America Doesn’t Need One Strategy for Coronavirus. It Needs Many.

People wait in line to be tested for the COVID-19 coronavirus while wearing protective gear outside the Elmhurst Hospital Center in Queens, N.Y., March 25, 2020. (Stefan Jeremiah/Reuters)
We should separate our thinking about hotspots from our thinking about non-hotspots and adapt our responses accordingly.

NRPLUS MEMBER ARTICLE O n Tuesday, President Trump made international headlines when he declared his hope that the American economy would broadly reopen by April 12 — Easter Sunday. The stock markets, buoyed as well by positive developments in negotiations for a federal relief package, surged. The projection was no doubt comforting to the millions of American families juggling the sudden cancellation of school with new remote-work obligations or, worse, pink slips.

But many, including the president’s frequent adversaries in the press, expressed skepticism that the physicians and scientists on the White House coronavirus task force agree with this timeline. They pointed to the continued harrowing experiences of countries further along the pandemic curve and to more sobering models and projections from other public-health experts.

Which side is closer to the truth? And more to the point, how will we know when the time is right to begin lifting onerous restrictions and transition back to a semblance of normalcy?

Economists, medical professionals, policymakers, the press, and the public crave a set of immovable milestones that, confirmed by empirical evidence, show our progress in ultimately defeating the coronavirus. Thanks to a scarcity of statistically significant data and a surplus of ever-changing variables, we are currently unable to operate with such a degree of certainty. But there are concrete steps we can take to get from here to there.

Right now, we are largely analyzing the little data we have on a nationwide scale. Instead, we should focus our efforts to stabilize our nation’s health-care system on a region-by-region basis. Most importantly, we need to separate our thinking about hotspots from our thinking about non-hotspots and adapt our responses accordingly.

Hotspots are areas where COVID-19 is currently prevalent or expected to become widespread in the near future. Today that’s the metropolitan areas of New York City, Los Angeles, Seattle, San Francisco, and New Orleans.

It is highly unlikely that these regions will be in a position to lift restrictions in just two weeks, and that should not be the aim of our policy there. Instead, the goal should be stability, plain and simple. We must ensure that local health-care systems and personnel have all the resources they need to care for COVID-19 patients while simultaneously managing the workload of patients with other acute or life-threatening conditions. This requires surging manpower, facilities, supplies, and tests, while also safeguarding the physical and emotional well-being of overwhelmed front-line workers.

Improving stability in hotspots also demands public compliance with aggressive steps to slow the spread of infection. These include existing shelter-in-place guidance, to reduce the number of new infections, prevent deaths, and limit the strain on our health-care system. A key component of this is ongoing community engagement and education, which allows ordinary Americans to see themselves as a crucial part of solving public-health challenges.

Policymakers ignore the importance of an educated and collaborative public at great peril. I know this firsthand. For five years, I served as the director of the Baltimore City Syphilis Elimination Program. Funded by the Centers for Disease Control (CDC) to prevent and control the skyrocketed number of cases in Baltimore, our task force instituted increased testing, improved the management of outbreaks, and actively enlisted the community in our efforts to prevent the spread of this disease. Thanks to this proactive approach, the city saw a significant reduction of syphilis cases.

Fortunately, most Americans still do not live in areas likely to be overwhelmed by COVID-19. For residents of states with a more manageable number of cases and with epidemiological profiles less likely to lead to uncontrollable spread, this national panic may seem excessive or counterproductive. However, efforts in non-hotspot areas are just as crucial to fortifying our nation’s health-care system.

In these areas, stability means vigilance and, most critically, testing. We must have confidence that everyone who the CDC says should get a COVID-19 test can get one. Success here means that the number of infection cases per 100,000 residents would remain low and not grow exponentially.

These regions, meanwhile, must clearly understand the capacity of their local health departments to detect new cases, identify those with whom infected people have had contact, and isolate those who have been exposed. By doing their part, these non-hotspot areas can help conserve vital resources for the hotspots that need them so desperately.

For those non-hotspot areas, following these public-health protocols could very well mean returning to normal life sooner. Local governments should still direct residents to practice good hand hygiene to reduce transmission, encourage vulnerable and older populations to protect themselves, and continue testing and monitoring for new cases. If the testing data over the next several weeks suggest that the non-hotspots have evolved into hotspots, then the response should change.

If we can adequately test and care for patients while protecting the general public, there is good reason to believe that by mid- to late April, some areas of the United States might be able to begin getting back to work and back to life, even as hotspots continue to require significant resources to stabilize. The scientific community and the American people have done, and continue to do, their respective parts. Now, political leaders need to help make it happen.

Jonathan Ellen is a pediatrician, epidemiologist, and public-health academic who previously served as the CEO of Johns Hopkins All Children’s Hospital.

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