Why it is insane to reopen the economy today
Reopening without preparation will lead to another predictable health and economic disaster
These days everyone seems to be asking the same question: “when can we reopen the economy?” I empathize with those wanting to reopen the economy, but this is the wrong question to ask. When we reopen the economy is not as important as whether we are ready to reopen it, how we can reopen it safely, and what would happen if we are unprepared to contain the resurgence of new infections that would surely follow.
In this article, I argue:
- Lack of capabilities to test widely, contact trace, and enforce quarantine make us woefully unprepared to contain new outbreaks.
- Premature reopening of the economy will lead to a new surge of cases and more deaths, requiring another shutdown.
- This in turn will likely cause the economy to collapse even further.
- A significant progress in ramping up testing, contact tracing, and quarantine enforcement will be needed before we are ready to reopen the economy.
Lack of testing and capabilities to contact trace and quarantine make us woefully unprepared to contain new outbreaks
Shortage in testing makes it impossible to detect and respond to an emerging outbreak in real time
We need to be testing widely to contain emerging hotspots of infections when they arise. Experts believe that, in order to safely reopen the economy, we need to be testing 152 out of 100,000 people everyday. Unfortunately, our current testing number stands at 45 per 100,000 people, or less than one-third of what is needed. Because of this testing shortage, many people infected with the virus are not being tested. In addition, a shortage in tests leads to a huge backlog of tests, resulting in a test turnaround time of more than a week in many states.
When tests are unavailable and take a long time to come back, each positive test represents only one of many infections that happened many weeks ago. Simply put, we cannot contain an emerging hotspot of COVID-19 infections if we don’t know it exists. By the time we learn about a new outbreak, the only way to curb new infections and prevent many more people from dying is to shut things down for a prolonged period of time.
Most states don’t have capabilities to trace contacts and enforce quarantine.
Mass testing helps only if we can use the results to trace recent contacts of newly positive cases (i.e. contact tracing) and prevent those contacts from spreading the virus to uninfected/unexposed members of the community (i.e. quarantine).
South Korea and Hong Kong, which have been lauded for their successful COVID-19 responses, implemented rigorous contact tracing and strict quarantine programs early in the pandemic. South Korea uses patients’ smartphone location data and CCTV footage to notify anyone who may have been exposed to the virus. The Hong Kong government runs a quarantine facility for those at the highest risk. While we can debate the privacy implications of these measures, it is clear that these programs have led to successful containment efforts.
As some states brace to reopen the economy, details on their plans and capacity to contact trace and enforce quarantines are notably lacking — because they don’t exist. Experts believe that 100,000 workers are needed to adequately contact trace. While Massachusetts has just begun assembling a team of contact tracers, most states don’t even have a concrete plan for establishing a contact tracing program, let alone a quarantine reinforcement mechanism.
Premature reopening of the economy will lead to a new surge of infections and more deaths, requiring another shutdown at a large scale.
The decisions around the COVID-19 pandemic thus far seem to have been guided by political needs as much as public health priorities. The pressure to reopen the economy has been escalating as more than 20 million Americans file for unemployment benefits over the last month. Demonstrators have gathered in places like Michigan and Texas to protest the shelter-in-place orders. South Carolina has already opened beaches and non-essential businesses, and many other states are considering following suit in the next couple of weeks.
(COVID-19) history will repeat itself
When shelter-in-place orders are lifted in several states, it is certain that existing infections in the communities will quickly turn into hotspots of new infections.
So let’s suppose such an outbreak starts in Charleston, South Carolina. As people intermingle with one another, the infection will spread quickly within the city, fueled by up to 50% of people who are infected and show no symptoms. Only a small subset of these people will be tested due to testing shortages, so the number of confirmed cases remains low despite an ongoing local spread. The outbreak remains invisible to the public eye.
Some of those newly infected with the virus will drive to nearby cities such as Jacksonville, Atlanta, or Charlotte. Others may fly to New York, Washington D.C., or San Francisco. And, no one will ask them if they have fever or cough at any of the state borders or airports. Their movement unrestricted, these Charlestonians can seed a new outbreak in communities around the country.
COVID-19 hotspots will then re-emerge across the country. In the “reopened” states, the infection will spread quickly. In a few weeks, an increasing number of people will develop fever, cough, or shortness breath. They will eventually get tested and the number of newly confirmed cases will skyrocket. At this point, it will be too late to contain the outbreak as there will be thousands — or even maybe tens or hundreds of thousands — of people infected with the virus. All we can do, then, is to close the economy down again in those reopened states and wait for the second wave of COVID-19 victims to flood the hospitals.
*The above scenario is hypothetical, but, it is more or less what has been happening in the U.S. for the last 3 months.
Unprepared reopening will lead to even more deaths
There are more COVID-19 cases (over 825,000) and deaths (over 45,000) in the U.S. than in any other country. Yet, experts believe that these staggering numbers are the results of only a small fraction (15%) of Americans having been exposed to the virus. In other words, there still remain 85% — or more than 300 million — Americans who can still be infected with the virus. If we reopen the economy unprepared to contain new outbreaks, our COVID-19 case and death numbers in the U.S. could easily double or triple by the end of the year.
Premature reopening will likely cause the economy to collapse even further
President Trump once tweeted that “we cannot let the cure be worse than the problem itself,” implying that the economic fallout from the shutdown could be worse than the the effects of the COVID-19 itself. But, does reopening the economy earlier in a pandemic actually lead to a better economic outcome?
To answer this question, let’s first imagine what would happen to a local outbreak in a state that is prepared to deal with it.
Adequate preparation can lead to a rapid containment of an outbreak with little disruption of unaffected areas
Let’s suppose that California moves quickly to ramp up testing and build technological and human resource infrastructure to conduct contact tracing and enforce quarantine. Then, what would happen to an outbreak in — let’s say — San Jose, California?
We can lock the city and its surrounding areas down for 2–3 weeks, limit the movement in and out of the city, and test even more widely in this region. We will have the ability to isolate those who test positive and quarantine their contacts, and deploy local public health and law enforcement resources to impose the quarantine. And, once new cases drop to near zero in San Jose, we can reopen the city.
We could do all of this while keeping San Francisco — 50 miles north — and the rest of the state mostly unaffected, though we will need to closely monitor for any new outbreak. In this scenario, businesses outside San Jose do not have to shut their doors or furlough their employees. The economy has a chance to recover.
South Korea has been successful in containing COVID-19, and suffered less economic damage than the U.S.
The above scenario happens on a daily basis in South Korea. Though there are clusters of new infections that pop up throughout the country, South Korea has been able to suppress them before they turn into a large outbreak. And it does so by widely testing people, and by using technology to efficiently and effectively trace contacts and enforce quarantine. As the result, South Korea’s cumulative death toll remains low at 238. In contrast, in New York at its peak, as many people died between lunch and dinner in a single day.
South Korea’s early investment in the outbreak containment capabilities has obviated the need to place the country under a lockdown. Schools and bars are closed but restaurants remain open. My cousins in Korea still hang out with their close friends, albeit in small groups and always with a mask on. My childhood friends in Korea get to leave their house to work in an office.
South Korea’s success in COVID-19 containment also has translated to less of an economic toll. In the month of March, approximately 200,000 —or 4 out of every 1,000 — South Koreans filed for unemployment. In contrast, 10 million — or 30 out of every 1,000 — Americans have done so in the same period.
If we reopen the economy without means to track new outbreaks or contain them effectively, it is a matter of time before we will need another prolonged period of a total lock-down. What will happen to the American economy when another 6 week lock-down across multiple states is required to prevent hundreds of thousands of people from dying? How many more people will lose jobs? How much more debt will the country have to take on to save its economy, yet again?
We need quickly ramp up capabilities to contain new outbreaks, and track our progress closely to assess our readiness for reopening
We must continue to push for a rapid ramp up in our testing capabilities. Fortunately, several new tests, including rapid tests that can diagnose an infection with 15–45 minutes, have been approved and deployed across the country. We should continue to do everything we can to increase the testing capacity around the country.
What has received less attention is the urgent need to build a robust contact tracing and quarantine enforcement system. We will need to hire hundreds of thousands of people to build an effective contact tracing program, and to enforce quarantine at home. Coincidentally, there are millions who have recently lost their jobs who are ready to be hired and deployed. Dr. Raj Panjabi argues that we should train them to aid with the COVID-19 response, including contacting tracing and enforcement of isolation and quarantine.
This program can be part of a new “New Deal.” During the Great Depression, the government hired people to build dams to contain water. This time, we can hire them to build and maintain figurative dams to contain COVID-19 outbreaks.
Our outbreak containment capabilities should be tracked to assess for readiness to reopen the economy
Every news outlet in this country seems to be reporting updated confirmed case and death numbers on a daily basis. Public health experts across the country have been projecting the hospital and ICU capacities needed to care for COVID-190 patients, and updating them based on our actual demands. These figures and projections have been helpful in preparing to deal with our first wave of infections as well as understanding our position on the “curve;” yet they do not offer much help in guiding us on whether we are equipped to prevent the second wave of infections.
Now that the peak of the first COVID-19 wave seems to be past us in most states, it’s time to focus on measuring and tracking our readiness to contain new outbreaks, and our readiness to reopen the economy.
We should track our testing capacity, including how many people we are testing as well as how many people we are capable of testing each day. We should measure how long each test takes to come back, and what percentage of tests return positive.
We should also track our progress in contact tracing, including how many people have been hired to perform contact tracing, and how many more people are needed to be hired. We should report the number of recent contacts identified, the percentage of recent contacts reached as well as under quarantine. Finally, we should provide both qualitative and quantitative measures on the effectiveness of the quarantine enforcement.
Only those states or cities that have demonstrated a significant progress on these measures should be allowed to reopen.
Social distancing: we are in it for a long haul
“Reopening the economy” will certainly not mean “going back to how things were.” In most states, schools will not reopen until the fall — and that is if they open at all this year. Restaurants will be required to maintain a certain distance between patrons. Stores will also be required to keep the occupancy below a certain threshold.
Experts predict that social distancing may be required into 2022 without a vaccine or effective treatments. And, we should be honest with ourselves that even if we have a vaccine or treatment approved in 6–12 months — which is unlikely — manufacturing and distribution of the vaccine to reach every American would require many more months — or even years. Antibody testing, though promising, has thus far been mired in scientific, practical, and ethical challenges, and may not help us in our efforts to reopen the economy safely, at least in the near future.
In other words, given that our anti-COVID-19 arsenal requires mass testing, contact tracing, and quarantine — all of which we don’t have — our only significant defense is social distancing.
Unfortunately, even Singapore, renowned for its successful containment of the virus thanks to robust testing, contact tracing, and strict quarantining, had to shut the entire country down last week due to a sharp increase in cases — mostly from migrant workers. We are learning that this coronavirus is more pesky and persistent that anyone ever thought possible.
So whether we have sufficient testing or not, or have shelter-in-place orders or not, we must continue to practice social distancing. That means no in-person birthday parties or large weddings for the foreseeable future. That means no Memorial Day barbecue or Fourth of July get-together, at least in a large group. If we are lucky, maybe we could sit down with our relatives to share a turkey and a pumpkin pie on Thanksgiving. And, that’s a big maybe.
The public discourse has revolved too much on when we can reopen the economy. This has diverted our attention from discussing how we can ramp up capabilities to contain outbreaks, without which we cannot open the economy safely.
This quote summarizes how I feel about the prospect of reopening the economy today: “insanity is doing the same thing over and over again and expecting different results.”
Before we rush to reopen restaurants, before we call our friends to go to a beach or a birthday party, and before we return to our offices, we must be honest with ourselves about what — if any — we are doing differently this time to contain new outbreaks that are sure to come. If the answer we arrive at is “not much”, it would be insane for us to expect anything other than more deaths, another shutdown, and a further economic collapse.
