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How to put millions of Americans back to work safely

The first workers to return could be coronavirus survivors who’ve developed some immunity.

Supplies arrive at the Wyckoff Heights Medical Center in Brooklyn on Tuesday. (Angela Weiss/Afp Via Getty Images)

There is mounting pressure to get the economy moving again by lifting social distancing and letting people go back to work. On Sunday, President Trump reiterated his view that as we fight the coronavirus pandemic, “The cure cannot be worse than the problem itself. We’ve got to get our country open.” But it’s imperative not to repeat past mistakes.

During the 1918 flu epidemic, premature lifting of social distancing restrictions caused second waves of illness in several major cities of the United States, the United Kingdom and elsewhere.

The question is whether there is a way to put people back to work safely — and how large a workforce this could be.

The answer is yes, and the number is in the millions.

Between 1.4 million and 3.5 million Americans could safely reenter the workforce over the course of the pandemic. The specific group is composed of those who contracted the novel coronavirus but were not hospitalized, who developed an immunity, who are between the ages of 20 and 59 and who are in the potential workforce.

In 2014, two of us were among the scientists who proposed a similar strategy in response to the Ebola outbreak, dubbing it MORE, or “Mobilization of the Recovered.” The idea is to get those who’ve already had the disease, and developed some immunity, into roles needed for society to function. To varying degrees, it can work in all countries affected by covid-19 today. In the United States, the potential is great. Here’s why:

The case fatality rate of a disease is the fraction of infected people who die of it — the number of deaths divided by the total number of cases. A simple idea, but also a moving target: Because of incomplete testing, we may not detect all cases; the figure will differ by age group, region and other factors. Based on Centers for Disease Control and Prevention figures as of Monday, we estimate a case fatality rate of about 2.5 percent for the country as a whole, meaning that approximately 97.5 percent of Americans who contract the virus would survive the disease.

Based on our understanding of other coronaviruses, such as those behind SARS and MERS — and the results of a not-yet-peer-reviewed March study in monkeys of this coronavirus specifically — covid-19 survivors will be immune to reinfection, for several months at least, and possibly far longer. As the nation’s top infectious-disease expert, Anthony S. Fauci puts it, “It’s never 100 percent, but I’d be willing to bet anything that people who recover are really protected against reinfection.” They likely also won’t be able to transmit the virus through coughing, sneezing or other respiratory channels. While they would still be able to transmit by touching contaminated surfaces, this risk can be minimized through improved workplace sanitation and personal hygiene.

We need a new test to know who has had — and recovered from — the coronavirus

Most important, when a blood test to detect antibodies — not the same as the test to detect the virus itself — becomes available, we will be able to identify this immune group. Once we have the antibody test, able-bodied adults in this cadre could reenter the workforce without risk to themselves, and with minimal risk to others, in some cases, returning to their former jobs or filling in for absentees until these people can return to their previous employment, if possible. This same immune cadre could be deployed as a supplemental health-care workforce to perform various nonspecialized functions, including hospital facilities maintenance, laundry, disposal, transport of patients, distribution of supplies, supervision of elderly patients and other jobs needed to meet demand.

And while there’s nothing beneficial about the spread of the virus, one potentially useful feature of our approach is that this immune pool grows in proportion to the number of infections, so the potential labor force is growing fastest roughly when the pandemic itself is. Which is just when we need it most.

This all applies, of course, to able-bodied adults. In this group, we include people ages 20 to 59 (53 percent of the population based on the most recent census estimates) who have not been hospitalized (86 percent of those, based on New York City data) and are in the potential workforce (80 percent of those, based on Bureau of Labor Statistics data).

Pulling all of this together, we estimate the fraction of those infected with the virus who could safely rejoin the economy: The 97.5 percent of the infected population who survive, multiplied by the 53 percent between ages 20 and 59, multiplied by the 86 percent who were never hospitalized, multiplied by 80 percent who are or were in the workforce. The product is our estimate that 36 percent of those infected by the virus will be able to safely rejoin the workforce within a few months.

The absolute number of workers this represents depends, of course, on an estimate of the total number of cases. Last week — after months of downplaying the threat — the White House conceded that there could be between 100,000 and up to 240,000 deaths, after Fauci said the U.S. may have “millions” of cases. How many cases would there have to be to result in 100,000 deaths? If there’s a 2.5 percent case fatality rate, as estimated above, there would have to be 4 million cases, of which 36 percent would be a labor force of 1.4 million. The number increases in proportion to one’s estimate of the final death toll of the epidemic. Using the same calculus, the federal government’s upper-end projection of 240,000 deaths translates to 3.5 million workers who could safely go back to work.

Trump gutted his personnel office. Now it’s doomed to fail when we need it most.

The essential point is that, even under conservative plausible assumptions, a significant labor pool, numbering in the millions, will be available to restart the economy without restarting the pandemic.

A few caveats: It’s important that the resources, human and otherwise, needed to do widespread antibody testing not detract from the real-time treatment of active cases. There are still crucial shortages of skilled medical personnel, personal protective equipment and resources necessary to actually administer testing on the required scale. In addition, this plan requires a highly accurate antibody test. It is essential that any test being used correctly identify immunity against this virus without unacceptable levels of false negatives and false positives.

There is also an equity dimension: Those of us who can continue doing our jobs by telecommuting need not physically hurry back to work or take temporary jobs in the health-care sector, which do carry risks, such as infecting loved ones through surface transmission. Fair compensation for those who do go back to the physical workplace would recognize these remaining risks.

We must avoid a second wave of this virus, a virtual certainty if we abruptly lift distancing in the midst of the crisis. But there is an evidence-based way to start slowly bringing those of us who’ve already had the disease back to work. It would be reckless for everyone to rejoin the economy at once, but millions of us can, and we can do it safely.

Coronavirus: What you need to know

Vaccines: The CDC recommends that everyone age 5 and older get an updated covid booster shot. New federal data shows adults who received the updated shots cut their risk of being hospitalized with covid-19 by 50 percent. Here’s guidance on when you should get the omicron booster and how vaccine efficacy could be affected by your prior infections.

New covid variant: The XBB.1.5 variant is a highly transmissible descendant of omicron that is now estimated to cause about half of new infections in the country. We answered some frequently asked questions about the bivalent booster shots.

Guidance: CDC guidelines have been confusing — if you get covid, here’s how to tell when you’re no longer contagious. We’ve also created a guide to help you decide when to keep wearing face coverings.

Where do things stand? See the latest coronavirus numbers in the U.S. and across the world. In the U.S., pandemic trends have shifted and now White people are more likely to die from covid than Black people. Nearly nine out of 10 covid deaths are people over the age 65.

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