"re-opening" is not a binary thing. People, Places, and Processes (PPP) define our current and future state. which people can go out, where they can go, what processes are in place when they do go out.
we aren't in a binary lockdown today. in sf, for example, anyone can go to the grocery store or "exercise outside". there are some processes in place (i.e. must wear masks to enter the grocery store; but not req'd to do temp checking on entry). our "lockdown" is already nuanced.
thus, it's not ideal to talk abt binary states. and it's non-sensical to believe we can "crush" the virus. even if # infected ppl in US fell to 50 we'd be where we were early March & infected would expand as before w/o a change in PPP. you can't just "return to normal"
defining rules and triggers for PPP makes the most sense and we should be talking about policy w/in this framework to make progress back to normalcy. we are already seeing governments (i.e. Israel) approach change this way.
luckily, for each of PPP, there appear to be massively asymmetric risk profiles. this is good news, because by restricting a minority of things, we can reduce a majority of the risk and keep ICU beds and deaths to low levels.
for People, age > 65 OR People with diabetes, high BMI, high blood pressure, or are immunocompromised, the risk of death may be as much as 85x the rest of the population. thus, restricting this minority's exposure seems like it could manage down the majority of ICU beds/death.
for Places, it seems unlikely that the virus is high risk in outside air (it's still a water-droplet dependent virus, moisture, viral proteins, & RNA degrade rapidly with sunlight, wind, and a lack of steel surfaces). restricting outdoor access is non-sensical.
indoor Places with an average radial density of <3 feet seem especially risky, incl bars, clubs, concerts, casinos, buses, trains, planes. could keeping just these Places closed or managing Processes in these risky Places cut majority of transmissions?
Processes can be dependent or independent of People or Places. face masks in all indoor spaces seems like it could eliminate majority of transmissions (china, korea, japan, singapore behavior as predictor). could hand sanitizing + no handshakes/kissing non-family cover the rest?
lots of time and attention being spent on Processes that don't make sense. antibody passports don't make sense until 40%+ infected rates (otherwise, you aren't changing anything anyway w low pop count).
onsite infection testing seems unrealistic. there exists no on-demand active infection testing today. Abbott system is slow/expensive. CRISPR systems could work but not scaled/approved. but temp checks could be a good proxy for catching ~40% of active infections and cheap/instant
it's clear there are a few things we can do that may affect a minority of our normal active behavior that could eliminate MOST of the risk/ICU beds/deaths and give us all the time we need to catch up with antibody therapies.
these can be broken down for People, Places, and Processes. the triggers for which People, Places, Processes change and when are less clear. work to be done, but we have enough to get started with a first phase for each.
what is clear, is we shouldn't be chasing People, Places, and Processes that AREN'T dramatically affecting risk (i.e. going to the beach on warm sunny day) yet we include as part of our naive binary "lockdown" narrative and penalize/shame.
binary states are easy to explain, debate, and frame right/wrong. few things, including the macro effects of this virus, or the lockdown response, is binary. we should stop using "lockdown" and start referencing restrictions around PPP to better frame the path forward.
