When will it end?
For all those who are subject to a coronavirus pandemic lockdown order, this is the key question. How long before American life can return to normal, without risking an uncontrollable re-outbreak and crushing hospitals?
The review examines three new reports from the American Enterprise Institute, the Center for American Progress, and the Harvard Safra Center for Ethics.
Although they differ in their conclusions, all three are bleak. In the United States, life will not return to normal until a vaccine is widely distributed and drastic interventions will be needed by then, once restrictions are relaxed, the three conclude.
The three reports call for a national lock-in period, which can only be lifted when certain conditions are met. For the AEI, the restrictions would facilitate state-by-state after a state has registered 14 days of daily decline in the number of new cases.
For CAP, the national lockdown would continue for 45 days, while for Harvard, the most draconian, it would last three months.
The three plans differ in several of their proposals:
- AEI plan: 14-day lockout, capacity for 750,000 tests per week
- CAP plan: 45-day lock, digital surveillance system for contact tracing
- Harvard Plan: three month lockout, millions of daily tests, digital surveillance
The nation’s ability to expand testing to the levels offered by Harvard is unclear – as is the willingness of the American public to accept a massive digital surveillance system that tracks every move.
As serious as it may sound, however, ongoing measures such as these may be the only alternative to a round after round of recurrent closings, if the epidemic re-ignites before a vaccine is available.
Three new reports predict that American life will not return to normal for more than a year, until a vaccine is available. Pictured: Times Square near empty Thursday
Once the restrictions are relaxed, with the reopening of schools and some non-core businesses, the three reports indicate that massive testing would be required, ranging from 750,000 tests per week for the AEI report, to 100 million amazing daily tests in one Harvard White Paper.
The CAP report also proposes a breathtaking national digital surveillance system using cellphone location data to track each person’s potential exposure to known cases.
Such a system, successfully deployed in authoritarian China, would undoubtedly pose difficult questions about privacy and individual freedom.
Although they differ in detail, the commonalities in the three reports are striking.
Until there is a vaccine, gatherings of more than 50 people should be prohibited and remote work should be continued as much as possible, even after the blockages have ended, they all agree.
With a vaccine that is safe and effective at more than a year old at best, it seems clear that American life will not return to normal anytime soon.
AEI: States could ease restrictions one by one after two weeks of new daily cases down
Among the three reports, the models of the conservative AEI think tank are the most optimistic about how quickly restrictions could be relaxed.
The AEI envisions individual states entering one by one into what they call “phase two,” a period in which the requirements for social distancing are relaxed, but not eliminated.
In the second phase, the majority of schools, universities and non-essential businesses could reopen, but homework would still be encouraged wherever possible. The gatherings would be limited to less than 50 people. People over the age of 60 or with health risk factors would still be encouraged to isolate themselves at home.
The report states: “The trigger for a transition to phase II should be when a state reports a sustained reduction in cases for at least 14 days (ie an incubation period); and local hospitals are able to safely treat all patients requiring hospitalization without using crisis care standards.
As an additional condition for phase two, the AEI states that the state should have the ability to test all people with symptoms of COVID-19, as well as the ability to conduct active surveillance of all confirmed cases and their contacts.
The AEI estimates that nationwide, 750,000 tests per week would be required to successfully trace contracts. Pictured: Coronavirus tests are administered in Malibu on Wednesday
This is called “contact tracing” or identifying people who may have been exposed to known cases and ordering them to quarantine for 14 days. The AEI estimates that nationwide, 750,000 tests per week would be required to successfully trace contracts.
Daily tests in the United States peaked at around 225,000 last week, so the AEI estimate seems workable.
The AEI plan calls for rapid tests to be available in clinics and pharmacies, and for a national system of random tests to track the background infection rate in the states and identify the spread in the community.
For people tested positive and their recent contacts, who did not need hospitalization, AEI suggests that “home isolation can be imposed using technologies such as GPS tracking on cell phone applications “
AEI argues that for a state to go to phase two, state hospitals must be able to immediately expand the capacity from 2.8 intensive care beds per 10,000 adults to 5 to 7 beds per 10,000 adults in the context of an epidemic or other emergency.
According to AEI, access to respirators in hospitals should also increase from three per 10,000 adults to a goal of 5 to 7 ventilators per 10,000 adults.
According to the plan, phase two would end when a vaccine is available or when the increase in the number of cases has triggered a return to locking.
Center for American Progress: National cell phone location monitoring system needed to track population before restrictions are relaxed
The recommendations as part of the CAP plan, a leftist think tank founded by Hillary Clinton campaign director John Podesta, are more pessimistic about the risks of breaking out of a lockout.
CAP reports argue that a national home stay policy mandated by the federal government must be instituted “for a minimum of 45 days”.
The report vividly speaks of the dramatic measures taken by the Chinese government to cause the pandemic, where in some cases families have been physically locked in their outside apartments.
“China’s lockdown has successfully suppressed transmission,” says the CAP report. “In China, a two-month lockout has reached near-zero transmission, although the government does not count asymptomatic positive cases. “
In order to enter their version of “phase two”, where the rules of social distancing are relaxed, CAP also calls for generalized tests, randomized surveillance tests and “instant follow-up of contacts”.
The CAP report explains that “instant contact tracing” means a nationwide digital surveillance system that tracks the movements of each citizen using location information from cell phones.
The CAP calls for a nationwide digital surveillance system which tracks the movements of each citizen using cellphone location data (stock image)
“These methods use GPS, Bluetooth, cell phone tower, and Wi-Fi data to determine whether the user’s phone sent the same signals as a COVID-19 individual’s phone during from the same period, “says CAP.
CAP writes with approval South Korea and Singapore, which have used cell phone applications to digitally monitor populations and track the potential exposure of known cases.
“These countries use mobile phone applications or mobile telecommunications infrastructure to notify individuals on their mobile phones through notifications or text messages if they are close to someone who has tested positive for COVID-19 ”, writes CAP.
“The entity hosting the data must be a trusted non-profit organization – not private technology companies or the federal government,” said the think tank. “The app could be developed for a purely public health nonprofit such as the Association of State and Territorial Health Officials (ASTHO) – an organization that represents state health authorities – that would host the data.
CAP suggests that the use of the contact search application be mandatory for anyone wishing to travel by airline.
Any return to a semblance of normalcy will require several restrictions and protections to minimize the risk of transmission of daily operations.
During phase two, the CAP requests the use of cloth masks in public, the ban on gatherings of more than 50 people, a limit of 50% of the capacity of all metros, buses and trains, and a Widespread telework wherever possible.
“Once collective immunity has been obtained through mass vaccination, any remaining restrictions can be lifted,” said the report.
CDC warns the only way for the US to get back to normal is by looking for “aggressive” contacts
The CDC has warned that the only way for the United States to return to normal life is to seek aggressive contact – but it will need an “army of healthcare workers” to be able to do so.
CDC director Robert Redfield said the health agency was working on a plan to get the nation out of the other side of the pandemic and reduce social distancing after the epidemic was brought under control.
This plan involves the search for “very aggressive” contacts, the search for people who have tested positive for the coronavirus and the search for all the people with whom they have been in contact and possibly infected until a chain of entire transmission is found and eliminated.
The country will also need to speed up testing for the virus, said Redfield.
CDC director Robert Redfield said health agency is working on a plan to get the nation out of the other side of the pandemic
“It’s going to be very aggressive – what I call blocking and tackling, blocking and tackling,” Redfield told NPR on Thursday of the emphasis on contact tracing.
However, Redfield warned that the United States will need an “army” of health care workers to be able to search for contacts on the scale necessary to reopen them.
“We are going to need a substantial expansion of public health personnel on the ground and this is going to be critical,” he said.
“We cannot afford to have multiple community epidemics that can turn into sustainable community transmission.”
The CDC has already deployed a SWOT team of around 600 workers across the country to help states prepare for this change.
“We currently have over 600 people on the CDC field in all states trying to help with this response, but we’re going to have to dramatically amplify that,” said Redfield.
Redfield admitted that the federal government will have to write in support of state and local public health services.
He said the plan was “well advanced” but did not disclose details of how the CDC would solve the problem.
“We are definitely in the middle of it all,” he said.
“Obviously, if we are to try to get the nation back to work soon after the end of this month, we are well advanced in this planning process. “
He did not rule out the use of technologies such as cell phone data to track patient contacts, NPR reported.
“People are looking at all of the different modern technologies that could be used to make contact tracing more efficient and effective,” he said.
“Are there more technophile ways to be more complete in the search for contacts? Currently, these things are subject to aggressive evaluation.
Extreme tests: Harvard’s white paper suggests that up to 100 MILLION tests a day may be needed to prevent recurring outbreaks
While reports from the AEI and the CAP say that massive and extensive testing is needed to lift the lockdown restrictions, a Harvard white paper says they don’t go far enough in their projections.
The Harvard paper argues that the estimates of the AEI and the CAP are low “one to three orders of magnitude.”
“Even in the most optimistic scenarios, we have to test millions of people a day to allow a meaningful return to the job market,” write the authors.
“Tens of millions a day seem more likely and more than 100 million may be needed in the worst case,” they continue.
A driver of a vehicle drops his COVID-19 test in a bin on a mobile coronavirus test site in Los Angeles on Friday. Harvard says up to 100 million tests a day may be required
In this worst case scenario, almost a third of the American population would be tested daily for coronavirus – a logistical challenge that seems almost impossible to overcome.
In a separate document from Harvard’s Safran Center for Ethics, it is argued that national blockages must persist for at least three months, until the end of June, in order to have any hope of containing the virus.
Harvard’s plan argues that in order to reduce the risk of repeat lockouts in the fall, a 90-day lockout should be spent building a massive digital surveillance system for contact tracing and the capacity of millions of tests daily, studying immunity in previously infected patients and isolating vulnerable populations.
The document proposes that anyone who proves immunity because of their survival from the virus should be allowed to leave quarantine, provided they volunteer to join a Medical Reserve Corps to fight the pandemic.