Right now, the overwhelming emphasis to combat the COVID-19 pandemic is appropriately placed on testing for the virus, protecting those who are most susceptible, treating the sick, and flattening the pandemic peak. Tremendous leadership, innovation, and dedication to containing the disease across each of these areas continues to evolve.
However, the threat by COVID-19 is not restricted to our health and health care systems. Confining millions of people to their homes forces a dramatic shift in social norms, strains public morale, and forecasts an exaggerated economic divide between those who are poor and those who are wealthy. Given that social distancing is currently the only available solution to contain and slow disease transmission, the next stage of our battle against this pandemic must also be anticipated and addressed: a well-designed system of recovery to attenuate the impending wealth gap and support workers. There is a medical approach that can help.
Managing the recovery curve begins with deliberate screening of individuals who have fully recuperated from known or presumed COVID-19, are demonstrably infection-free (namely, two or more negative viral tests, each at least 24 hours apart), and develop documented immunity. Protocols should be established to rapidly test not only for the presence of the virus but also for acquired immunity in those who now appear to be healthy post-infection. These antibody tests for immunity are becoming available both nationally and internationally. Once identified, those who are no longer infectious and also carry immunity through measurable antibodies can return to the workforce. Stemming the economic tide and resuming social norms, step by step, can help mitigate the repercussions for our society including the severe negative economic, cultural, and emotional impacts of the pandemic that are yet to come.
There is historic precedent for dealing with pandemics effectively by mobilizing the first wave of infected people who have fully recovered and are no longer contagious. Long before the existence of vaccines, antibiotics, blood tests, and personal protective equipment (PPE), those who survived dreaded diseases like the bubonic plague took care of those who were actively suffering from the infection.
Similarly, the first wave of recovered COVID-19 individuals who carry serologically proven immunity (i.e., protective antibodies) can be at the forefront of reinvigorating key jobs. These roles can range from essential health services to small businesses and may require retraining and redeployment.
An analogy to war, as suggested by many, is accurate in the modern era only if one recognizes that effective advances on the battlefronts were synchronized with recovery, rebuilding, and workforce retraining on the home front. During the height of World War II, for example, this construct was epitomized by sayings like “Keep the home fires burning” and embodied in the character of Rosie the Riveter. Those who have recovered can begin to restore our society’s productivity and help care for those who remain at risk for or are fighting the infection. We are not implying that this is easy or straightforward. We are saying that approaches and systems to facilitate recovery must be considered with the same vigor to protect our economically vulnerable as is being applied to protect the medically vulnerable amongst us.
Recovery must be employed in concert with prevention and treatment. Solely flattening the pandemic curve while ignoring the additional long-term impact on society, particularly for those most economically vulnerable, will be devastating. Our health care systems, in concert with state and federal government agencies, must institute rigorous procedures to follow up with suspected and known infected individuals who have fully recovered and must employ both viral and immune testing.
As in wartime, empowering and supporting one another through this pandemic and its impending aftermath is critical. To do so requires both flattening the infectious curve to maximize our collective health and initiating the recovery curve to maximize our societal and economic well-being.
Rebuilding our communities together requires a proactive strategy. Just as viral testing should have been adopted early and often, we must follow up now with monitoring for both viral clearing and established immunity and put in place systems to identify and mobilize healthy workers who have recovered from COVID-19.
Dr. Mark C. Poznansky is director of the Vaccine and Immunotherapy Center at Massachusetts General Hospital, and infectious diseases physician and associate professor of medicine at Harvard Medical School. Dr. Jacqueline A. Hart is director of the Bassuk Center on Homeless and Vulnerable Children, Families, and Youth.
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