As the first coronawave subsides, three alternative near-term futures rise to the surface:
“Freeze in place” — shut the country down repeatedly during every new wave of viral spread, which will last maybe two years.
“Surrender” — restore business as usual and let the virus run its course through the population, which would likely kill 2 million people.
“Mobilize and transition” — prevent new waves from getting started by aggressively identifying and isolating individuals who have contracted the virus.
Obviously the third option is best. If successfully implemented it’s more cost-effective than option one and more humane than option two. It’s how South Korea has kept its casualties down without dragging economic and social life to a standstill. What’s required? Widespread testing at a rate of millions of tests per day, proactively identifying and isolating infected people and tracking/isolating their recent social contacts, and isolating vulnerable populations. It’ll require a lot of tech, a lot of personnel, and persistent logistical management across all levels of society to get it done right.
What are the odds that the US can get it done? The motivation is there: new cases and new deaths are expected to decline dramatically over the next few weeks; soaring unemployment and dwindling revenues have rocked the economy; Trump wants to get the recovery started ASAP. What about capability? Testing is still in short supply, with slow turnaround on results; the federal government remains reluctant to intervene, its most prominent positions occupied by bureaucrats known more for loyalty than for competence; state governments are strapped for cash and resources; the cooped-up social isolates are getting cabin fever.
Walmart and Amazon are rolling out infrared thermometers to test all employees for fever on a daily basis. Taking someone’s temperature isn’t as sensitive as the virus lab test, and it won’t identify asymptomatic carriers who can infect others. But the testing is cheap — use the same thermometer on many people — and it’s noninvasive — the device is placed near but not on the forehead. Using the thermometer doesn’t require specialized medical training, and the results are immediate. If the infrared readout shows fever, then that person can be set aside for quarantine, more precise COVID lab testing, and social contact tracing.
CDC has yet to issue recommendations for employee screening — big surprise — but this front-end detection method actually seems implementable on a wide scale. It doesn’t require a big deployment of tech and personnel by a central governmental administration that repeatedly botched testing in its efforts to contain the first corona wave. Employers and employees are motivated to prevent isolated cases from spreading through the workforce. If the employers follow through on promises of fully paid sick leave for corona-related illness, then the workplace screening might actually work.
What if the fever identified at the workplace turns out to be caused by something other than COVID — flu, for example, which infects tens of millions of people every year? Will workers diagnosed with flu still self-quarantine, receiving paid sick leave until they recover? If so, then flu season, managed primarily through a “surrender” mode that kills tens of thousands of Americans annually, might likewise be contained more successfully under the “mobilize and transition” strategy. If everyone with a fever self-isolates with sick pay regardless of which bug is causing the illness, then there might be no reason to test specifically for COVID, saving time and money and logistical headaches.
This sort of worksite-based, widely distributed, low-tech, front-end case identification system might actually work. Daily temperature checks could be extended to schools, nursing homes, prisons — anyplace where groups of people converge on a daily basis. But who’s going to monitor adherence to self-quarantine? High-tech tracking could work: program a robotic workforce to monitor each quarantined individual’s GPS via cell phone telemetry, making sure they’re staying home. It’s cheap and relatively non-invasive; it’s been extremely effective in South Korea.
But to whom would the corona-bots report the quarantine violators? What sorts of enforcement tactics will be threatened and implemented? And who’s going to track and isolate social contacts of the already-infected in order to limit population-wide spread? What’s needed is intensive local intervention deployed across the whole population. Employers’ incentives are limited to their own workers, so they can’t be expected to do the follow-up case tracking. There are no existing governmental agencies at any level that’s equipped to take on this job.
A Harvard white paper proposes the creation of a new national agency to take charge of viral containment:
Throughout the periods of quarantine, individuals who can be tested serologically and shown to have immunity would be exempt from quarantine as soon as they have immunity and on condition that they deploy in the Medical Reserve Corps, a group of volunteers overseen by the Department of Health and Human Services that supports pandemic services “including surveillance, vaccination, mitigation measures, communications, and education.”
The Secretary of HHS is Alex Azar, appointed by Trump just over a year ago; before that he was CEO for Eli Lilly. Big drug companies like Lilly deploy thousands of representatives across the land, tasked with schmoozing with doctors and hospital execs in efforts to increase sales. Azar is a lawyer by training and a sales guy by inclination. He’s not an ops guy or a science guy. Still, it’s conceivable that Azar could use his big-pharma experience to hire the right people, getting a Medical Reserve Corps up and running in short order. Serologic testing for antibodies is already underway, so it might be possible to find enough already-immune workers to staff the Corps.
Would Trump authorize this sort of aggressively proactive, systematic effort to stay ahead of the next wave? Or would he take a half-assed stab at it, blame everyone but himself for failure, then fall back into “surrender” mode, letting the virus run its course, killing a couple of million people, before declaring victory in time for the November elections?