Reopening - The Missing Piece

I wanted a credible government source for a model of how continued social distancing vs opening the nation looks. The above chart, generated by the UK’s National Health Service, tells us what should be obvious: the more we practice social distancing – until there is a cure or a vaccine – the faster we end this. Pressures to open early pose an immediate threat to ignite second or more waves of the virus, a lesson we should have learned from the 1918-20 killer Spanish Flu debacle (which killed around 675,000 Americans, and well over 50 million worldwide).

Without that cure or prevention, highly contagious pandemics do not dissipate in a couple of months. For those unwilling to practice common sense social distancing, remember that the virus does not recognize state of national borders or follow human wishes. Politicians are under pressure to open and resume to normality, so even the most responsible governors are loath to project a true timeline; they seldom go more than a month or so in their self-limiting requirements. The President, who has always prioritized the economy over health – from supporting litigation to kill the Affordable Care Act because it would impose new financial burdens on business to a belief that the damage to the economy could be far worse than the toll of COVID-19 – made it clear than any longer term imposition of social distancing that did not reopen the economy in a relatively short time was “unsustainable.”

We also face two longer term realities: First, we need to adjust to a real, economically and socially reconfigured post-COVID-19 world. Second, given the rash of recent serious outbreaks (COVID-19, SARS, MERS, Ebola, HIV, Zika, H1N1, cholera), this is not the last pandemic. We will have exhausted massive resources in our COVID-19 war, which will put pressure on limiting our future preparedness (which absolutely includes the pandemic-accelerator, climate change), but failure to prepare for the next outbreak could be fatal, even politically terminal.

“President Trump announced new federal guidelines on Thursday [4/16] for the easing of social distancing orders put in place to slow the spread of the coronavirus, leaving their implementation and timing up to state governors. At first glance, the three-phase guidelines seem unlikely to alter the ‘new-normal’ routine for many Americans.

“At a White House briefing of the coronavirus task force, Trump said government experts believe that the peak of new COVID-19 cases ‘has been flattened.’ [It has only in certain states and not otherwise.] As a result, Trump said his new guidelines ‘will allow governors to take a phased and deliberate approach to reopening their individual states.’

“The deference to state governors comes days after Trump boasted that his ‘authority is total’ on the question of reopening the country. But the president also made clear that he wanted a quick return to normal life.

“While Trump painted an optimistic picture of his administration’s efforts to curb the spread of COVID-19, his health experts — Dr. Deborah Birx and Dr. Anthony Fauci — made clear that the criteria they helped develop to guide states in their decision to lift shelter in place restrictions were stringent.

“Saying that the reopening would be staggered and that states and counties would have to go through ‘gated criteria of 14 days of decreasing evidence of illness,’ Birx outlined the tiered recommendations for loosening restrictions… ‘Phase one begins with all vulnerable individuals, including those with comorbidity continuing to shelter in place, and insuring that those that first go out in public are not those that are the most vulnerable to bad outcomes in this disease,’ Birx said. ‘And then insuring that we continue to do 6-feet [minimum] physical distancing in public spaces and continuing to avoid large gatherings and all non-essential travel.’” Yahoo News, April 17th.

“As talk turns to how the United States can at least somewhat safely reopen its economy amid the world’s largest and deadliest coronavirus outbreak, this three-part strategy has become the closest thing to a consensus among experts, epidemiologists and even the Wall Street executives on President Trump’s newly formed economic task force… That’s the good news.

“But there’s bad news too. According to the latest data, the U.S. is nowhere near being able to test or trace at the scale necessary to transition out of lockdown. Meanwhile, Americans have yet to accept the idea that isolation will continue to be a part of everyday life…

“Without widespread immunity, the coronavirus will start to spread as soon as social-distancing measures are lifted. Hundreds of thousands or even millions of Americans could die. That’s where test-trace-isolate comes in. The more people you can test — both for current infections and the antibodies created by prior infections — the more accurately you can determine who’s safe from the virus and who’s spreading it to others. The more robust your ability to trace the movements of people infected with the virus, the more rapidly and comprehensively you can inform everyone they’ve come in contact with. And the more you can do that, the more everyone can isolate and stop spreading the virus further… This is epidemiology 101. But when you compare where we are today to where we need to be, the gap is startling.

“Take testing. Experts disagree about how many tests we’d need to do per day in order conduct effective coronavirus ‘surveillance’ in a post-lockdown America. Nobel Prize-winning economist Paul Romer says 22 million or more.  The Edmond J. Safra Center for Ethics at Harvard University says ‘millions’ (at least). Five hundred thousand is generally considered the bare minimum required just to test everyone with symptoms and their close contacts… During the week of April 6, the U.S. averaged 150,000 tests a day.

“This isn’t a backward-looking blame game about the testing lapses that made America’s coronavirus outbreak worse than it had to be. It’s about what happens next. We’ve made a ton of progress since early March, when daily tests numbered in the hundreds. But that progress has basically stopped. So far this week we’re actually averaging fewer tests per day — 145,000 — than last week. Why? Because we’re running out of swabs, pipettes and chemicals, according to commercial labs.” Yahoo News, April 16th.

As Donald Trump has left getting the necessary medical supplies and equipment to the states, which are now forced to operate in an open market in competition with each other and the federal government (FEMA) bidding up the price (sapping the state budgets to insure rising profits to the sellers – oddly, many of whom are Chinese), getting what is needed just might not be achievable within any timeline we find acceptable. And without some uniform enforced standard of accuracy and effectiveness, what some states are buying just might not work.

For example, “some COVID-19 antibody tests, including those being used by public health departments in Denver and Los Angeles and provided to urgent care centers in Maryland and North Carolina, were supplied by Chinese manufacturers that are not approved by China's Center for Medical Device Evaluation, a unit of the National Medical Product Administration, or NMPA, the country's equivalent of the U.S. Food and Drug Administration, NBC News has found.

“Two U.S. companies — Premier Biotech of Minneapolis and Aytu Bioscience of Colorado — have been distributing the tests from unapproved Chinese manufacturers, according to health officials, FDA filings and a spokesman for one of the Chinese manufacturers. Many of the unapproved tests appear to have been shipped to the U.S. after the FDA relaxed its guidelines for tests in mid-March and before the Chinese government banned their export just over two weeks later.

“If COVID-19 antibody tests are unreliable, they can produce false results, either negative or positive, health officials said. The use of such tests has been widely discussed as a way to ensure that employees are healthy enough to go back to work and to find COVID-19 survivors who may be able to provide blood plasma to severely ill patients.

“Officials at the Association of Public Health Laboratories have expressed concern about the reliability of the numerous antibody tests being sold or used across the country with little scrutiny. Scott Becker, the association's chief executive, told NBC News that FDA officials are working with the Centers for Disease Control and Prevention, the National Institutes of Health and the Biomedical Advanced Research and Development Authority to evaluate the performance of the tests.” NBC News, April 17th. That Chinese companies might be the biggest beneficiaries of our upward-bidding purchasing frenzy is galling. I wonder if those companies are sending “thank you” notes to the President.

The problem, of course, is how much pain can the United States stand before all hell breaks loose. Protestors, already gathering unhealthy groups to let state governments know that they will no longer tolerate intrusion into their life choices, are just the tip of the iceberg. On the other hand, nature has given the COVID-19 virus the most aggressive need to infect and replicate of any infectious agent since the Spanish Flu. It does not respect governmental policies, borders or our deepest psychological and financial fears. It wants to grow! The yearning to be able to reopen added to the contagious drive of COVID-19 just might be the perfect, and most horrible, storm.

                I’m Peter Dekom, and being in that older, vulnerable group that many are willing to write off, I am acutely aware that so much of what we need to do get past this to the cure/prevention stage will come down to what we, as individuals, actually do with or without a government mandate.