Getting to the COVID-19 finish line: A drama in three acts
Vaccines are coming, and there’s no question that they are our best hope. But simply waiting for their arrival puts us on the road to perdition. In the U.S., hospitalizations are almost double their spring peak, and daily deaths are at a seven-day average of more than 2,000—a high we haven’t seen since late April—and they’re continuing to rise.
At this pace, at least 200,000 more Americans will die of COVID-19 by spring 2021, adding to the 290,000 deaths to date. Numbers like these bring us close to the losses suffered in the Civil War, our nation’s deadliest conflict, when 620,000 American soldiers died.
It doesn’t have to be this way.
We think the story of the end of the COVID-19 pandemic must unfold in three acts. To save the most lives and defeat the virus swiftly, we need to understand the coming sequence—even if we will work on all three acts simultaneously.
We managed to flatten the curve last spring, and we know far more about COVID-19 now than we did then. But flattening the curve in the middle of winter, when people can’t socialize outdoors, is a different story. And we now know that telling millions of young, healthy Americans to stay home indefinitely does not work when they’re at no more risk from COVID-19 than from the seasonal flu.
These three acts require holistic and responsive strategies that allow us to fight the current crisis while creating a bridge to the vaccines that are months away from broad distribution.
Act I: Mastering “epinomics”
Act One is about balancing epidemiology and socioeconomics (what we call “epinomics”). An epinomic approach involves managing risk—and the recognition that we cannot eliminate it entirely. We need targeted public health measures that decrease risk with the lowest socioeconomic cost. For example, we know that schools are reasonably safe and extremely important. They should mostly be open. Dining out and traveling, however, come with much higher risk and are not as vital in the short term. These activities should be mostly curbed where prevalence is higher.
For this act to succeed, Congress must pass urgent fiscal stimulus support to give citizens the food, income, and employment security needed to make these measures bearable and compliance possible. We can also include measures to provide support for the most health-vulnerable populations.
Act II: Virus monitoring
Act Two is about scaling a robust monitoring system of testing and tracing to contain the virus—in particular, by undertaking more proactive screening testing of populations, rather than relying solely on reactive testing for likely cases.
Once health measures flatten the virus, and as vaccine administration ramps up, public officials will be under enormous pressure to broadly open society and the economy—and citizens will be more than ready for looser restrictions. But it will still be cold in much of the U.S. in February, March, and April, and vaccines will not yet be readily available to much of the population. To manage at this phase, we’ll need strong testing capacity, which we are still sorely lacking in many regions.
We’ve made real improvements with diagnostic testing in cases where there are symptoms or presumed exposure, but we still don’t have enough rapid tests to randomly and broadly screen entire populations, such as nursing homes, schools, and prisons, so that we can find asymptomatic cases and act fast. And it’s not just about quantity of tests. Many of the rapid tests we have aren’t accurate enough, are even less accurate on kids, and need further approvals by the FDA.
We need national guidance and systemic support to get the necessary level of screening testing in long-term care facilities, schools, businesses, and across society at large. Our modeling suggests that regular screening testing of about 3% of the U.S. population would enable us to relax restrictions to the same degree we could by vaccinating about 40% of the population—which makes broader testing an incredibly important strategy while we wait to complete our vaccine rollout.
Act III: The perfect rollout
Act Three is about completing the administration of vaccines. We got the best early holiday present possible with the announcement of vaccines that are 95% efficacious. Now we begin the hard work of managing the greatest logistical challenge of our time. We need to execute a flawless rollout and provide clear, transparent communications that drive uptake. At the same time, we need to motivate people to continue observing safety measures and maintain virus-monitoring systems until the supply of vaccine doses grows and we can build up to herd immunity in the spring and summer—and declare victory.
The challenge through these three acts is how to maintain vigilance. Some people may mostly be worrying about when they can get a vaccine and return to normal life—one where they can stop wearing a mask, travel without fear, and see their colleagues and friends in person. But there are 100 million health-vulnerable Americans and more than 50 million exposure-vulnerable workers on the front lines. The pandemic has so far been extremely regressive, impacting these populations at disproportionate rates. If, given what we now know, we fail to take the appropriate actions over these three acts to limit that regressive impact and protect these 150 million, shame on us.
So what do we do right now?
Traversing the three acts will take a coordinated, whole-society response. As eyes shift to vaccines, all stakeholders have critical roles to play and should take the following immediate actions:
The federal government must act immediately and pass a robust fiscal stimulus package to provide income, food, and employment security to protect those whose livelihoods are hampered by public health measures. Without it, we risk not only another recession but the loss of hundreds of thousands of additional lives. The government must also provide support to protect the health-vulnerable, further technology and testing capacity, as well as implementation guidelines to support screening testing and school reopening. Finally, it must continue to move at warp speed to complete reviews and deployment of vaccines.
State and local governments must get people to wear masks and progressively reduce those activities that best allow them to optimize the epinomics. They should provide the resources to help reopen schools safely. They must redouble their focus on ramping up screening testing and tracing capacity—especially in communities of color that have borne a disproportionate burden to date—so they are ready to contain the virus when we are at lower community prevalence at the end of Act I. Lastly, they need to prioritize the vaccination of populations that are most health- and exposure-vulnerable, while implementing robust strategies for administration, data collection, and communication. The federal government should explicitly dedicate some of its next stimulus package to support states and municipalities in these vaccination efforts.
Business leaders must call on Congress to pass a stimulus bill and advocate for sensible public health measures. They should take extra steps to protect their employees and customers, in part by scaling their own virus-monitoring systems. They should also plan for providing time off for eligible employees to be able to get vaccinated, or sick leave for those who have side effects afterward. Globally, in geographies where their employees may have more difficulty accessing vaccines, they can play a role in securing vaccine supply for the communities in which they operate.
Citizens must wear masks and continue to limit the size, frequency, and duration of gatherings. They should tightly manage an “interactions budget” and only expand it as the virus and public health measures pull back. They should participate in screening testing and support tracing and quarantining efforts, and they should seek access to vaccines as soon as they are eligible.
We have been limping along on the road to perdition. This is our last chance to take the off-ramp to the finish line. Let’s not waste it.