How do we get out of this coronavirus pandemic nightmare? A new paper suggests the road we should take and the signposts we should look for on the way.
The 20-page report, published on the American Enterprise Institute website, comes from a group of public health experts led by former US Food and Drug Administration commissioner Scott Gottlieb. Gottlieb, now a fellow at AEI, is one of the experts on the advisory group guiding Massachusetts Governor Charlie Baker.
“What I wanted to do with this was set out very clear measurable milestones and very clear objectives of what can improve when those milestones are reached,” he told STAT. “And give people something to shoot at. Because I think that reports that aren’t very granular aren’t very useful.”
The report envisions four phases:
Phase I is the current phase, when the pandemic is growing, there is community transmission in every state and social distancing measures are in place, causing massive disruption to everyday life. “These measures will need to be in place in each state until transmission has measurably slowed down and health infrastructure can be scaled up to safely manage the outbreak and care for the sick,” the report said.
In Phase II, schools and businesses can reopen, and much of normal life can begin to resume “in a phased approach,” but there will still be various restrictions, the report said. In Phase III, with widespread testing and a vaccine or a treatment available, physical distancing and other restrictions can be lifted. In Phase IV, the authors recommend, we should prepare for the next pandemic.
For many cooped-up people now, the biggest question is how we get from Phase 1 to Phase 2. The report suggests the signposts that will indicate when it’s safe to move to Phase 2.
“To guard against the risk that large outbreaks or epidemic spread could reignite once we lift our initial efforts to ‘slow the spread,’ the trigger for a move to Phase II should be when a state reports a sustained reduction in cases for at least 14 days (i.e., one incubation period); and local hospitals are safely able to treat all patients requiring hospitalization without resorting to crisis standards of care; and the capacity exists in the state to test all people with COVID-19 symptoms, along with state capacity to conduct active monitoring of all confirmed cases and their contacts," the report said.
When we do get to Phase 2, life still won’t be the same, the report suggested.
Schools and businesses will reopen, but some physical distancing measures and limitations on gatherings will still need to be in place, the report said. People over 60, people with underlying conditions, and other high-risk populations will still be advised to “limit their time in the community.”
The report also recommends improvement in public hygiene, with “deep cleanings on shared spaces" becoming more routine. While the work of identifying and isolating infected people and their contacts would continue, “the public will initially be asked to limit gatherings, and people will initially be asked to wear fabric nonmedical face masks while in the community to reduce their risk of asymptomatic spread.”
“Those who are sick will be asked to stay home and seek testing for COVID-19. Testing should become more widespread and routine as point-of-care diagnostics are fully deployed in doctors’ offices,” the report said.
As for Phase 3? “Once a robust surveillance sentinel system is in place, coupled with widespread point-of-care testing and a robust ability to implement tracing, isolation, and quarantines—and this is supported by the availability of therapeutics that can help mitigate the risk of spread or reduce serious outcomes in those with infections—or alternatively a vaccine has been developed and tested for safety and efficacy, we can enter Phase III,” the report said.
“Physical distancing restrictions and other Phase II measures can be lifted when safe and effective tools for mitigating the risk of COVID-19 are available,” the report said.
In Phase 4, it will be time to gird ourselves for the next pandemic, the report said. “After we successfully defeat COVID-19, we must ensure that America is never again unprepared to face a new infectious disease threat. This will require investment into research and development initiatives, expansion of public-health and health care infrastructure and workforce, and clear governance structures to execute strong preparedness plans,” the report said.
But we’ve still got a ways to go. Coauthor Caitlin Rivers, an assistant professor of epidemiology at the Johns Hopkins Center for Health Security, told STAT that Phase 1 wouldn’t be ending soon.
“I don’t think we are close to moving out of Phase 1,” she said. “I think staying home is what we need to be doing right now. And how fast we get to Phase 2 will really depend on how effective our interventions are now and how aggressively we are able to scale up our capacities.”
Ezekiel Emanuel, a health policy expert and vice-provost of the University of Pennsylvania, in an op-ed piece in The New York Times offered a slew of recommendations for fighting the pandemic, saying it could allow the country to slowly begin reopening in June.
His recommendations included: a nationwide shelter-in-place or quarantine for the next 8 to 10 weeks, with possible exceptions in some less-affected counties; increased testing both for infections and for immunity during the quarantine; preparation by hospitals during the quarantine; increased contact tracing; and a mass education program so people develop better hygiene habits.
Once the steps are taken, he envisioned that we could “slowly open up parts of the economy in June" and described a phased approach to reopening.
“This is not a perfect solution. It is a middle course that can save lives and save the economy,” he said.
Martin finucane can be reached at firstname.lastname@example.org.