Is the United States, at any level of government, trying to get daily life for Americans back to normal as quickly as possible? Because it doesn’t look like it.
Canada, Germany, France, and Britain – comparable, advanced Western nations who were also caught unprepared – have broadly reopened and new daily cases and new daily deaths are trending down.
In the U.S., concern over rising cases* is leading to reinstituting lockdowns (California), rolling back re-openings (Texas), and generally slowing down the crawl towards normalcy.
Our public health more closely resembles Brazil and Mexico than Canada or England, which, sorry Brazil and Mexico, is a red flag.
What’s the big deal, you may be asking. The more cases we have, the closer we are to herd immunity.
The status quo, though, is also unacceptable. I’ve been severely critical of the lockdowns from the beginning (see here, here, and here). There is no economic or social predictability right now. Open up with tons of restrictions, more infections, lock down again, wait, wait, wait, open up again. And on and on. It’s Groundhog Day governance, and it gets harder and harder to maintain because we become fatigued and resigned.
When lockdowns end, cases rise dramatically – even with social distancing and masks – until there’s another lockdown. It buys time, but not much else.
What if we had a plan that allowed society to be mostly or even entirely normal, that kept new daily case counts very low, that got easier and easier to maintain over time, and would, at worst, require occasional moderate restrictions, but nothing like what we’ve experienced since March?
The idea I’m going to throw out there is not mine. It’s from a smart friend, and I can’t un-see it.
The only science-y concept you need to know to understand this plan is Rt. That measures how transmissible the virus is in any given area. Rt can go up or down, depending on many factors, one of which is social distancing. When Rt is above 1, the virus spreads quickly. When it’s below 1, it dies quickly.
To illustrate how close we could be to getting rid of COVID-19 in California, and in every state really: if California reduces Rt from its current estimate 1.05 to 0.50, and keeps it around 0.50, the virus could be completely gone by Labor Day. That math also works for Florida and Texas.
That’s less of a reduction in transmissibility than California had from March to April during its first lockdown. So it’s doable.
But for this to work, California, and every state, needs to be able to prevent the virus from spreading again when restrictions are eased.
A voluntary, cash-incentive program that encourages everyone who was recently in close contact with someone who has COVID-19 to get tested right away, and to voluntarily self-quarantine until they receive a negative test result. This would need to include an abundance of test kits and enough lab infrastructure and techs so that results can be processed and communicated quickly, ideally within 24 hours.
The federal government would need to underwrite this – billions of dollars for the cash incentives, for the testing infrastructure, and for a huge public messaging campaign. Billions of dollars is nothing when the economic cost of shutting down every few weeks is trillions of dollars.
And this wouldn’t be a band aid, like Congress’s $2 trillion CARES Act. It could be a solution.
Here’s how one version of this could work: Let’s say I saw a friend yesterday. Today, he tells me that two nights ago he was at a bar, and the bar just posted on Instagram that one of its patrons two nights ago tested positive for COVID-19. My friend says he tested positive, and that he was paid $30 to test, and will be paid $30 for each day he quarantines until a test result comes back negative, and another $10 if I get a test.
I get a test, get paid $30, stay home the next day to wait for results, another $30, test comes back positive, I’m home for two weeks, making $30 a day, and another $10 for every possibly infected contact of mine who gets tested.
How would a local government know if someone who tested positive is self-quarantining? Each city or state could devise its own plan. Maybe set up comfortable quarantine hotels where people could voluntarily live for a couple weeks. Give people the option of downloading an app. Or just trust people to do the right thing.
Would some people scam the system? Of course. The CARES Act will likely pay out billions of dollars in fraudulent claims. There’s always fraud.
But Americans are eager for life to return to normal. Most people who test positive would self-quarantine. Most people would not scam the system. And as positive tests trend down, there would be fewer opportunities for fraud, anyways. Also, this idea doesn’t require 100% compliance to work. As long as enough infected people test early and quarantine early, the virus could quickly die out.
There would need to be tons of PSAs, all over TV, podcasts, internet. Everywhere. Runny nose? Get tested, stay home for a day or two, let your close contacts know, we’ll pay you. We’ll pay them. Something like that.
If enough people who should test and self-quarantine do so early, and if you could sufficiently reduce Rt – maybe with no restrictions, maybe with modest restrictions – maybe the virus goes away and stays away, if you don’t let up.
You don’t have to cut off every infection, not even close. You just have to cut off enough to keep Rt low. And every infection you prevent through voluntary testing, contact-tracing, and self-quarantine – voluntary inconveniences that make you money – is one less infection you need to cut off through masks, social distancing, and lockdowns – forced restrictions that harm society. And as cases get lower and lower, maintaining this type of program gets easier and easier.
But right now, there are lots of reasons to not get tested even if you probably should. Los Angeles promises free tests to anyone who wants. I know someone who was tested two weeks ago and still has not received the result. And that was after having to wait three days to even schedule a test that was a 30-minute drive away and took two hours to complete.
Meanwhile CDC guidelines advise anyone who has been in close contact with someone who has COVID-19 to self-quarantine for 14 days, even if they test negative.
Yes, false negatives are definitely a thing. So on an individual level, the prudent thing to do, especially if you’re in close contact with someone who’s at-risk, may be to self-quarantine even if you test negative.
But at a societal level, in the real-world, if you want tons of people who should get tested to get tested quickly, make it easy and give them money.
None of this involves coercion or Chinese-style tracer phone apps. It is entirely voluntary, and thus American.
If something like this idea worked in Los Angeles (or anywhere), we could maybe have Dodgers games, concerts, and no masks in 7 or 8 weeks.
And if we kept the system going, the government could spot a possible outbreak before it got too late. Maybe close down large gatherings for a week or two, and then open back up. Nothing nearly as destructive as what has happened since March, and what will continue to happen unless we pivot or get lucky.
Could something like this idea be the quickest path to a full re-opening? Maybe. And it doesn’t violate our basic liberties. The same can’t be said for the diktats issued since March by so many power-drunk and clueless governors and mayors.
What we’re doing now is not working. We have to try something new. As California locks down again, and as more states move in that direction, there’s an opportunity to do something useful with this bought time, there’s an opportunity to take advantage of the fact that daily case counts could be very low within a few weeks – there could be an opportunity to set up a program that would minimize the likelihood of a third lockdown.
And the White House and federal government need to step up. States and cities don’t have the resources to build something like this.
Our leaders owe us a credible plan that could make America look like America again. If they don’t offer one soon, it may not.
In the U.S., for the past two weeks, every day there have been between 40,000 and 60,000 new confirmed cases, which, because we catch probably somewhere between 1 out of 3 and 1 out of 5 infections, translates to something like 120,000 – 180,000 infections daily (using the 1 out of 3 ratio). This is far lower than the likely peaks in March and April, which were probably something like 400,000 new infections every day. But still not great.
Disclaimer: Every number referenced in this article except for current and past confirmed cases and deaths is based on current best estimates, and thus subject to change.
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