The flailing response to the new coronavirus pandemic has taken a potentially dangerous turn: US president Donald Trump and his top advisers are publicly musing about soon reopening businesses and allowing public gatherings.
These considerations are over the objections of public health officials who fear that unless the spread of the novel coronavirus—which causes the disease known as Covid-19—is slowed, the US health system will be overwhelmed. Serious Covid-19 cases can require weeks of hospital care and the use of mechanical ventilators, forcing hospitals to ration care not just for those suffering from the disease but everyone else who is sick or injured as well.
But the choice between reopening the US economy and protecting the health of the country’s citizens is not one the government needs to make. The latter, in fact, would allow for the former. There’s plenty of evidence that an aggressive public health program would enable the US to begin re-starting the economy without exacerbating the spread of the illness.
While the US federal government has repeatedly been slow to implement the kind of swift and large-scale responses that have worked to “flatten the curve” in countries like Japan and South Korea, allowing their economies some room to breath, it’s not altogether too late. Here are the steps the US needs to take now to get people back to work.
The US has already missed the chance to stop community spread of the disease, but doctors say isolating clusters of the disease from the general population is still key to slowing its spread. While it is still too early to draw broad conclusions from what so far has been limited testing, the difference between the Bay Area in California and New York City is still instructive: On March 16, when the two metros had 300 and 450 cases respectively, the Californians received stay-at-home orders. New Yorkers waited four more days. Today, there are just over 1,000 cases in the Bay Area, and NYC has more than 17,850.
Unfortunately, many US states, even those with growing outbreaks like Louisiana and Georgia, are not taking these steps.
With the disease now spreading within the community, the critical task is separating the infected from the healthy, but there is only one way to do that: Test people to see if they are carrying the virus, which is different from an immunity test we’ll talk about later.
South Korea has been a leader in this, and is now manufacturing 100,000 test kits a day. In the US, hospitals around the country have more people reporting symptoms than they can test—and the even bigger problem is detecting people who are carrying the virus without symptoms.
By figuring out who is healthy and who is not, smart decisions can be made about who can go to work and who should be isolated. In South Korea, testing takes place at drive-through sites and special hospital booths. There’s also widespread temperature checks, with thermal cameras and thermometers, at public buildings and restaurants.
The US has tested between 80,000 and 350,000 people so far—the lack of a concrete number is indicative of the disorganized response—but epidemiologists say we need to be testing more than 100,000 people a day to effectively track the disease.
The US doesn’t have the tests to do that right now. So far, the Trump administration has not relieved test shortages at hospitals and has yet to use the Defense Production Act to compel private companies to help. On Tuesday, the Federal Emergency Management Agency said it would use the law to produce 60,000 test kits, but abruptly reversed its decision, saying it was able to obtain them without coercion. Yet there is still a massive shortage of this key tool that would give pandemic fighters the information they desperately need about their foe.
At least some private companies are working on solutions, with Amazon piloting a home-delivered test system in Seattle.
If the US can get a handle on who is infected and where, we can start using tried-and-true epidemic fighting techniques to figure out who they may have infected, and isolate them. In some places where the virus is widespread, it may be too late for tracing efforts to prevent the need for extreme social isolation.
But other cities, earlier in the curve, could benefit from a comprehensive tracing effort, allowing them to avoid full-scale sheltering in place by cutting off clusters of infected people from the general populace. “South Korea is a democratic republic; we feel a lockdown is not a reasonable choice,” Kim Woo-Joo, an infectious disease specialist at Korea University, told Nature.
That’s likely to mean legwork, and may require hiring more public health workers. There are also increasingly high-tech—and perhaps ethically dubious—means to do so. Eleven countries, ranging from South Korea to Israel, are using mobile phone location data to figure out where infected people have been, and then using that data to identify others who may have been exposed to the virus. The civil liberties implications are worrying, but the rapid roll-out of this technology is a reminder that private business already has access to much of this data, and may be an opportunity to think hard about how it should be used.
The logic of social distancing is simply that most countries don’t have the medical equipment necessary to handle so many ill patients at once, so the best way to avoid rationing care is to keep the number of cases manageable. Another response is to increase the capacity at hospitals so that high infection rates don’t lead to unbearable stress on the health care system. In New York City, now the global hot spot for the disease, a convention center is being converted into a 1,000-bed hospital for non-Covid-19 patients. New York University is allowing final-year medical students to graduate early and the state is calling for retired health care workers to come back to work.
Still, key supplies are missing, particularly mechanical ventilators and personal protective equipment like masks, face shields and gowns. So far, the government has relied on voluntary efforts in the private sector to increase access to those supplies, but it will take months to get the more complex products flowing out of factories.
This is perhaps the most important step toward normalcy: Figuring out who is immune to Covid-19 after recovering from an infection.
That requires a different kind of test from the ones used to see if the virus is present in your body. With these tests, your blood is examined for the antibodies your immune system has created to fight off the virus. Some physicians are already using laboratory versions of these tests in an effort to treat sick patients with blood transfusions from recovered patients, in the hope that the antibodies will help the suffering patient recover. But in the long-term, a more reliable version of the test that can be administered on a large scale will allow public health authorities to determine who can safely go back to work.
The world won’t be done fighting coronavirus this year, or likely next. Researchers say that a safe vaccine won’t be available until 2021. And therapeutic treatments that make it easier for victims to survive the virus will also take time to be developed and proven in clinical trials. In the meantime, it’s going to take repeated applications of a combination of the above tools to keep dealing with flare-ups of the disease. The sooner that we recognize the breadth of the challenge, the more manageable those flare-ups will become.