How to get the economy safely back to work in just 2 weeks
Our country desperately needs a coronavirus end game. Putting the country into another month’s quarantine, as the president just announced, is not an end game. If after a month the infection and death rates are down, which they surely will be, and we release everyone back into the wild, the rates will go right back up. To prevent that we need to test the “healthy” as well as those with symptoms.
The main reason for testing the sick is to isolate those who don’t have the disease from those who do. As for those who are infected, the test doesn’t much matter. At this time, their therapy is little different from that applied to patients with other respiratory diseases.
Testing the “healthy” is vital for two reasons.
First, the “healthy” may be infected and asymptomatic, yet still spreading the virus. Hence, testing the “healthy” can help us quarantine those who are infected but so far asymptomatic. Such individuals can choose to quarantine by themselves or with their household members.
Second, the “healthy” who test negative can be allowed to return to work, attend school, shop, frequent restaurants, etc. What’s more, they’ll do so knowing they aren’t coming into contact with infected individuals.
Indeed, the goal, as discussed in this column, is to test every American at a single point as often as needed to identify those who are and who are not infected and to isolate those who are infected. This will stop the rampant spread of infection in its tracks. If we reach a point where the infection rate begins to rise because the population has not yet acquired herd immunity or been vaccinated, we could repeat the group testing that we propose as frequently as needed. Being tested, even on multiple occasions, is a small price to pay to get out of quarantine and return to a normal life.
This policy can start immediately thanks to group testing. Group testing is enormously more efficient than individual testing, as it dramatically reduces the number of tests required to sample the entire population and is feasible in a timeframe necessary to isolate infected individuals. We propose a universal testing scheme based on voting districts, not dissimilar to universal voting. On each universal testing day, each individual would be swabbed twice at their assigned testing station, using two separate swabs. One swab from each individual would be pooled with approximately 1,000 other swabs of other individuals whose identities would be recorded by the government.
The pooled sample would be tested immediately. If the pooled sample is negative, we would know, with just one test, that all 1,000 people were virus free. Alternatively, if the sample is positive, each of the 1,000 remaining second swabs would be tested individually to determine precisely who within the group are the positives. With complete compliance, we’d identify each positive individual in the country while reducing the required number of tests to a number that could be performed in a day — roughly 330,000 pooled cohort tests assuming the infection rate is 1/1000, followed by a few million tests to identify the positive members of the groups. In short, we could test the entire U.S. population essentially overnight, and quarantine all infected individuals immediately so that they would no longer spread the infection. The quarantine could be of the individual or of all members of the household, but would require strict oversight, food delivery and medical monitoring.
The size of group tests should be smaller in hot spots, larger in cold spots, and could be adjusted over time based on population disease prevalence data. A second factor would be confirming the sensitivity of PCR reactions for the largest swab sample sizes and adjusting the extraction procedure — details that could quickly be worked out in centralized laboratories. PCR is an exquisitely sensitive testing method, as it exponentially amplifies the viral genetic material.
Group testing is so efficient that millions of people will be cleared to return to society within a few days. Those not cleared will remain in quarantine. And repeat testing would ensure that false negatives are quickly found and that the virus is very quickly contained. This plan will save hundreds of thousands and perhaps millions of lives and avoid another Great Depression.
Of course, not everyone will or will be able to comply. This is an important limitation of our proposal. But even if we identify only 70 percent of the current infected, universal group testing will have an enormous impact on the spread of the disease and will have empowered millions of Americans to return to their normal lives.
The president should set up a Department of Molecular Biological Defense within the Department of Defense and assign appropriate logistical and health experts, as well as military personnel as needed, to operationalize this national testing protocol. This is fully in line with his role as a wartime president.
Laurence Kotlikoff is a professor of economics at Boston University. Michael Kotlikoff is the provost of Cornell University and a professor of molecular physiology.
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