Path Forward: Road Map to Reopening

April 13, 2020

U.S. Chamber of Commerce President Suzanne Clark interviewed Dr. William Hanage, associate professor of epidemiology at Harvard’s T.H. Chan School of Public Health, on the path to reopen the economy during the first episode of Path Forward.

Their conversation focused on three steps required to restart the U.S. economy:

  1. Slow the spread of the virus through good public-health practices
  2. Find ways to conduct widespread testing for both the virus and COVID-19 antibodies
  3. Learn to make this a more livable situation for employers, employees, and customers

If we can accomplish these steps, the conversation suggests there’s likely to be a return to “semi-normal” life in the weeks and months to come.

SLOW THE SPREAD

The most crucial thing right now is slowing transmission and reducing the impact on healthcare systems. Everywhere that the virus has hit has seen it spread gradually, and then suddenly, leading to high demands in the healthcare system. The consequence being that healthcare workers are working to save lives and scientists don’t have the time to examine the data as carefully as they would like. Preventing the catastrophic surges and stopping the flow of newly infected people into the healthcare system will allow healthcare workers to deal with the virus.

Pandemics do not come around very often. The difficulty in understanding the evolution of a pandemic is that in the early stages we naturally see the most severe cases, but we have no idea what might be boiling beneath the surface. How many cases go undetected because people are asymptomatic or exhibit only mild symptoms? Large amounts of cases of those who are asymptomatic or exhibit mild symptoms is not a cause for optimism because it makes outbreaks much harder to control. Scientists are still determining the true spectrum of severity and what the true mortality rate is. This important data will most likely be available after this initial surge, over the next few months.

RAMP UP TESTING

There are two types of tests that need to be conducted. One is the test to detect the virus, SARS-CoV-2, which tells us whether a person is infected. The other is an antibody test, which tells us that a person has been infected by detecting the presence of antibodies against SARS-CoV-2 in the blood. Testing for both the virus itself and the antibodies is going to provide us with some very important information. First, testing people for the virus will allow us to identify and isolate those with positive infection to prevent further surges that overwhelm our hospitals. Second, if we can determine the fraction of the public that has been exposed to the virus, possibly infected, and therefore has evidence of immunity, then is it possible that those people can begin to go about normal life if there is evidence that these antibodies create meaningful immunity. In order to do so, it is crucial that we distinguish immunity between SARS-CoV-2 and other beta coronaviruses to not confuse the two and thus leave people to believe they are immune to SARS-CoV-2 when they are in fact not.

Dr. Hanage pointed to some promising innovations. By examining sewage, he said, we hope to measure how many people have been infected in a community. Sewage examination for the purpose of detecting SARS-CoV-2 is in the process of being peer reviewed.

Testing is imperative to proactively detect new infections, identify positive cases and then begin testing their close contacts. Once widespread testing is underway, we can begin documenting people who have antibodies and potential immunity. Scientists continue to study these critical questions.

THE NEW “NORMAL”

We may be able to achieve a new normal by summer. What does that look like? It’s hard to say for certain, but we can assume that social-distancing will play an important role in everyday life. Large gatherings are said to be of concern because of the risk the virus will spread to a larger group. According to Dr. Hanage, it will be challenging to hold traditional concerts, festivals, and sporting events for some time. Smaller gatherings, with appropriate social-distancing measures in place, could be achieved relatively soon. Antibody testing will be key here as people will be considerably more relaxed if they believe they might have immunity.

Slowing the transmission of the virus is extremely important to reopening the economy. When getting back to work, we must recognize that if we allow the surges to build up again, they will seriously threaten healthcare, and that in and of itself will damage economic activity. In order for us to get to population immunity, we will need to see 50% or more people infected, or the development of a vaccine. Many groups are working to develop a vaccine, but we’re unlikely to see one reach the market for at least a year.

Businesses are asking what equipment they need to get their employees back to work. The answer will depend on the sector, Dr. Hanage said. Supplies of personal protective equipment (PPE) are stretched thin, so essential workers, especially healthcare workers, should be prioritized. Because SARS-CoV-2 is commonly spread by people who do not even know they are infected, masks can help reduce the risk of spreading the virus to others. Though more evidence is needed to determine the effectiveness of masks, scientists are optimistic that cloth face coverings can help slow the spread.

Finally, it is crucial that we learn to adapt to the new normal that coronavirus has created in communities across the country. We must make this pandemic a livable situation. The goal is not to necessarily eliminate the disease, rather to prevent the surges that damage healthcare and economic prosperity. It is reasonable to believe that those people that have identified as immune to the virus could carry some sort of identification in the future that shows they are immune. Multiple rounds of physical distancing may be needed in all facets of life moving forward. We’ll eventually learn from our mistakes and our achievements. For instance, Dr. Hanage said, building a stronger healthcare system and understanding the role of children in this pandemic will be very important discoveries that come out of this. It is believed that children are much less likely to get infected and die from the virus, but it will be important to understand the role children play in transmitting the virus. Moreover, the use of digital technology may be used to identify if people have been in areas where there has been high risk of transmission and encourage them to be tested.

If there’s one thing for certain, change is a constant that supports innovation.

FULL RECORDING OF THE ONLINE EVENT

Path Forward: Road Map to Reopening with Suzanne Clark and Dr. William Hanage