Now that all 50 states are in various stages of reopening, there will be an increase in infections once again. We need surveillance systems to detect these increases as they happen. Waiting for a rise in hospitalizations or deaths is too late: By the time these lagging indicators rise, the outbreak is well underway.
Two types of surveillance testing are required. First is regular testing of vulnerable populations such as nursing-home residents and those who are incarcerated. The initial case is the canary in the coal mine: Finding one means there are almost certainly dozens of others. Second is random population testing. If we only test those with symptoms or exposure, we will never know the true prevalence of asymptomatic covid-19 in a community.
On a population level, we will know we have sufficient testing when the percent positive reaches below 10 percent — any higher than that and we aren’t casting the net wide enough. For the data to be even more meaningful, we also need to know the percentage of people who are positive by race and Zip code.
My ideal scenario would be to have a dashboard for every state that includes all this testing information, with data displayed in real time to direct further interventions. Policymakers should then set criteria for when restrictions must be reimposed. We already know the deadly cost of delay and inaction.
Second, we need clear and consistent messaging. Throughout the crisis, communication from the Trump administration has been muddled, at best. Guidelines for safe reopening from the Centers for Disease Control and Prevention, delayed for weeks, were not issued until most states had already announced reopening plans. When these guidelines did come out, they lacked the specificity that I’m used to seeing from the CDC.
The predictable result? Crowds of people at various Memorial Day celebrations. It’s obvious that many Americans misunderstand what reopening means.
This must change. The White House’s coronavirus task force has stopped its daily news conferences. The CDC should be allowed to step in with daily briefings of its own, which it was doing until early March. During my time as a local health official, I relied on the CDC to explain the rationale behind its recommendations so I could tailor the guidance to the communities I served. The more specific the guidelines, the more empowering they are. Checklists not only increase safety, they also give businesses the information — and cover — they need to assure patrons and employees that they are following the best available evidence.
The vitally needed message is that reopening means we must be on guard even more than before. More people are returning to work, which will result in more person-to-person interaction and increased disease transmission. We all have to do our part to reduce unnecessary risk. If you’re going back to work, stay as safe as you can there, and don’t engage in social interactions outside of work that could further spread the virus. Stay away from crowded spaces. Keep up physical distancing. And, yes, wear a mask.
Third, we need a coordinated national effort. The United States is still nowhere near the testing, tracing and isolation capacity necessary to rein in covid-19. States continue to bid against each other for critical supplies, and personal protective equipment like masks could well be in short supply again if there is a second wave of infections.
Let’s begin by setting a national strategy for developing and distributing the millions of tests needed per day. Instead of arguing about whether this action is necessary, the federal government should figure out how to produce these tests and track progress transparently.
It should be obvious to everyone by now why there must be coordination to procure equipment and medications that every state needs. The Trump administration must meet the moment, prepare for future surges and anticipate what’s ahead, including with new questions arising such as how to equitably allocate limited supplies of treatments and vaccines. It’s not too late for it to rise to the occasion.
Our country has seen enormous suffering already. At the beginning of the outbreak, we could say that the virus was new and that we just didn’t know how best to respond. One hundred thousand deaths later, there are no more excuses. We know what we need to do.