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How do we exit the COVID-19 lockdown?

How do we exit the COVID-19 lockdown?
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Most of the U.S. has state-mandated shelter in place orders to mitigate the COVID-19 pandemic. Yet, most of us are already asking when will life return to normal? We must understand that the current shelter in place orders cannot have a firm end date and may not be lifted until deep into summer. Resuming work, school and social activity will depend on a sharp and sustained reduction in new COVID-19 cases and the ability to identify, monitor and treat new cases. The hard truth is that normal, like handshakes, might be a thing of the past and a new normal will govern our lives going forward. 

Life in the new normal will require all of us to be vigilant in monitoring COVID-19. If we return to life as it was pre-COVID19, new infections will surge again and all of our time in isolation will have been for nothing. The shelter in place orders we now live under are important to flatten the curve — reduce the number of people requiring emergency room care or hospitalization so as not to overwhelm and collapse the health care system. How effective the shelter in place strategy is will depend on compliance, which is leaky at best. But, it must be understood that the shelter in place orders, no matter how effective, will not eliminate the virus and new infections will resurge if social distancing becomes too relaxed. 

If left unchecked, SARS-CoV-2 will eventually infect more than half of the people on the planet. If those infected develop a lasting immunity, then this level of worldwide infection would reduce the number of susceptible individuals. This drop in the numbers of susceptible hosts will break the chain of infection and transmission, providing protection to the remaining susceptible population — a concept known as herd immunity. But, this course of unfettered infection to acquire herd immunity would come at the staggering cost of millions upon millions of lives. The time bought by the shelter in place orders must be used to develop vaccines and anti-viral drugs, which will produce herd immunity without the loss of life. 

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Given the time required to develop safe and effective anti-viral drugs and vaccines and the fact that immunity to SARS-CoV-2 remains a big unknown, we must develop a game plan for resuming life amidst a pandemic without a vaccine, pharmacological intervention or established herd immunity. This game plan will need to be thoughtfully phased so that restrictions are lifted gradually with time to monitor the effect on new infections. The core of this phased plan requires four equally important points at a minimum.

First, serology tests must be available to determine who has protective antibodies to SARS-CoV-2 and how long they maintain them. Those who have been infected and recovered should have immunity to protect them at least in the short-term (1-2 years), but possibly for life. People with protective antibodies can safely return to the workforce and bolster society and its economy.

Second, we must implement widespread testing for infection. Testing must be a centerpiece of the strategy because an estimated 25 percent of SARS-CoV-2 infection result in the asymptomatic spread. The lack of widespread testing has been a serious shortcoming of the U.S. response to the COVID-19 pandemic thus far. That must change going forward. As lockdown restrictions are loosened, we must have widespread testing to monitor the resurgence of cases to know at what point the relaxing of restrictions have gone too far.

Third, handwashing and social distancing will remain the mainstays of the new normal. These are still the best ways to protect ourselves from infection and will have to be practiced in the near future to prevent resurgence until a vaccine, antiviral, or herd immunity is developed. 

Fourth, local, state and federal governments will need to invest in resources for a coordinated response plan to monitor COVID-19. This plan must be nimble to identify and isolate localized resurgence of new infections that will arise when we resume work, school and social activities and, importantly, travel. Contact tracing will be important to a renewed strategy of COVID-19 containment. This response plan must be able to re-instate as well as lift layers of restriction. If we cannot detect and isolate cases in a coordinated manner through the cooperation of local, state and federal governments, then we cannot prevent the return of the outbreak. 

The response to the COVID-19 pandemic thus far has been likened to putting an airplane together while flying it. As our plane spirals out of control, we are scrambling to read a complicated and incomplete instruction manual. As a nation, we must work to marshal protective resources, public health monitoring, and strong scientific and political leadership as we exit the safety of lockdown in order to find our new normal. 

Felicia Goodrum Sterling is a virologist and a fellow of the American Academy for Microbiology. She is a professor and scientist at the University of Arizona. James Alwine is a virologist and a fellow of the American Academy for Microbiology and of the American Association for the Advancement of Science. He is a professor emeritus at the University of Pennsylvania and a visiting professor at the University of Arizona.