The coronavirus clock is again ticking for federal and state governments. Just as Donald Trump took fire for a tardy response to the pandemic in January, February and March, his decisions in April and May — and those by governors — could dictate how the nation emerges from the crisis.
Infection rates appear to be mercifully stabilizing, with 90% of Americans sheltering in place. And as governors and mayors make plans for reopening, one constant remains the need for testing, testing and more testing, with the added complication that there are now two kinds of coronavirus tests in play.
What does it all mean?
Containment and mitigation
The world has learned two fundamental ways to defeat COVID-19. One is to prevent the disease from taking hold in a community: containment. The other is what happens when containment fails, limiting infection and death through social distancing, closing businesses and sheltering at home: mitigation.
Containment requires vast amounts of diagnostic testing at an early stage. This is the cotton swabbing of throats or nasal passages to analyze for a diagnosis.
South Korea, which identified its first COVID-19 patient almost the same January day as the United States, quickly rushed out hundreds of thousands of diagnostic tests to learn who was infected — and also began treating and isolating those people and anyone with whom they were in contact. The result was that the virus was largely contained with so far 222 deaths.
By contrast, the United States failed even to create a diagnostic test quickly and then produce it in sufficient numbers. Without the ability to identify who was infected and tracing their contacts, the disease spread rapidly in the states of Washington, New York and elsewhere, and the only alternative was to mitigate the crisis by urging or ordering Americans to stay home. The nation shut down, the economy tanked and, as of Tuesday evening, nearly 25,500 have died.
Coronavirus and the fall
There's now hope of returning to some semblance of normalcy in the month ahead. White House scientific adviser Anthony Fauci called for a "rolling reentry." And diagnostic testing would again become imperative for whatever national plan is adopted.
A second form of test has emerged as important, one that analyzes a blood sample to identify past infections that were missed because of a lack of tests or because symptoms were so mild, the illness was assumed to be something other than COVID-19.
OTHER VIEWS:No employer in America can afford to just sit and wait
That test — a version of which has yet to be approved by the Food and Drug Administration — would help gauge the true spread of the epidemic and also identify people who might now be infection-resistant after developing antibodies to the virus. They might be able to safely work in nursing homes or hospitals, or simply return to their jobs without fear of contracting or spreading the illness.
But for the millions of Americans not yet immune to COVID-19, the diagnostic tests that were in short supply during the outbreak (and are still not available to anyone who wants them, as the president falsely promised March 6) will still play a crucial role in many return-to-work proposals that experts outside the White House are offering. This is especially true given that there might not be a vaccine against coronavirus until next year and scientists fear that the virus could reemerge this fall.
One plan envisioned by Nobel-prize winning economist Paul Romer argues for more than 20 million diagnostic tests conducted per day as the nation reopens for business, so that any infected person can be quickly quarantined.
A more modest proposal, co-authored by former FDA chief Scott Gottlieb, suggests a capacity to do 750,000 diagnostic tests per week, something closer to what is done now, while continuing to maintain some level of social distancing.
Trump says he is forming an "Opening Our Country" task force to come up with plan. And a coalition of states along the West Coast and in the Northeast are also organizing to plot a course for ending shelter-in-place orders.
Whatever is contemplated must guard against the reality that the virus will bounce back as restrictions are lifted. "Hopefully," Fauci said Sunday, "we will be able to respond to that rebound in a much more effective way than what we have seen now in January, February and March."
Lives depend on sufficient testing to guide our response. Before the nation can reopen for business, the Trump administration needs a credible plan to deliver those tests.
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