How I think we should live with COVID-19
It’s time that we accept that until we find an effective therapeutic or a vaccine, COVID-19 isn’t going away. Initially and building on observations from previous outbreaks and re-openings in Wuhan and South Korea, there was a feeling that we could hunker down for 8-12 weeks & the disease would eventually go away, perhaps to return when the weather cools. But things haven’t gone as hoped. For one, COVID-19 hasn’t fully gone away in Asia where it originally broke out. In addition, we aren’t finding a correlation with warmer temperatures as originally hoped. This is somewhat good for fears of a new wave as the weather gets colder but bad for the hopes that the summer would vaporize the virus. So whether you come from the perspective of President Trump and others who thought it would simply run its course, or hard-core public health-types who wanted to fully lock down the country in hopes we can isolate our way out of it, COVID-19 is here to stay and will be until either we find an effective therapeutic or vaccine. We could debate whether we locked down or long enough - we certainly did less than other societies - but we’re beyond that now. The disease is too diffuse in too many places to simply lock the country down longer and wait it out. The public response in late April where we saw states like Georgia open perhaps prematurely has confirmed it. The economy can’t handle it, we can’t handle it and the morbidity of the disease outside of the elderly & immunocompromised doesn’t justify it.
As a result, we’re going to have to find a way to accept and live with COVID-19 as an active risk in our lives. One thing we’ve learned is that First Responders have shown with proper precautions we can keep infection rates down. It turns out the basics of proper hygiene work. Those who work in closed facilities surrounded by infected & contagious patients have antibodies at lower rates than the population at large in New York City. This demonstrates that with proper equipment & education, most can significantly increase their level of activity and manage the risk contracting the disease. This requires:
Wearing a mask when outside your residence
Wearing gloves when touching anything outside your residence. This includes in stores & public transportation, where only masks are required
Keeping distance from others, especially in confined settings
Frequent & thorough hand washing
Not touching your face with your hands
In addition to rewiring our behaviors, it will be necessary to more aggressively test anyone who chooses to end their own self-imposed quarantine. We can open business, schools and all institutions, contingent upon the fillowing:
Anyone who chooses to participate must waive all liability for a positive test & must receive an antibody test
Though we don’t know if a positive antibody test means someone is immune and certainly those positive shouldn’t stop exercising proper hygiene, whose with antibodies don’t need regular surveillance testing until we learn otherwise
People should be divided into 3 categories and tested for COVID-19 accordingly
High sensitivity provider (e.g. Doctors, Nurses, Nursing Home Employees) - These people should be tested daily
Provider (e.g. other essential employees, teachers & others with a high amount of contact within 6 feet in the course of their jobs) - these people should be tested twice a week
Participant (e.g. Students, other employees who can moderately distance) - These people should be tested weekly
If anyone tests positive, they must quarantine for two weeks. In addition, anyone who they have had contact with since their last negative test must do the same for at least one week.
Establish a nationwide database of last test & quarantine status. This will help ensure testing occurs on a frequent enough basis. Everyone who seeks entry to any establishment should be checked against the quarantine list and must be denied entry if on the list. There are those who may express concerns about privacy in this regard. This does not mean giving out any health information; rather it is a list of who is allowed into public spaces and who is not. And if you do not want to be registered, then you can enjoy your privacy in your own home. This has precedent. There is no law requiring children to be vaccinated, but good luck getting your child into a pre-school in New York City who hasn’t been
It should go without saying but doing the above will require hiring a small army of contact tracers. I don’t think we should be giving up our liberties and installing apps on our cell phones to track our collective movements as has occurred in Asia, but the ideal strategy of “test & trace,” which was successfully pursued isn’t a matter of skill or will, it’s a matter of political will. With unemployment likely to exceed 20%, the government shouldn’t have a problem hiring highly-qualified people as temporary contact tracers. It’ll both help off-set unemployment and enable the rest of the country to open up
In addition, as the government considers new stimulus to support businesses, we need to find smarter ways to support successful businesses and not sustain businesses that should otherwise fail. Using subsidies effectively can keep critical business from failing. For example, to support airlines, the government should mandate that planes fly no more than 50% full. Yet in order to keep the airlines from going bankrupt, the government should match all ticket sales 100%. So if you buy a ticket on a flight, the government does too. Similar strategies can be adopted for entertainment, non-profits, restaurants and other businesses necessary to sustain our way of life that we would like to exist once we have an active vaccine in circulation.
The last and most difficult challenge seems to be with our relationships. It’s very easy to come up with rules for businesses and public goods but there has been little guidance. When can children have playdates and under what circumstances? When can we see grandma? It seems to me that we should cautiously start to open our bubbles slowly and allow kids to be kids outside. As camps & schools reopen, those bubbles will naturally expand, but we should try to keep to the smaller groups established in them outside of those events. And family is challenging as well. As states open, I think it’s only right for families to start to see each other again in small groups , outside and still be cautious not to see those who are immunocompromised. At least through the summer. My family always has large events for certain holidays. It was heartbreaking to have 96 people on a Zoom call for Passover, but also inspiring. For Thanksgiving, hopefully we’ll all be together, but it may need to be Zoom again with 5-10 groups.