Everyone in America has the same question: When will life be back to normal?
The answer, experts say, is unsatisfying, with the timeline obscured by the country’s inability to catch up to the coronavirus’ spread. Health specialists and economists are calling for an enormous surge in testing capacity. They also urge a similar increase in the number of people dedicated to contact tracing — the tracking and isolating of cases of COVID-19 — before the economy can be reopened safely.
There’s little evidence the country is ready or able to immediately implement those measures.
Testing remains uneven. Projections call for more deaths and hospitalizations to come, with Florida hitting its peak later this month or next.
Even as President Donald Trump says the economy will hopefully be reopened “very, very soon” and Gov. Ron DeSantis won’t rule out that Florida students could be back for two weeks of classes next month, many prognosticators are reluctant to even guess when life could return to some semblance of normal.
Doctors say drugs to better manage symptoms and prevent the worst cases could be months away while developing a vaccine could take a year or longer. Florida Surgeon General Scott Rivkees said Monday some level of social distancing might be necessary until a vaccine is available.
“I don’t know of a magical date when everything would be okay again,” said Cindy Prins, an epidemiologist at the University of Florida.
Academics have begun releasing plans for restoring public life, generally calling for a slow drawback of social distancing, based on geography and risk. Some do not believe people will be back to cheering at ballgames or celebrating holidays in big groups until fall at the earliest. Restaurants might come back sooner, but with the tables spread far apart. At work, and the grocery store, people might need to continue wearing masks.
Social distancing, despite popular misconceptions, was never meant to be a cure. It was “a pause button” to buy time for health and elected officials to marshal resources, said Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security.
Once the economy is reopened, experts have alternately suggested America needs to process millions of rapid tests per day, or to have 100,000 new workers investigating positive cases. Florida is the third-largest state in the country, with a highly vulnerable population of elderly people. Last week, it reported about 60,000 tests. In March, state officials scrambled to hire 100 people from local universities to help 264 infectious disease specialists already working on contact tracing.
State officials did not provide answers when asked how many people are working on contact tracing in Florida, or how many contacts they could reach in a day. They also did not say whether DeSantis has drafted plans for reopening the economy, or specify what percentage of people in a given area would need to be tested before the state can assume a regional outbreak is contained.
Health and economic specialists say these are the questions Florida needs to answer. DeSantis’ statewide safer-at-home is set to expire April 30.
“We will continue to prepare, mobilize and distribute resources across the state in the coming weeks as we respond to this virus,” said Jason Mahon, a spokesman for the Florida Division of Emergency Management, in a statement. He said contact tracing is happening regularly, just as epidemiologists do for other infections like HIV, Hepatitis A and Hepatitis B. “As additional resources, tests and new technologies become available, the state will explore every avenue available to keep Floridians safe.”
Recent research shows how extraordinary the state’s response must be if leaders wish to swiftly reopen Florida for business.
Specialists from Johns Hopkins Center for Health Security and the Association of State and Territorial Health Officials said the United States must hire 100,000 new workers and train them to do coronavirus contact tracing. The idea is that freeing up society will certainly lead to more infections, but aggressive individual casework can mitigate the virus’ spread.
They noted that in Wuhan, the Chinese city believed to be the source of the pandemic, the government deployed 9,000 workers to conduct tracing for a city of 11 million. Florida alone has more than 21 million residents, and has drastically cut public health funding in the last decade.
“A contact tracing effort of this unprecedented scale and of this critical and historical importance to the functioning and reopening of society has never before been envisioned or required,” the researchers wrote. “And our current core public health capacity is woefully insufficient to undertake such a mammoth task.”
Prins, the UF epidemiologist, said the United States lost time early when it did not have the means to test people widely. With a pandemic, time means lives — as the disease spread unchecked and more people were hospitalized or died. That’s part of what necessitated social distancing — a step that was more like an ax than a scalpel, restricting everyone because we did not know enough to limit only those who were sick.
“We lost control,” said Asal Mohamadi Johnson, a public health professor at Stetson University. “That is the unfortunate truth.”
A recent report from the American Enterprise Institute noted state officials should look for a 14-day sustained reduction in cases before reopening parts of the economy. If public life starts again too suddenly, without a system in place to identify and isolate patients, officials will have to reinstate the blunt social distancing approach.
While top health officials say more tests are coming with faster turnarounds, including one that could identify someone who has virus antibodies with only a finger prick, there is no concrete timeline for scaling up millions of tests a day. Further, medical research has not yet determined exactly how long a patient who recovers from COVID-19 will have immunity, or how strong that protection is. Better understanding of the process is critical to knowing who can go back to work and when.
“We’re going to need to have some identifying button or something that they can use that will indicate that they are immune,” said Dr. Charles Lockwood, dean of University of South Florida’s Morsani College of Medicine.
Paul Romer, a Nobel Prize-winning economist who has called for a dramatic increase of U.S. testing, has suggested innovation and the clearing of bureaucratic choke points will allow the U.S. to test each resident at least once every two weeks.
“When someone tells you that ‘We could never test that many people,’ ask ‘Ok, so your plan is to stand by and do nothing as asymptomatic spreaders kill their colleagues?’” he wrote on Twitter last week.
A team tied to Harvard University, in a paper titled “When Can We Go Out?,” argued for a response dependent on a national unity rarely seen in American history. They called for a multi-trillion dollar government injection and a reorientation of the flailing economy to work on the coronavirus response. That would involve creation of contact tracing technology, the development of masks and other protective equipment and a boosting of the Medical Reserve Corps of immune people to help with education and tracking.
Other countries have had some success with accelerated testing and aggressive contact tracing, including Iceland and Singapore, a small, wealthy country in Southeast Asia that was able to keep the virus relatively at bay for weeks before returning travelers and outbreaks in migrant worker housing caused cases to rise. But such efforts have sometimes relied on technology like GPS tracking that would immediately raise significant concerns about privacy and personal liberties in the United States.
Complicating the planning process further has been a series of mixed messages from the federal government. In recent weeks, the president has vacillated between calls to reopen the economy and pleas for social distancing.
The White House has declined to issue a national stay at home order, delegating authority to the 50 states to close down public spaces. But on Monday, Trump appeared to announce on Twitter that the federal government — not the states — would decide when the usual order is restored.
“Some in the Fake News Media are saying that it is the Governors (sic) decision to open up the states, not that of the President of the United States & the Federal Government,” Trump wrote. “Let it be fully understood that this is incorrect.”
The president has said he plans Tuesday to introduce a new federal working group he has called the “Opening Our Country Task Force.”
Times staff writers Graham Brink, Justine Griffin, Langston Taylor, Lawrence Mower and Malena Carollo contributed to this report.
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