Dr. Mark McClellan MD, PhD and the director of the Duke Margolis Center for Health Policy co-authored with several other experts, a roadmap to re-open the US economy a few weeks ago. It is predicated on looking at evidence, and checking capabilities for testing, surveillance and public health. It had four basic stages:
- Control the Spread (we are here right now)
- Limited re-opening with massive surveillance
- Deployment of therapeutics and vaccines to return to normal-ish
- Prepare for the next pandemic
The writing team laid out a fairly clear set of criteria for a region to move from Phase 1 to Phase 2:
Trigger for Moving to Phase II
A state can safely proceed to Phase II when it has achieved all the following:
• A sustained reduction in cases for at least 14 days,
• Hospitals in the state are safely able to treat all patients requiring hospitalization without resorting to crisis standards of care,
• The state is able to test all people with COVID-19 symptoms, and
• The state is able to conduct active monitoring of confirmed cases and their contacts.
That means a state has a clear peak and a very steady decline. States may go with a smoothing function for a decline as there seems to be strong day of the week seasonality on reporting (Saturday-Monday is light, Wednesday is a local peak of reported cases) or they can require fourteen continual days of decline where each day has a lower case count than the previous day. It means the healthcare system is near normal with nurses, doctors, aides, and cleaning staff all having appropriate protective gear. It means there is a robust testing regime in place that can quickly smother any local flare-ups by rapidly identifying and isolating anyone who was in contact with an infectious individual. It means a lot is in place with a lot of planning and preparation having occurred and then a competently executed public health campaign. If there are failure points in testing, tracing and isolation, the state or a region can flip back to Phase 1 of shutting down to stomp down on the reproductive rate again.
Now the relevant question is: Has Georgia, South Carolina, Florida, Tennessee met any of these criteria?
The answer would be, no.
I believe those states have decided that mostly black and brown and “unproductive” old people are going to die from this and they are willing to lose those people.
@Princess: Probably “eager” rather than “willing”.
I was tempted to use a row of laughing emojis, but this really isn’t funny.
I’ll also note that a day after Trump issued the guidelines with a vague 14-day criteria, he issued his “LIBERATE” tweets.
I think Princess has hit upon the true answer. The press and powers-that-be take the concerns of a small amount of white men 100x more seriously than they take the concerns of anyone else. That’s why the coverage of these extremely small demonstrations is all out of proportion to their actual importance.
Even up heah in the Commonwealth, we had “protesters” at the Bourne Rotary, demanding that Cape Cod be reopened.
It will be interesting to see where those yahoos are in, say, 14 days.
Huh. This is an American Enterprise Institute paper?
@Princess: I think this has been a conclusion looking at the death statistics of last month. Of course, how this will work in the coming months as this disease spreads out to predominately white rural areas and exurbs will be interesting. Puts a whole new emphasis on the phrase of “dying for whiteness.”
Any plan should have a clever exploit of the fact that the virus is not nearly as dangerous for the young. Here in Quebec less than 1 percent of the dead are under 50.
Give ’em 21 days. What’s the odds the answer involves empty fields, backhoes & lime (of the inorganic variety)?
To call those clowns “assholes” is to malign a hardworking & essential part of the body.
Harvard has it own “bi-partisan” plan, animated here by Vi Hart, one of the authors.
The requirements for reopening aren’t independent. If a state has a sustained drop in the # of new cases, you still need to have the testing and contacts tracing infrastructure suitable for testing *all of those new cases, and their contacts, every day*.
For example, Georgia has about 600 new cases every day (WaPo), so a requirement would be that the number is really dropping across a 2 week period, *and* that Georgia can actually do a good job contact tracing those 600 new cases, and testing the probably close to 6000 contacts.
Now, Georgia is nowhere near a two week sustained drop in new cases (the last increase in cases occurred from 4/20-4/21), and I’m also skeptical that Georgia has the contact tracing and testing infrastructure to track the contacts of 600 cases every day — I’d have to imagine that would require locating and testing at least 6000 people per day.
@Pittsburgh Mike: Assume on average at least 40 unique contacts would need to be traced per infected individual.
He missed the most important first step:
A demonstrated commitment to expand and report on testing for everyone AND mandated quarantining AND mandatory electronic monitoring
If the states are allowed to only test those with symptoms, they are free to cover up unreported cases and deaths. We are already deep into a systematic cover up of cases to cover up the incompetence of the Hot Orange Mess in the WH. And to spread disinformation about the public’s relative safety. All so a bunch of privileged assholes can order their employees back to work and then deny them unemployment if they can’t or don’t want to go back to a plague factory.
I do not think that ANY of our states is ready with a testing and isolation regime…see the comments of John Cochrane of Stanford..
“We will need a robust public health response, to keep a small number of cases from ballooning, and allow the economy to open. We will need the response we should have had in January. “Testing” is one of many inputs to that response. But “testing” is not the response itself. An effective public health response needs a detailed, competent bureaucracy, temporary relief from thousands of privacy regulations — and swift assurance that those privacies are reinstated when it’s over — and enforcement in order to something useful with the tests. I doubt Americans will put up with the enforcement. I doubt our government has the capacity to put them to that test. ”
We could wait 5 years for a full testing regime. So we will have to end the lockdowns knowing that in mind.