The coronavirus crisis has upended American life, and fresh ideas are needed for dealing with the problems it’s creating. Here is a collection of smart solutions. We are expanding this list as we receive more ideas.
Have an idea? Submit it here.
Borrow from the New Deal: Create a Covid-19 Recovery Corps
By Steven Joffe and Ezekiel J. Emanuel
As coronavirus spreads across the United States, the number of cases may soon surge into the tens of millions. When these people recover, most are likely to be immune. Many are unemployed. It need not be so.
America needs a Covid-19 Recovery Corps, now.
Survivors of the 2003 SARS epidemic, caused by a related coronavirus, appear immune to reinfection for a year or more. Although studies are urgently needed, all the experts, including Anthony S. Fauci of the National Institute of Allergy and Infectious Diseases, believe covid-19 immunity is likely similar.
Covid-19 survivors are a critical resource, both to perform tasks that non-immune individuals cannot safely do and to get the economy moving. To enlist them, the federal government should immediately create a CRC modeled on New Deal programs such as the Works Progress Administration.
CRC associates could perform essential support roles in hospitals: preparing and delivering meals, transporting patients and samples, helping to clean. They could staff drive-through testing centers so health-care workers wouldn’t have to. They could care for, teach and tutor children whose parents must work. They could assist in places where physical distancing is impossible, such as nursing homes. They could deliver food to people who are self-isolating. They could go door-to-door as census workers.
Congress and the president will have to muster the political will and cooperation needed to establish a major new program. A mechanism will also be needed to certify who is a survivor. Soon, we will have a serological blood test to determine who has antibodies against the coronavirus. Until then, we will have to confirm active infection followed by resolution of symptoms, passage of time or repeat viral testing.
Americans need work, and there’s plenty of work to be done by people immune to the virus. By taking advantage of a precious resource — immune covid-19 survivors — a CRC could meet these needs without fanning the flames of the epidemic.
Steven Joffe is a pediatric oncologist and interim chairman of the Department of Medical Ethics and Health Policy at the University of Pennsylvania Perelman School of Medicine. Ezekiel J. Emanuel is a professor and the vice provost of global initiatives at the University of Pennsylvania.
Donate your stimulus check to someone who needs it more
By Maggie Master
As a sequestered writer, I remotely submit a radical idea: I plan to sign over my forthcoming stimulus check to someone in need. And if you are able, I think you should, too.
There are an estimated 130 million Americans in the middle class. Consider: If even 20,000 stimulus recipients chose to pool our $1,200 checks, we would create the grass-roots equivalent of a $24 million micro-bank. That’s some serious grant-making power.
What could this look like? Pass your payment along to someone whose services you normally utilize — a barber, a nail technician, a house cleaner — whose work has evaporated. Donate to a reputable organization channeling resources to affected households. Buy gift cards to local businesses. Those are just a few ideas. A friend and I have created a website to help people make high-impact donations. It also shares resources for those in need.
Megan Greene, an economist at the Harvard Kennedy School, has advocated for wide-reaching stimulus checks. But she notes that government is inherently a sledgehammer, not a scalpel. Such bottom-up grant-making, she says, "could be an incredibly powerful way to address the fatal flaw in our policy tools.”
In Maryland, 84,000 of my fellow citizens filed for unemployment. If even 20,000 people could deliver our checks directly to them or to the organizations scrambling to serve them — and if another 20,000 could promise to “pay it forward” by supporting struggling local businesses through patronage or donations — we could make a significant impact. All of us at home are wondering what life will look like when this illness has run its course. Together, let’s make sure that the places we love survive, and that the people on whom we count in boon times can get through this hardship.
Maggie Master is a writer living in Baltimore.
We need more bankruptcy judges. Congress can help.
By Peter Friedman
If we are “roaring into a recession,” as Goldman Sachs projects, and a wave of covid-19-related bankruptcies follow, our bankruptcy system will be overwhelmed. To avoid this foreseeable calamity, Congress should immediately authorize a substantial increase in federal bankruptcy judgeships to handle the load and ensure that our economic courts of last resorts can meet their critical obligations.
A company’s ability to restructure its debt and obtain a fresh start is a fundamental tenet of U.S. corporate law. Our system has worked in past downturns, allowing businesses of every type to reorganize and save jobs rather than wither and liquidate. In a real sense, U.S. bankruptcy courts and judges are the hospitals and doctors for ailing businesses, and they must be sufficiently staffed and supported. Without more bankruptcy judges to face what some predict could be as much as a fourfold increase in cases, the system will be hard-pressed to carry out its mission.
In this time of growing crisis, the need for additional bankruptcy judges is especially acute in venues that may face heavier volumes of filings. And Congress should amend current law so that bankruptcy judges can temporarily serve anywhere in the country, not just intheir home districts.
Liberals and conservatives ought to come together on this issue. Bankruptcy courts cannot be packed with ideologues by the president or the Senate; bankruptcy judges do not have life tenure and are selected by other judges, not politicians. Historically, this has been done with great care and has led to an exceptionally high-quality pool of capable bankruptcy judges with extensive subject-matter expertise. Our judiciary can fill new judgeships in the same way now to meet our needs.
The United States has seen the costs of failing to prepare before a crisis spins out of control. Appointing additional bankruptcy judges before the bankruptcy system is inundated is a low-cost proposition with significant benefits. Failing to prepare leaves systems overwhelmed and lets contagion spread. We can’t afford for that to happen.
Peter Friedman is a partner in the restructuring practice at O’Melveny & Myers LLP.
End voter registration
By Ellen Kurz
As the coronavirus threatens our nation’s health and democracy, now is the time to act to ensure a legitimate general election in November. There has been a lot of talk about voting by mail — but we’re missing a critical piece of the democracy puzzle. We need to ensure every eligible citizen not only can cast their ballot safely but also obtain a ballot in the first place. The best solution is to skip voter registration altogether and send a ballot to every eligible citizen for the November election — not just to registered voters.
Even in a normal cycle, only about 60 percent of eligible voters take part in our elections. Civic groups and political parties spend millions of dollars and months on the ground registering voters. But this year, they won’t be able to go door-to-door or set up shop outside supermarkets to register voters due to social distancing guidelines. By ending voter registration, we’ll not only protect our democracy, but we’ll also give it the vital boost it needs.
This is especially critical because registration is already used as a tool to suppress the vote. Before recent elections, we’ve seen Georgia, Indiana and Ohio purge hundreds of thousands of people from voter rolls. Without bold action, we can expect an election that isn’t just unrepresentative but is also delegitimizing of the next government’s response to the multiple crises we will face.
We already have the resources to make sure everyone can vote. The government has records, such as Social Security numbers, that could serve as voter rolls when individuals turn 18. State agencies — such as the Department of Motor Vehicles — have this information as well.
With only a fraction of Americans choosing their leaders, our democracy is already extremely fragile. We can come out of this pandemic with democracy on a lifeline, with a select few choosing our next president, or we can act now and have a healthier democracy when this ends. Wouldn’t that be the best silver lining?
Ellen Kurz is founder and chief executive the voting-rights advocacy group, iVote.
Lift restrictions on blood donations from gay men
By Kevin Ballen and Reese Caldwell
At a White House Coronavirus Task Force news conference on March 19, Surgeon General Jerome M. Adams outlined one action that young people like us can take to help our country during the coronavirus: “We know many of you are home practicing the president’s guidelines for social distancing, but one thing we should all consider, especially our millennials and Gen Z, is donating blood.”
Dr. Adams, we hear you and we want to help. The Red Cross is asking for blood donations, as thousands of drives have been canceled across the country because of coronavirus fears. Our country is facing a dire blood shortage, and yet we, along with millions of other healthy gay men, are being turned away.
At the height of the AIDS epidemic in the 1980s, the Food and Drug Administration barred gay men from donating blood. In 2014, the FDA modified this ban to prevent gay men from giving blood if they have had any sexual contact within the past year, even if they test negative for HIV, practice safe sex and are in a monogamous relationship. Meanwhile, straight men and women, all of whom are capable of having HIV, face no restrictions on blood donation (even if they engage in risky sexual activity).
It is long past time to lift this discriminatory policy. Other countries, such as Italy and Spain, have moved toward individual risk assessments rather than discriminatory bans on gay men, and have faced no issues with HIV in the blood supply. The United States is in a national crisis: the coronavirus threatens our health-care system, and a blood shortage only adds to the stress. We call on President Trump to sign an executive order revising the blanket restriction to an individual risk assessment, accounting for HIV testing and safe sex practices. This is an opportunity for the administration to respond quickly and effectively to our current crisis. Millions of gay men want to help. Please let us.
Kevin Ballen and Reese Caldwell are sophomores at Harvard College studying sociology and molecular and cellular biology, respectively.
Let foreign-trained physicians join the fight
By Leslie Omoruyi
As the coronavirus crisis puts intense pressure on the health-care system, the Veterans Affairs medical system and some governors are asking doctors and nurses to come out of retirement. And in some hospitals in New York, final-year medical students are already working as clinical observers and note-takers to help manage the spread of covid-19. But there’s another resource hospitals should examine: foreign-trained physicians.
There are an estimated 65,000 doctors in the United States who have not done any residency training in the country and therefore cannot be licensed to practice. Many of these doctors have extensive medical schooling and postgraduate training and possess clinical competence in diagnosing and managing infectious diseases. Due to the highly competitive nature of U.S. residency programs and restrictions from the Balanced Budget Act of 1997, which limits the annual number of residency slots supported by Medicare, many U.S. medical graduates and foreign-trained doctors do not make it into residency programs.
This contributes significantly to the increasing deficit in the physician workforce. The Association of American Medical Colleges predicts that over the next decade, the United States will see a shortage of more than 120,000 physicians. Addressing the health-care labor shortage by asking retired nurses and doctors to come back to work may temporarily boost the health workforce, but certainly doesn’t address future outbreaks. Also, these retired professionals are mostly seniors with a higher mortality risk for covid-19 in any clinic setting.
Tapping into the massive pool of foreign-trained physicians could ameliorate gaps in health-care quality resulting from a high patient-to-physician ratio, especially during health crises such as the covid-19 pandemic. The system should decide how to use these doctors, perhaps by engaging them in community preventive medicine and population health planning or offering easy paths to restricted licenses in infection prevention and control. Given the emergency before us, why would we turn away their expertise?
Leslie Omoruyi is a foreign-trained physician and independent health-care consultant in Lynchburg, Va.
Emergency responders can help besieged hospitals. Here’s how.
By Aarron Reinert
Covid-19 is straining the capacity of America’s hospitals, so why not consider alternate models?
Right now, reimbursement for emergency ambulance service is tied almost exclusively to the transportation of a patient to a hospital emergency room. But it doesn’t have to be that way.
The Centers for Medicare and Medicaid Services and the Department of Health and Human Services have the authority to grant waivers that would compensate first responders for providing care for some patients in their homes.
Waivers could also be issued to reimburse ambulance providers who transport patients that need less intensive care to alternate destinations, such as urgent-care facilities. If a patient requires ongoing monitoring, emergency first responders can assist with ensuring regular telemedicine visits are scheduled to allow them to maintain contact with their medical teams without having to leave home — minimizing potential community spread.
This approach would reduce crowding in hospitals, allow them to preserve scarce beds for those patients who need them and ensure doctors and nurses can devote more time and resources to the patients most in need of the highest level of care.
Giving paramedics, EMTs and other front-line health-care providers priority access to personal protective equipment would also help ensure there is manpower to fuel this alternate delivery model. The national shortage of gloves, masks and other equipment put America’s paramedics, EMTs and fellow first responders at an unacceptable heightened risk. It is imperative that lawmakers include a provision in the next phase of the stimulus requiring the health and human services secretary to issue guidance ensuring that ambulance providers and suppliers are given priority access to such equipment.
First responders and those we serve need government leadership and dedicated funding to support new, innovative approaches during this crisis.
Aarron Reinert is president of the American Ambulance Association.
It’s time for emergency physicians to put away our stethoscopes
By Jeremy Samuel Faust
Since 1986, federal law has mandated that any patient requesting emergency medical care must be evaluated by a physician to assess for any threatening conditions. The law, often referred to as the “anti-dumping law,” requires that physicians perform a medical screening evaluation, including a physical examination.
Over time, the interpretation of this mandate has slowly expanded, not by law so much as by custom. This is why emergency rooms have become our nation’s safety net for care. Despite increasing popularity of urgent-care clinics and telehealth, many patients who could have safely been cared for elsewhere still end up in emergency rooms.
While many of us embrace that mission with pride, it is dangerous and wasteful in the coronavirus pandemic. We need to course-correct to keep everyone safe. Exposing patients to emergency rooms is now far riskier than it was before. In turn, health-care workers must assume that all patients are infected. This forces us to blow through personal protective equipment that we desperately need so that we do not become infected ourselves.
Over the past few decades, we have learned that many, if not most, of our physical examination maneuvers provide little reliable information. In most cases, the information we need can be obtained simply by interviewing patients. But old habits die hard, and patients seem to love our stethoscopes. In our current situation, that simply won’t do.
We need the federal government to allow us to perform medical screening exams via video or through glass doors, even for patients entering emergency rooms. The removal of the requirement that we evaluate every patient by hand will save resources and keep everyone safer.
In recent meetings and phone calls with stakeholders, the Centers for Medicare and Medicaid Services has signaled that it is seriously considering making this change. But it has not materialized, and time is of the essence. The moment to act is now.
Jeremy Samuel Faust is an emergency physician at Brigham and Women’s Hospital in the Division of Health Policy and Public Health, and an instructor at Harvard Medical School.
Include local media in the stimulus package
By Suzanne Nossel and Viktorya Vilk
Local news outlets across the country are providing essential, up-to-the minute information aimed at keeping communities safe. Even in cities under virtual lockdown, the news media has been recognized as an “essential service” for public health and safety, alongside hospitals and grocery stores. Local media outlets have been rising to the occasion, breaking stories, guiding the public on do’s and don’ts, and holding leaders accountable for life and death decisions. Many have dropped paywalls on their covid-19 coverage, recognizing that it represents an essential public service.
But while they may seem to be thriving, local media outlets still suffer from the disintegration of longstanding, advertising-based business models. That, coupled with the mass migration of consumers to social media platforms, has stripped local news outlets of their prime source of revenue, leading to the closure of one out of every five local newspapers and the slashing of newsroom staffs in half over the past 15 years. The spread of covid-19 has made this chronic illness acute: The closure of local businesses and slowdown in economic activity are depriving local news outlets of essential revenue to keep operations going. In recent weeks, several publications have dropped print editions, or made plaintive appeals to readers for the financial support necessary to sustain operations.
As Congress and state legislatures contemplate massive stimulus bills aimed to keep our economy and society afloat, local media outlets should be part of the package. Funds to replace lost revenue and ensure that local news outlets continue to provide essential coverage of the pandemic and other topics will enable communities to stay informed, healthy and connected through this crisis. The monies need to be carefully safeguarded to ensure that the infusion of public funds does not compromise editorial integrity or deter hard-hitting coverage. Local media is among the vital organs of our democracy and must not be allowed to fail.
Suzanne Nossel is chief executive of PEN America. Viktorya Vilk is the director of digital safety and free expression programs at PEN America.
Lift tariffs on Chinese medical equipment
By Susan Shirk and Yanzhong Huang
China, where the coronavirus epidemic seems to have peaked and life is slowly returning to normal, currently has a surplus of protective medical gear, including masks, gloves and gowns. The country mobilized resources to manufacture the equipment and is now ready to export it to countries in need. On March 9, China announced it would export five million masks to South Korea. China has also provided testing kits, masks and protection suits to more than 80 countries, including Italy, France, Pakistan, Japan and Iran.
Why, then, isn’t the United States buying the equipment it needs from China? Because President Trump’s tariffs are standing in the way.
Since 2018, the Trump administration has imposed more than $400 billion dollars of tariffs on imports from China; $360 billion dollars of duties remain in place. Critical medical products, including face masks, gloves, protective goggles and thermometers, have been subject to Section 301 import tariffs.
The administration has offered to grant exclusions from import tariffs for certain medical products imported from China. But on March 5, the office of the U.S. Trade Representative (USTR) approved just 200 specific requests from individual companies to have their purchase of items needed to handle the epidemic excluded from the tariff; some of the requests from health-care companies were denied. On March 10 and 12, the administration said it would temporarily reduce some tariffs on Chinese products to address the pandemic, yet the list covers only a handful of urgently needed products.
On March 20, USTR announced that it was considering “possible further modifications to remove duties from additional medical care products” related to the COVID-19 virus and would collect comments from interested parties until at least June 25. Yes, that’s three long months away, a period in which thousands of doctors, nurses and patients could die because they lack protective gear.
Public health and safety demand that President Trump immediately lift all tariffs on the medical products we need. American lives are at stake.
Susan Shirk is research professor and chair of the 21st Century China Center School of Global Policy and Strategy at University of California, San Diego. Yanzhong Huang is a senior fellow of global health at the Council on Foreign Relations and a professor at Seton Hall University’s School of Diplomacy and International Relations.
Let foreign-born health-care workers live in peace
By Christopher Richardson
While, as a nation, we are praising and proud of the herculean job being done by health-care workers, what we don’t realize is that more than 1 in 6 of U.S. health-care workers are immigrants. For U.S. doctors, the statistic is even more pronounced, at 1 in 4. In the states hardest hit by coronavirus, California and New York, more than a third of all health-care workers are immigrants.
These individuals, who are being forced to work night and day as our doctors, nurses and pharmacists during our national crisis, must also confront unfair immigration provisions such as the administration’s travel ban, administrative processing roadblocks, arbitrary green card caps and the new public charge rule. President Trump’s policies are adding undue stress to an already stressful existence to these workers. Close to 30,000 DACA recipients are health-care workers, including 200 who are slated to be doctors, yet they will probably lose their status come June, as the Supreme Court will likely allow Trump to eliminate the program. And there are rumors that the Department of Homeland Security may be planning raids and deportations against these DACA recipients who are saving the lives of Americans.
We shouldn’t ask these immigrants to risk their lives in labor for us but spend their waking hours under threat of losing their status or deportation. Trump should suspend his byzantine immigration policies for these health-care workers immediately, work with Congress to exempt health-care workers from any immigration caps and set up task forces within DHS and the State Department to expedite their current cases — whether those cases be non-immigrant visa renewals, Green card applications or naturalization. We, as a nation, cannot afford to lose them. This is the least we can do for them after all they have done for us.
Christopher Richardson is a former U.S. diplomat and immigration attorney.
Unleash fourth-year medical students
By Donald W. Landry
On March 20, around 20,000 fourth-year U.S. medical students learned which hospital they are assigned for their residency during the annual National Resident Matching Program. Normally, they would begin serving patients in July, but there’s a way to do it now.
If medical schools instead confer MD degrees immediately, instead of waiting until the end of the semester, these hospitals could hire, train and deploy an extra 20,000 physicians at a time when we are straining to “flatten the curve” of the covid-19 coronavirus. This proposal is a few weeks old and has already passed from Columbia University to New York State. But others should take up the idea of accelerating fourth-year medical students into their chosen life of service.
At Columbia, most of our medical students — representative of similar medical students throughout the country — want to help, even if it is not their time. But the fourth-year students are fully prepared. They have completed all the clinical rotations required for the MD degree. Under normal circumstances they would now be taking electives or conducting research, perhaps not even seeing a patient during the final few months of medical school. They would in the normal order receive their MDs in May and begin as interns (first-year residents) by July.
I propose instead that medical students be graduated now and given the opportunity to serve in this time of great need. I imagine most would jump at the opportunity. If they were not caring for covid-19 patients directly, they could free more experienced physicians to undertake that necessary work.
Donald W. Landry is physician-in-chief, chair of the Department of Medicine and director of the Division of Experimental Therapeutics at New York-Presbyterian Hospital/Columbia University Medical Center.
House mild cases in hotels
By Jeremy Samuel Faust and Cass Sunstein
One of the toughest decisions facing physicians and public health officials is where to send patients who test positive for the covid-19 coronavirus. For the small but significant proportion with severe or critical illness, the decision to hospitalize is trivial. But where to send the apparently large majority of cases that are mild or even symptom-free?
These patients, often young, need to be isolated to reduce spread. But using a hospital bed for isolation alone takes up capacity, puts others at risk and chews through protective equipment that doctors, nurses and other staff desperately need.
A natural alternative is to send people home, with clear instructions to self-isolate. But in some cases that is not feasible, and it poses evident risks. The World Health Organization recommends placing mildly ill patients in dedicated covid-19 facilities as the gold standard for isolation. While countries such as China have the logistical capability to erect new hospitals for this purpose in a matter of days, most places cannot achieve that.
Fortunately, there is a potential answer: America’s prodigious hotel industry. And in case you haven’t noticed, there is plenty of room at the inn.
The federal government should use its financial and legal resources to temporarily convert some large hotels, reeling from the current economic situation, into covid-19 isolation facilities. Under recently issued federal guidance, these spaces are not required to provide medical attention.
Under ordinary circumstances, the suggestion that the federal government might seek to take over a hotel would run into serious legal objections. But under current conditions, we suspect that many hotel executives would line up to draft temporary and renewable lease agreements with the government. This could also help stave off unemployment in the travel industry.
Yes, all of this needs to be paid for, and strong steps would have to be taken to reduce health risks to housekeepers and staff. But whatever the upfront costs and risks may be, the downstream benefits — in terms of health, economics and more — are likely to exceed them.
Jeremy Samuel Faust is an emergency physician at Brigham and Women’s Hospital in the Division of Health Policy and Public Health and an instructor at Harvard Medical School. Cass Sunstein is Robert Walmsley University Professor at Harvard and a former administrator of the White House Office of Information and Regulatory Affairs.
Forget stimulus checks. Send prepaid cards instead.
By Herbert Lin
The administration and members of Congress have proposed giving Americans a significant amount of cash to stimulate the economy, such as a check for $1,000 or more to every American adult.
Stimulating the economy by providing spendable cash is a good idea, but what would prevent those in the financially well-off categories from simply investing that money instead of stimulating the economy by spending it?
One way is to provide immediate cash to all adult Americans, but in the form of prepaid Mastercard or Visa cards that expire in a certain time — such as three months — rather than in the form of paper checks.
This approach has several advantages. First, it virtually guarantees that recipients will spend the cash. Facing the possibility that their stimulus cash will expire, recipients in all financial brackets will be anxious to use the money. Even the well-off will hate the idea of losing free money that they could have spent.
Second, recipients of prepaid cards can use them immediately, whereas a check needs to be deposited first. Although electronic banking with online check deposit is increasingly common, many people do not have access to such a service. And going to the bank violates infection-control guidelines.
Third, amounts on prepaid cards that are not injected into the economy can revert to the U.S. Treasury and perhaps be recycled for later use. With paper checks, the Treasury recovers only those that are not deposited, whether or not they are spent.
The fundamental principle is to increase the likelihood that spendable cash sent to consumers will be spent immediately. Regardless of the details of such stimulus program, that principle should be observed.
Herbert Lin is a senior research scholar and the Hank J. Holland Fellow at Stanford University.
Provide health care at the neighborhood level
By Stephen Grill
As a neurologist living in a Washington, D.C., suburb, I want to propose a strategy to help reduce the burden on hospitals as this pandemic plays out.
Many doctors have begun practicing telehealth from our home offices. But I wonder if clinicians might be able to organize, in concert with their local hospitals, to help their communities in some way.
Once organized, and if given some medical supplies, we might help with screenings at our neighbors’ houses. Perhaps we could monitor neighbors recently discharged from hospitals. Or, in my own field, I might visit a person concerned that their facial weakness might be a stroke. A simple examination or an online consult might determine it to be a less serious Bell’s palsy, potentially avoiding an emergency-room visit.
I don’t know if this is practical, and I know hospitals do not have the resources to set up such a system or offer supplies right now. But with the help of social-networking services for neighborhoods, clinicians could self-organize. They could indicate their expertise, their availability and what they would be willing to do. It is not a lot of work to do it now and perhaps it may pay off.
The writer is a neurologist at the Parkinson’s & Movement Disorders Center of Maryland.
Let patients test themselves at home
By Shantanu Nundy and Marty Makary
Missing from the current discussion about rapidly ramping up testing for covid-19: doing it at home. Testing for the coronavirus can be performed using a nasal swab (the equivalent of putting a Q-Tip in your nostril). There is little scientific reason as to why this can’t be done by people at home under the direction of a doctor. Research on seasonal flu comparing the accuracy of self-collected swabs vs. professionally collected swabs shows that they are nearly equivalent.
Here is how at-home testing could work:
Step 1: Individuals with symptoms call in to their doctor’s office or use a telemedicine service to be assessed by a qualified health-care professional who can order tests, often billing a patient’s insurance company directly.
Step 2: Those who meet CDC guidelines for testing and are able to test themselves and be safely managed at home are sent a testing kit by overnight mail or direct delivery from a nearby facility (which could include labs, pharmacies or specially set-up public-health depots).
Step 3: Individuals would then self-swab, guided by an instructional video or a virtual health-care professional, and then mail the sample to a testing facility or drop it off. All three steps could be done completely from home — not only convenient for those who are already feeling ill but also ensuring social distancing.
Governments and private organizations should issue guidance on at-home testing for clinicians, laboratories and public health professionals. Also needed: removing state and local regulatory barriers that slow down and sometimes prevent labs from processing samples collected by patients. And government and private organizations should provide funding to laboratories and researchers to invest in validating and improving the effectiveness of at-home testing.
With swift action, at-home testing could ensure widespread, equitable availability of care and slow the spread of covid-19.
Shantanu Nundy is a primary-care physician and chief medical officer at Accolade Inc. Marty Makary is a professor at the Johns Hopkins School of Public Health, editor in chief of MedPage Today and author of “The Price We Pay.”
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