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NEW: With Dr. Zeke Emanuel, our big plan to end the coronavirus crisis, based on data and evidence. Without a plan, we will have waves of infection and economic depression. https://www.americanprogress.org/issues/healthcare/news/2020/04/03/482613/national-state-plan-end-coronavirus-crisis/
If Trump refuses to act, governors must take the lead. Americans are willing to do their part to break transmission, but they need to have faith there is a plan that will work. Here are the components >>
#1: A stay-at-home policy for a minimum of 45 days. Using a model by the University of Toronto, via @NickKristof, this would break transmission through October—after the peak in April, new cases would decline and be flat this summer.
#2: Markers for when the stay-at-home policy can be lifted: transmission is suppressed to ~20 new cases per million per day and new cases are declining. The goal: suppress transmission to the levels of South Korea, which did not lock down society.
#3: Ramping up testing to South Korean levels so every individual who has a fever, and every member of a household of a positive case, has access to a test.
The U.S. still badly lags South Korea in tests per capita: 3,345 tests per million vs. 7,971 tests per million. If the U.S. had the same tests per million as South Korea now, that would be equivalent to 2.6 million tests.
#4: To minimize transmission in hospitals and reduce their burden, states and hospitals must set up screening clinics and drive-through centers to test people with suspected symptoms. Like South Korea did.
#5: States must conduct surveillance testing, sending swab kits to representative samples of every county. This sampling will discover asymptomatic people, enabling officials to verify when transmission has been broken.
#6: Transmission can't be broken, or testing conducted at scale, if health care workers don't have access to masks, gowns, gloves, goggles. Widespread drive-thru testing isn't possible unless volunteers can be trained and equipped with PPE.
#7: Instantaneous contact tracing, as in South Korea and Singapore: use technology to notify people via notifications or text messages if they've been in close proximity to a COVID case. And public maps to inform the public of locations of cases.
Normally, when there's a confirmed case, investigators would trace the contacts the individual had. For COVID, this is simply not possible without technology, according to modeling. We need to eliminate the delay between case confirmation and notification of contacts.
To adopt this solution in the U.S., many protections must be put in place. The entity must be a trusted, purely public health nonprofit—not tech companies or the federal government—such as the Association of State and Territorial Health Officials (ASTHO).
Additional protections: Data is automatically deleted after every 45 days. Sharing of data with any non- public health agency is prohibited. Sharing of data with 3rd parties and the sale of data is prohibited. Any data shared publicly is anonymized.
#8: Although manual contact tracing by itself will not be effective, state/local teams must be expanded to follow up on contact tracing using technology. CDC teams must be expanded and deployed to emerging hot spots.
#9: States must set up centers to isolate anyone who tests positive or has a fever, on a voluntary basis, in designated hotels, college dormitories, or other facilities. States must provide hotels for front-line health care workers so they can protect their families.
#10: States and cities must use aggregated, anonymized cellular data to assess compliance with stay-at-home orders and determine whether targeted enforcement is necessary.
#11: Transportation workers—ticketing agents, TSA screeners, flight attendants, bus drivers, subway workers—are essential front-line workers who must be provided masks, gloves, and paid sick leave.
#12: Airline passengers must pass a fever check. Screening procedures must ensure physical distancing. Planes, trains, buses must be sanitized with deep cleaning daily. Subways, buses, transit stations must limit passengers to 50% capacity.
#13: The CDC and states should issue guidelines on the use of masks. Because there is some evidence of some mechanistic efficacy of homemade cloth masks, the guidelines should instruct the public how to make and use cloth masks.
#14: When a state lifts its stay-at-home order, some restrictions must remain in place: Employers continue to allow telework; mass transit protections remain in place; gatherings of >50 people still banned.
Once herd immunity is achieved through mass vaccination, all remaining restrictions can be lifted.
The steps that need to be taken to end the coronavirus crisis are not unknown; they are clear and informed by evidence and the experience of other countries.
