How to prevent second wave of coronavirus cases for New York

How to prevent second wave of coronavirus cases for New York
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Following weeks of stay home orders and business closures, New York is finally starting to reopen. While most residents are eager to resume their lives, New York does not have final strategic guidelines or any systematic approach that will help us to avoid the feared second wave of coronavirus infections. If we are to reopen safely, then we have to start by introducing sensible guidelines based on our knowledge of the coronavirus to date in order to prevent a second wave of infections and avoid the need for stay home orders or business closures during the recovery in the future.

We know that the coronavirus has not mutated over the last three months, meaning that its biology, lethality, and transmissibility remain the same as when the lockdowns started. We know that more than 10 percent of New York residents are antibody positive, meaning that they have overcome the coronavirus and are presumably immune to reinfection. This would offer limited protection for those who have not been infected, but this alone is certainly insufficient to prevent a second wave of infections.

What sets this disease apart from the other coronavirus strains over the past century, which were both significantly deadlier, is the fact that this coronavirus has many asymptomatic carriers, making it a larger invisible world threat than the Middle East respiratory syndrome and severe acute respiratory syndrome. Before New York starts its process to reopen, it is absolutely critical to identify these asymptomatic carriers so that we can prevent or at least dramatically reduce the spread. In doing this, we can prevent a second wave that is more devastating than the first wave.

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Given that we know some people are more vulnerable to the coronavirus than others, only those individuals under the age of 65 years old with no significant medical issues should be allowed to enter society at this time. These individuals could provide the labor force needed to allow the more vulnerable to stay at home while still enabling the critical recovery in the economy. Those over the age of 65 or those who are younger and have significant medical issues should not enter society if at all possible until there is a vaccine or an effective treatment that is widely available.

There are several misperceptions as to when and how people can safely enter society without risking exposure to the coronavirus, as the public has been told that most activities can resume as long as precautions are taken, despite the deadly toll of the coronavirus. The way to clear up this confusion is by continuously expanding testing. Unfortunately, however, we have extraordinarily little data because of limited testing to date.

Individuals who are under the age of 65 with no significant medical issues should be subject to a system of risk stratification, which would be given to those people who enter society with the goal to help these individuals understand their own risk factors. Every New York resident would receive both coronavirus testing, which determines whether one currently has it, as well as antibody testing, which confirms whether one has already had it. Individuals would then be designated as green, meaning safe for entry, yellow, meaning moderate risk of entry, or red, meaning no entry yet.

People who test negative for the coronavirus and positive for the antibody should be designated as green because they can safely enter society and feel reassured that they are not susceptible to getting reinfected with the disease. Further, the individuals who test negative for the coronavirus and negative for the antibody should be designated as yellow and can start to enter society with caution since they are still susceptible to infection.

Individuals who test positive for the coronavirus should be designated as red, should quarantine for two weeks, and should not enter society unless they have had two consecutive negative coronavirus tests 24 hours apart. Moreover, this testing needs to be done at the minimum of once a month, ideally once a week, to determine whether the individual has contracted the coronavirus or has the antibody to guard against future infection.

We cannot prevent a second wave until we identify asymptomatic carriers who might spread the disease and identify all those who can enter society with low risk levels or who are coronavirus negative and antibody positive. To avoid a second wave that could overwhelm the health system, increase the death toll, and create further economic devastation, then we have to impose policies that will protect the most vulnerable and rely heavily on testing to figure out all the various infection risk levels of individuals.

Sandra Gelbard is a board certified internal medicine doctor and clinical instructor at Langone Medical Center and Lenox Hill Hospital in New York City. She is a member of the American Medical Association and American College of Physicians and has been featured in numerous news programs.