By Richard Danzig and Marc Lipsitch
Problem: Minimizing errors and uncertainties about and maximizing confidence in our judgments about cure will soon become as important as present efforts at disease detection. People who recover from Covid-19 probably can work in hospitals, emergency response settings and ordinary jobs without fear of infection, because evidence so far suggests they will have effective immunity to the virus for at least a year. But we need to identify these people and assess how soon after their recovery they become unlikely to infect others.
Response: Assuring that someone has immunity against this new virus requires tests that are distinct from the PCR tests of nose and throat swabs now being used to identify infections. We need to develop and distribute antibody tests, which can indicate when people are immune, and set standards to minimize the chance that they will infect others. The Department of Health and Human Services needs to make this a stated priority and set aside substantial resources to achieve it, even at the cost of diverting resources from present urgent needs.
Problem: If current efforts at social distancing succeed in spacing out infections, we face many months of demand for treatment that stand to cripple health systems.
Responses: It’s essential to reduce demand for hospitalization by establishing methods to support lengthy treatment at home. These include telemedicine, house calls by nurse practitioners, on-line instruction for home care-givers, and support for safe travel to hospitals. A national task force is needed to identify all such possibilities and provide reassurance that they are appropriate.
A second task force should be formed to orchestrate the production of enormous quantities of ventilators, personal protective equipment for health care workers and other medical supplies, and to ramp up our capacity for viral testing. President Donald Trump’s invocation of wartime powers to direct the production of critical equipment is a key first step. We need to mobilize at scale for a range of medical supplies. This task force should operate indefinitely and report to a single manager in the federal government.
A third task force should provide ideas to federal, state and local governments as well as private hospitals for how to increase patient capacity – for example, by building temporary hospitals, and repurposing medical facilities such as outpatient surgery centers. It should also recommend appropriate regulatory changes to accomplish these things.
In order to be able to take up good ideas as they arise, the three task forces should work on weekly deadlines but have no set end point.
Problem: Pervasive illness affecting most of the U.S. population over the course of a year will threaten not just health care systems but other critical infrastructure as well.
Response: People responsible for food production and delivery, power distribution, telecommunication, drinking water, transportation, cyber services and police need to ramp up efforts to protect and maintain these systems, and to detect and report any fragilities and failures. The Defense Department should be engaged to backstop these systems. The Pentagon is already moving to provide incidental support including hospital ships, but a fundamental reorientation of the Department will be needed to prioritize missions at home. The president should appoint a deputy national security adviser to coordinate the effort.
Problem: It is essential to ensure that the U.S. can hold a national election in November safely, securely and democratically, even if contagion persists and social distancing is still necessary.
Response: This problem might be best addressed by enlisting a private, non-partisan entity (for example, a major foundation) to offer expert advice to Congress and to state and federal officials. With a sense of urgency and more than half a year to plan, voting by mail or via the internet – or other alternatives – could be made to work everywhere.
Problem: A long school shutdown and widespread illness will mean missed education, the loss of school nutrition for needy kids, difficulties for teachers separated from their workplace, and psychological effects.
Response: The 50 states can address these issues individually, or they can, more effectively, band together to devise high-quality approaches, calling in help from private sector and nonprofit leaders.
We can win the war against Covid-19 as we have won other wars: by treating it as both an emergency and a long-term challenge. We are rich, ingenious and resolute enough to prevail. But this virus has already shown we cannot wait until the moment of need to get organized.