their own safety and the safety of our communities, students who leave Massachusetts for the holidays should not return in person until the second surge is controlled.

7. Increased room air ventilation, enhanced hand hygiene, and cleaning and disinfection. Businesses unable to comply with ventilation and hygiene requirements should temporarily close.

8. Physical distancing and limiting contacts. The CDC states, “Close physical contact, shared meals, and being in enclosed spaces have all been associated with an increased infection risk.” Current MA guidance applies only to personal settings. Guidance should be consistent across both personal and business settings.

9. Universal use of face masks. Massachusetts has a mask mandate and generally high compliance. This has led to low transmission in schools and daycares. Non-essential indoor activities where masks cannot be worn should close immediately.

10. Widespread availability and use of effective vaccines. Massachusetts has a plan for phased vaccine distribution based on principles of risk and equity. Current vaccines appear to be very safe and better than 90 percent effective.

The prospect of having widely available vaccines that could effectively control COVID-19 within the next year makes enacting public health measures now even more critical, as we can see the finish line. We urge our fellow Massachusetts citizens to heed the guidelines above and we call on our elected and appointed leaders to implement all other necessary measures to protect the health of its citizens. If we can work together to prevent transmission for a few more months, thousands more Massachusetts residents will stay alive. More than 500 residents died last week— more than double the week before. How many more people need to die before we act? We are running out of time.

The COVID-19 Action Coalition: Rebecca Perkins, MD, MSc, Co-Founder, COVAC; Sushama Scalera, MD, emergency physician, Vice President of COVAC; Laura Hagopian, MD, emergency physician, Senior Director of Operations, COVAC; Elana Pearl Ben-Joseph, MD, MPH, pediatrician, Executive Director of Communications for COVAC; Suzie Bertisch, MD, MPH, sleep medicine physician, and clinical researcher, Executive Director of Strategy for COVAC; Elissa M Schechter-Perkins, MD, MPH, is an emergency medicine physician, Executive Director of Advocacy for COVAC; Susanna Huh, MD, MPH pediatric gastroenterologist, Co-Founder/President of COVAC; Christopher Garofalo, MD, Family Medicine physician, Co-Lead COVAC Detect and Protect Team; Leah Schafer, MD, radiologist, Co-Lead COVAC PPE Team.

The views expressed in this article are the authors’ own and do not reflect the official opinions of the institutions at which they work. The COVID-19 Action Coalition (COVAC) is a Massachusetts-based physician-led, grassroots non-profit that advocates for evidence-based public health practices.