Gottlieb’s trigger for reopening businesses: When cases in your state have declined for two straight weeks

Not even then, really, but that’s the most basic prerequisite. It’s common sense. Why would we want people mingling again before we’re positive that the virus is no longer spreading aggressively? Gotta make sure the fire is (mostly) out before we start putting gasoline back into the economy. Watch, then read on.

Gottlieb and his colleagues at AEI published a plan yesterday for how and when states should consider relaxing social distancing practices and letting people go back to work. Its official title is “National coronavirus response: A road map to reopening” but we can think of it as “A roadmap to turning the U.S. into South Korea.” A two-week decline in cases is the foremost requirement — and in a way, it’s the easy part. Cases in New York are projected to peak as soon as 10 days from now. Conceivably NYC will have seen two weeks of declining case numbers by the fourth week of April.

The next trigger, being able to rapidly test anyone with symptoms, also seems feasible. Gottlieb and his team believe that once the entire U.S. is able to test 750,000 people per week, we’ll have the threshold capacity we need to test everyone who needs testing. By my count, we tested a bit more than 600,000 people last week. We’re getting there. As he says in the clip, the main impediment in testing right now isn’t the tests themselves or the labs required to perform them, it’s basic tools like swabs for taking samples.

The third trigger for reopening is making sure that local hospitals are “safely able to treat all patients requiring hospitalization without resorting to crisis standards of care.” That … may take a little longer than two weeks after peak cases in New York, although maybe not in a place like Seattle that acted early to keep people from gathering together and is now reaping the benefits in the form of a health-care system that hasn’t (yet) been overloaded. Any state following Gottlieb’s guidelines thus has an incentive to institute social distancing early. The sooner you do it, the less of a crush at the hospitals, the sooner you can get back to work. Plus, according to a new survey of economic experts, it’s good for the local economy in the long run:

We already sort of knew that but it’s nice to have expert opinion aligned with empirical data.

So then: Two weeks of declining cases and enough tests to cover every new patient with symptoms and an end to the crush in hospitals. It seems plausible that states like New York that are climbing the proverbial curve right now and/or states that shut down early to head off a major outbreak could meet those conditions before June. States that acted more slowly, perhaps not. But there’s another trigger for ending lockdowns that Gottlieb’s plan mentions. This one seems dodgier to me:

Implement Comprehensive COVID-19 Surveillance Systems. The move toward less restrictive physical distancing could precipitate another period of acceleration in case counts. Careful surveillance will be needed to monitor trends in incidence. A high-performing disease surveillance system should be established that leverages:

1. Widespread and rapid testing at the point of care using cheaper, accessible, and sensitive point-of-care diagnostic tools that are authorized by the Food and Drug Administration (FDA);

2. Serological testing to gauge background rates of exposure and immunity to inform public-health decision-making about the level of population-based mitigation required to prevent continued spread in the setting of an outbreak; and

3. A comprehensive national sentinel surveillance system, supported by and coordinated with local public-health systems and health care providers, to track the background rate of infection across states and identify community spread while an outbreak is still small and at a stage in which case-based interventions can prevent a larger outbreak.

ILINet, the surveillance system for influenza-like illness in the United States, is a potential model for SARS-CoV-2 surveillance.

Medical professionals, are we capable of putting a system like that in place soon-ish? Rapid point-of-care testing is just getting going, but Abbott announced last week that it’s developed a test that can identify COVID-19 infections within five minutes and is planning to roll out five million per month for use in doctor’s offices. If they’re good for that, and if their testing machines are in wide enough use, that would meet Gottlieb’s target of 750,000 tests per week. Serological testing is also in the works; a biotech company is hoping to test everyone in Telluride, Colorado, to see how many have been infected, a model that could be expanded if it’s successful.

What about a “comprehensive national sentinel surveillance system,” though? That sounds like … an undertaking, as does Gottlieb’s team calling for authorities to “massively scale contact tracing and isolation and quarantine.” They want the feds to use smartphone GPS to make sure people diagnosed with coronavirus are staying home, in isolation, and they want a “surge” in the existing public-health workforce to trace the contacts of each new infected person and make sure those people are in self-quarantine for 14 days too. That’s exactly what South Korea is doing, and the feds are already looking at smartphone data that tracks movements. But building a bureaucracy to do the sort of contact tracing we need at the scale we need feels like something that’s not going to be done in a matter of months. What’s the plan for reopening if local health bureaus just can’t pull this together by June?

One more thing. In order to prevent entire families from being infected by one sick member, they want infected people to have the option of quarantining away from home. Where, though? Hotels are going to want to use their rooms to get back to business once they’ve reopened. And even if they have vacancies, they won’t want guests to know there are coronavirus patients in the building.

If all of this is achievable and achieved, we’ll essentially have rebooted our system for coping with epidemics on the South Korean model. We screwed it up in the first days of the outbreak by not testing enough; now we’re locked down to deny the virus fuel while it burns itself out. Once the flames are mostly extinguished, then we reemerge, supposedly, into a new South Korean reality — tons of testing, sustained surveillance of the sick, no hospital meltdowns, no mass lockdowns, everyone wearing masks in public (another wise recommendation from Gottlieb and company), and judicious application of more modest social distancing measures while we bide our time for a vaccine to arrive.

If we can pull off the reboot, we can even move to a stage Germany is already approaching, one where people who have tested positive and recovered are given certificates validating their immunity and freeing them up to return to the work force early. That’s the only silver lining in getting COVID-19: If you survive, in theory you should be free from the strictures the rest of us are coping with. You passed your trial by fire. You get your certificate and you’re done.

Is all of this actually doable? It’s above my pay grade. From Gottlieb’s perspective, though, maybe it’s enough for now to help people understand why the feds are delaying on reopening. There is a strategy here; there are things that can be done to reopen for business in a safe-ish way; but it’s not a two-week fix. Not a two-month fix for some places either, I’d guess.

Here’s Governor Blackface in Virginia issuing a stay-at-home order for the state through … June 10th. Why so long? Play it by ear and reassess every two or three weeks.

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