Thread by @JeremyKonyndyk

How long must this last?

No question we need to restore economic activity and human mobility ASAP. But there's a right way to do it and a super-wrong way to do it.

The President's comments frighteningly suggest he is leaning toward the super-wrong way. washingtonpost.com/politics/trump…

There should be no minimizing the risk in either direction here. The longer we keep the economy paused, the more businesses and jobs we lose - a huge problem.

But if we un-pause prematurely, we lose many lives and overwhelm hospitals. That's a huge problem too.

A recent Harvard study, like the Imperial College study last week, projects that temporary one-off social distancing measures would simply delay, not avert, a surge in cases.

So lifting those measures before we are ready just puts us back at square one.

https://twitter.com/joshmich/status/1242260240684310528?s=20

What the President is contemplating is truly dangerous. Even now, the situation developing in NYC seems on course to eclipse Wuhan and potentially northern Italy.

Easing off the brakes too early just guarantees more US cities reaching that same point.

https://twitter.com/jburnmurdoch/status/1242229271395028993?s=20

The lives at risk are not just COVID19 patients. They're also the lives of anyone who has a car accident, has a heart attack or a stroke, or otherwise ends up in an ER with any life-threatening health issue.

If our ERs are crashing due to a wave of COVID19, *everyone* suffers.

Harming our economy is a terrible option; crashing our health system is too. But those are the immediate options.

And if our health system crashes, it ain't exactly good for the economy. So the real choice is:

- economic pain
*or*
- economic pain + a lot of death

The policy and public health challenge, therefore, is how to massively accelerate the protections we need to have in place in order to safely and confidently begin un-pausing the economy.

I see several priorities:

Phase 1 must bring exponential case growth back down to a manageable level.

For now in the US, this is *only* possible through a version of what China did, and what Italy is doing: a sledgehammer approach of prolonged, painful social distancing measures.

Important to remember that the cases now showing up in ERs are people infected 10-15 days ago (avg ~4-5 day incubation period and ~8 days to develop severe symptoms).

So what we're seeing currently is only the front edge of the wave that is about to hit our hospitals.

And already we're facing huge national shortages of PPE, ventilators, tests.

A pause of only a few weeks will not be enough to bring transmission back down to manageable levels.

We would at best tread water at the (very bad) level we're at now, and soon face another wave.

So as we endure this long painful phase, we need to be actively preparing phase 2: putting down the sledgehammer and switching to a scalpel approach of targeted ongoing suppression to avoid renewed waves of transmission.

This starts with a massive scale up of free testing, so we can identify and rapidly isolate anyone who is sick.

Must pair this with huge scale-up of contact tracing (core epi tactic of ID'ing & monitoring every contact of a confirmed case). This is really hard to take to scale.

But China & S. Korea prove it can be done with innovative/intrusive big-data tools, and workforce expansion.

Adapting this to the US is a huge innovation challenge: building big-data tools for contact tracing, but consistent with our own laws and values. Tough, but do-able.

Along with that, we need a huge surge in local public health workforce to actually carry out the tracing. Could do this via a big Americorps-style program to reinforce local health depts.

Will not be cheap, but far cheaper than pausing the economy.

Mass testing + mass contact tracing in turn enable much more targeted quarantine practices: affecting only those clearly linked to a known case, rather than preemptively covering everyone, as we must now. And quarantine could last only until testing confirmed someone's status.

Alongside all this must be a ramp-up of COVID surveillance, so if a wave starts building somewhere, we can see it in advance and dial the distancing measures back up.

These measures,surveillance, testing, and rapid targeted quarantine and isolation, build one line of defense.

Also need to build other lines of defense simultaneously.

Surging add'l protection & support to high risk groups, so that elder-care homes, prisons, detention centers, shelters, etc do not become incubators of transmission. (Another case for Americorps-for-public-health)

Investing in changes to health system readiness.

-Separate screening and intake for COVID from normal ER functions; perhaps even at distinct central facilities (China has done this).

And bolster capacity of health systems across the country to handle future surges in cases.

Much of this in turn rests on major supply chain and production investments. Scaling up testing, high-risk facility support, and health system readiness all require huge increase in PPE availability. Also need far more ventilators, as we're beginning to see.

So that's the Phase 2 package:
- Breakthrough on big-data public health tools
- On-demand testing
- Surge in public health workforce
- Strengthen disease surveillance
- Targeted quarantine/isolation
- Ramp up production of PPE and other items
- Surge in health system readiness

And this must all be ready within 2-3 months to minimize economic harm.

This is what China has put in place; it's what S. Korea put in place. It's our modern-day Manhattan Project.

But it's not where the focus seems to be for the White House. And that's a huge problem.