Thursday, April 23, 2020

Tired of the COVID-19 Lockdown? Here is a Responsible Reopening Plan

People are getting tired of the COVID-19 lockdown. Surveys show that a majority still put a greater priority on protecting public health than on reopening the economy, but either way, we would all prefer to do both. A plan released yesterday from the Harvard-based Safra Center for Ethics shows that is possible, if we are willing to take the necessary steps.

The Roadmap for Pandemic Resilience (“The Roadmap,” in what follows) is not the first try at finding a way to safely reopen the economy, but it outclasses all previous attempts with its a realistic timetable, fact-based quantitative benchmarks, and a detailed institutional structure. By comparison, the vague guidelines offered by the White House are little more than slogans and aspirations. Here are the key features that distinguish The Roadmap from other reopening plans:

Testing. The White House talks of expanding testing from its current rate of 150,000 or so a day to 300,000. That is barely enough to test people who have severe symptoms, let alone enough to test nonsymptomatic essential workers to make sure they do not spread the virus or to conduct the random surveillance testing we need to know exactly where the virus is (and is not) in our communities. The Roadmap calls for 2 million tests a day, quickly rising to 5 million. Sound like a lot? Those numbers fall only in the middle of a range of credible testing estimates reviewed by the Kaiser Family Foundation, but they are enough if the right people are tested at the right times.

Achieving the needed level of testing is going to require careful coordination of the complex supply chain that produces diagnostic machines, swabs, reagents, and all the other necessary bits and pieces. To coordinate the effort, The Roadmap calls for a Pandemic Testing Board (PSB) at the federal level, akin to the War Production Board that the United States created in World War II. The PSB will need to do more than just manage the supply chain for existing types of tests. Innovation will be needed, both in conventional tests for the virus itself and in serologic testing for markers of immunity.

Supported isolationLike all credible reopening plans, The Roadmap calls for testing to be followed by contract tracing and isolation of individuals who have active infections or have been exposed to the virus. What makes this plan different is its emphasis on supported isolation. To quarantine people must not be to sentence them to economic ruin.

For the essential workers who comprise some 40 percent of the labor force, support during any necessary period of isolation means full sick pay and a guarantee of a job at the end of the quarantine period. Support must also be extended to vulnerable groups like nursing home residents, the incarcerated, and the homeless. For everyone, supported isolation is needed to remove the economic desperation that drives vulnerable individuals to break quarantine and report to work while sick.

Realistic and systematic phase-in. It is easy to talk about a phased opening, but The Roadmap, unlike the White House version, lays out the phases in detail:
  • Phase 1: Slow the spread, build pandemic resilience, and mobilize essential workers safely. This should begin immediately and require about two months. Its focus is on expanding testing to 2 million per day to cover the entire essential workforce, and to make sure there are enough temporary replacements for essential workers who are found to need a period of isolation. During this phase the Pandemic Testing Board and related structures will begin their work. At the end of this phase, from 40 to 55 percent of the labor force should be back on the job.
  • Phase 2: Expand the definition of “essential” and begin relaxation of collective social distancing orders. During this phase, which should require another month or so, testing capacity should grow to about 5 million per day, with appropriate follow-up in the form of tracing and supported isolation as needed. Universal social distancing can be eased, but vulnerable populations will need to be cautious about re-entering the community. At the end of this phase, about 70 percent of the labor force should be back on the job. Those who can telecommute would continue to do so.
  • Phase 3: End the economic misery of collective stay-at-home orders. By the end of this phase, 80 percent of the workforce should be back on the job. Support structures should be in place to allow vulnerable communities to relax their degree of social distancing.
  • Phase 4: Fully mobilize the pandemic-resilient economy and stay open. Reintegrate the remaining workers into the economy, including those telecommuters who wish to return to their offices. Reopen schools. Continue vigilant testing and monitoring in order to identify and contain any outbreaks that may emerge.
Does all this sound expensive? You bet. But the cost of such a testing and tracing program — $50–500 billion over two years — would be dwarfed by the economic cost of continued collective quarantine, estimated at $100–350 billion per month. The cost would also be insignificant in comparison with the loss of tens of thousands of lives if premature reopening led to a second spike in infections.

Will the public buy it? In a recent Morning Consult poll, 81 percent of respondents chose “Americans should continue to social distance for as long as is needed to curb the spread of coronavirus even if it means continued damage to the economy” compared to just 10 percent who said “Americans should stop social distancing to stimulate the economy even if it means increasing the spread of coronavirus.”

Will Congress buy it? Will the president? They will if they hear from you. If you are in the 81 percent, don’t let the noisy demonstrations of the 10 percent drown out your voice. Let the political establishment know: You are tired of the COVID lockdown AND you want to end it the right way.

Previously pubished at  Photo courtesy of