Most states have now implemented some form of stay-at-home order in an attempt to stop the spread of COVID-19. As a result of this broad social distancing policy, economic output has fallen sharply, causing great hardship for many Americans
To begin the long climb back to an active economy, open schools, and a sense of normal life without reigniting another wave of the outbreak, we must start to build the information and response systems necessary to sustain a different public health strategy: targeted social distancing. At local, state, and federal levels, we need the ability to rapidly identify emerging hot spots and infected individuals, and to appropriately place the respective individuals and their direct contacts — sometimes perhaps even entire communities and neighborhoods —– into protective self-isolation. This strategy also puts great focus on protecting all high-risk people, the elderly, and chronic patients with comorbidities.
As part of this new approach, we must implement rapid testing at scale, including for people with no symptoms. This is the common element in all countries that have been able to manage and limit the impact of the COVID-19 virus, such as South Korea and Germany. It must become an urgent national priority to apply all available industry and academic capabilities in this effort and to remove even the smallest inappropriate regulatory barrier to building large-scale rapid-testing infrastructure.
Current experience from countries like South Korea and Israel underlines the importance of targeted intelligence and even surveillance (with appropriate safeguards) that integrates data from a national testing program with many other data sources. Every single necessary piece of technology and all required data-analytic tools already exist to do this — in fact, most are already available at scale within the private sector.
For example, American companies already collect and even sometimes publish extremely valuable data, such as the number of people with COVID-19 symptoms in each zip code and population mobility across neighborhoods and communities. However, these data need to be integrated into actionable intelligence to get us ahead of the outbreak. The federal government should immediately put together an interagency unit that engages industry and academic expertise to build intelligence capability needed to win the battle over COVID-19.
Aside from broad testing and targeted integrated intelligence, the entire population must be continuously engaged regarding best practices to reduce community infection rates. To help minimize the virus spread, appropriate personal protective equipment and public infrastructure must be made available at scale — at affordable prices — to all members of the public. These include subsidized masks, for those who can’t afford market rates, and infrastructure such as screening for fever at the entrance of malls and other sites of public gathering.
Equally important is protecting and caring for high-risk individuals — every one of them. Unlike the traditional paradigm of the US health system, which puts the focus on care in hospitals and clinics, the post-coronavirus world requires a shift to maximum remote home health management using telehealth systems, implying the development of new processes and skills.
The COVID-19 outbreak forced the US health system to rapidly deliver remote care through a variety of telehealth systems. This forced experiment should be leveraged to ensure that no one at risk has to unnecessarily jeopardize themselves or other members of the community when attempting to see a doctor in person or by going to grocery stores and pharmacies.
A new approach to public health, based on targeted social distancing, commits us collectively and as individuals to significant investments, hard work, and major behavioral changes. The idea of being tracked and advised (or even directed) to follow certain practices stands in stark contrast to what many people regard as the most precious elements of American values.
To be clear, we might still get lucky — for example with a vaccine or other speedy medical breakthroughs. However, to bet only on this over the coming months would be unwise. Absent such amazing good fortune, and without the ability to practice targeted social distancing, we are like to be in repeated damaging cycles of closing-reopening-closing.
Building effective targeted social distancing would create a dimension of resilience that the country desperately needs. So while we hope for a soon-to-be-found vaccine, we have to find a thoughtful way, a careful way, to make these hard choices, and do what it takes, immediately.
Simon Johnson and Retsef Levi are cochairs of the COVID-19 Policy Alliance and professors at MIT’s Sloan School of Management.
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