Any “return to normal” depends on testing.
There has been much speculation about when we might expect things to return to “normal.” Never mind the fact that this situation will render our society unrecognizable in ways we can’t quite predict, there are some basic criteria we can look to for understanding what’s required to enable us to turn the economy back on.
First we need to understand that this will not be a top-down decision, but rather a bottom-up one. Individuals need to feel that they are not putting themselves, their families, or their communities at risk by leaving their houses. Until that happens, there can be no resumption of normal activity.
For that to happen, people need to believe the odds they will be infected are very low, or near-zero. This will require either a vaccine or a testing regimen so widespread and frictionless that we can be absolutely certain that we know where all infections are, and that no new outbreak is underway.
Testing is where the United States has failed. Instead of a single coordinated, nationwide testing approach, individual states are left to fend for themselves, Lord of the Flies-style. Governors are competing to acquire tests from public and private sources. New York developed its own test. Johns Hopkins, UNC and Duke each developed tests. LabCorps, Quest, and Oscar (a company allegedly owned in part by Jared Kushner) all have tests. And of course the US lost precious time by declining to use a WHO test in the early days of the outbreak, opting instead to develop its own test which was beset with failures.
It’s difficult to say whether this is a failure of coordination and planning or of American-style capitalism, or both. Regardless, we are left oarless in our battle against this virus, and all we can do as it ravages the country, raging its way through our most vulnerable citizens and their communities, is watch. We need fast, frictionless testing and we need it now. Today, people who need tests often can’t get them; people who get them often have to wait up to 14 days for results. That’s useless.
Hope is on the horizon, though. In an interview yesterday, Bill Gates discussed the emergence of a self-swab test that can be administered at home. Right now, testing requires a trained healthcare worker to do an invasive sinus swab, while wearing personal protective equipment (PPE). That equipment must be discarded, and availability of that gear is one of the capacity constraints we currently face. All that goes away with self-testing. If such a test can become available nationwide overnight, we will be on the road to recovery.
An antigen blood serum test is also necessary to identify (and certify) people who have had the virus and can return to work. While we don’t know 100% right now that reinfection is impossible and we can’t rule out the emergence of additional strains, we can say with some confidence that people with antibodies to the current virus are among the least at risk. They can be employed to rebuild the economy right away. And a makeshift “vaccine” made from their white blood cells may also be usable to protect essential workers like doctors and nurses.
It is pointless for the US to try to pin down dates. This will be over when it is over, but we can consider a few milestones and key metrics.
• When Italy returns to work, we can consider that we might do so a few weeks later, assuming widespread availability of testing.
• When hospital capacity starts to free up, we are probably getting to the other side. But we must have testing.
• When all 50 states have passed their peaks of daily new cases and new deaths, we are a few weeks away from recovery.
• When states stop competing for and squabbling over test kits and instead begin to use a single nationwide self-testing system, available to anyone who wants it, we will be close.
The US administration has suggested that some areas may be able to go back online sooner than others; that could be possible, but not until we are on the other side of this. Any suggestion that we can end physical distancing by Easter is pure fantasy, and the numbers of cases and deaths we will see in the next two weeks will make this clear. Bill Gates said at least 6–10 weeks of total lockdown is necessary, and that is realistic.
Assuming lockdowns are not recklessly ended (and sadly, some governors may make that choice) sometime this summer the deaths will start to subside, and we will be able to think about returning to work. That will only be possible if testing is freely available to everyone. Every American should demand an end to our current feudal, dark ages testing approach and call for free nationwide testing now.
A vaccine is at best case 12–18 months away, and if we are realistic, probably longer. The difference between a year or two of lockdown and four to six months is testing.
