The 4 Plans To End Social Distancing

The 4 plans to end social distancing, explained

The plans all say the US needs more testing. But they differ on how much more.

If there is any agreement with the coronavirus pandemic, it’s this: Everyone is looking forward to ending social distancing and reopening the economy. President Donald Trump has loudly advocated for it, sometimes in defiance of public health experts. Other officials, like former Vice President Joe Biden, and experts agree that they want the economy to reopen, but they’re more cautious with making any promises about when and how.

Several experts and think tanks have released plans for what this might look like. The right-leaning American Enterprise Institute (AEI) and left-leaning Center for American Progress (CAP) put out detailed proposals. Nobel Prize–winning economist Paul Romer did as well. Harvard’s Edmond J. Safra Center for Ethics, which has worked on bioethics issues in the past, has put out several white papers about confronting the crisis. (Biden also laid out a plan in a New York Times op-ed, but it’s pretty vague.)

The plans are grim. They do suggest there’s a way back to normal life, but they make clear that it will likely take a long, uncomfortable, even painful time to get there. The CAP and AEI plans in particular suggest the US won’t be able to fully end social distancing until 12 to 18 months from now — with a true end requiring a vaccine or some other therapeutic to prevent or treat Covid-19, the disease caused by the SARS-CoV-2 coronavirus.

To put it in terms my colleague Ezra Klein did, these plans are a bit scary. They show the US is likely stuck with some level of social distancing for at least months and possibly a year or more. That’s going to lead to a significantly weaker economy, with lost wages and higher levels of unemployment. That’s less time people can spend with friends and family. It’s less time with favorite hobbies and activities. It’s a formula for a loneliness epidemic.

But that’s all necessary, according to the plans, to slow and halt the spread of the coronavirus, which could lead to hundreds of thousands or millions of deaths if left uncontrolled.

While they differ in important ways, the plans suggest the US will go through the crisis in three phases:

  • In the first, and current, phase, America does widespread social distancing. The idea is the country needs broad, untargeted physical distancing measures to flatten the curve of new coronavirus cases. Until cases drop to a certain point, it’s just not safe to go out. This will likely last at least a few more weeks.
  • In the second phase, the US relies on surveillance, particularly more widely available testing, to ease social distancing measures. This would not mean a total end to physical distancing. The proposals mostly still call for prohibiting large gatherings and limiting socializing for vulnerable populations, such as those who are older or have compromised immune systems. There’s also a possibility the country or parts of it will have to go back to much more widespread social distancing if coronavirus cases increase. This phase could end up to 12 to 18 months from now.
  • In the third and last phase, a vaccine or other treatment that can reliably prevent or treat Covid-19 is developed. This allows the country to end social distancing entirely — though hopefully it establishes policies to better mitigate future disease outbreaks.

The plans, however, really begin to differ when it comes to how social distancing can be eased during that second phase — with different views on what kinds of tools should be used.

AEI and CAP lay out a framework through which the US phases into more testing and less social distancing, although CAP focuses much more on digital surveillance and contact tracing through a phone app. Harvard’s Safra Center explicitly calls for much more testing than CAP and AEI, but it also envisions a wartime-like mobilization that seeks to, in essence, make the best out of the country’s time social distancing. Romer’s plan is perhaps the most aggressive and single-minded on testing, calling for a scale of testing that no one else does.

A big caveat: These plans carry some assumptions, because there’s still a lot about Covid-19 and the coronavirus we simply don’t know. It’s uncertain if the virus could burn out in the months ahead or if hotter temperatures could slow its spread, which may cut the need for social distancing in the future. It’s unclear if people can become reinfected. Scientists are still figuring out all the ways the virus spreads and how deadly it truly is.

These plans, then, are about trying to put forward the best ideas with the best information available.

One thing they don’t address is political feasibility, and it’s not clear the US could actually follow any of these plans successfully. America has already struggled with its response to Covid-19 — failing to prepare for a pandemicbotching the rollout of tests, and suffering shortages in health care supplies. It’s been slow to fix these problems. Even as cases and deaths have grown, some leaders, including the president, have suggested that reopening the economy is a top priority. All these factors should cast doubt on how well any of this will be handled.

But the plans, at least, offer a way out — as grim and potentially unfeasible as the path may be.

The plans rely on extreme social distancing now and much more testing

The plans generally all say that extreme social distancing, as most parts of the US are practicing now, is needed to get Covid-19 cases low enough that it’s safe to resort to softer measures. The CAP plan even suggests the US needs to lock down further, arguing that all states should issue and enforce stay-at-home orders — which hasn’t happened so far — for 45 days.

The US needs extreme social distancing in part because it let the outbreak get so out of control before taking proper action. As a recent New York Times investigation concluded, Trump received warnings from his administration’s officials and experts for weeks that the outbreak was getting bad and required quick action, but he ignored such warnings. Some local and state officials, like New York’s, were also relatively slow to act. That amounted to, in one example, weeks in delays in getting coronavirus tests out — what the Times dubbed “the lost month.”

“What social distancing is doing is reversing — of course, with the cost of tens of thousands of Americans dying — the losses of two months of inaction,” Ashish Jha, the faculty director of the Harvard Global Health Institute, told me.

Every plan is clear that ending social distancing will require widespread testing — several times larger than the amount of testing the US is doing now — to track and control new clusters of outbreaks.

Though the plans agree on that, they differ on how much testing is needed. CAP doesn’t set an exact target, explaining “the number of tests needed should be guided by conditions on the ground.” AEI initially set a target of 750,000 per week, but the report’s authors clarified that was a bare minimum for when there are no more regional outbreaks and that as many as 3.8 million tests a week, or more than 500,000 a day, could be needed. The Safra Center suggests at least millions of tests a day. Romer is the most aggressive on testing, calling for more than 20 million tests a day.

The US is not there yet. Over the week of April 6, the country averaged about 150,000 tests per day. That’s an improvement from early March, when daily tests numbered below the dozens and later the hundreds. But the daily total hasn’t improved much compared with the week of March 30, when the US completed an average of more than 130,000 tests a day. And it’s a far cry from what any of these plans are calling for.

Early on, there were regulatory hurdles to testing people and private labs doing Covid-19 tests. Today, the problems are largely focused on supply: There aren’t enough swabs, test kits, reagents, personal protective equipment, staff, or machines to run the specific tests required, with different places experiencing one, some, or all of these problems on a day-to-day basis.

“Any one link in the chain of supply, any restriction in the chain of supply, can suddenly create a bottleneck,” Louise Serio, a spokesperson for the American Clinical Laboratory Association (ACLA), which represents the private labs, told me. “No labs have, really, the predictable, consistent access to all the supplies we need.”

The tests themselves could also be better. More accurate, faster tests and ones that check for potential immunity could all help if they become widely available. For now, these other kinds of tests are still in development or scarce.

According to all the plans, the US will need to fix its testing shortfall to safely ease social distancing anytime soon.

The plans differ on what comes after today’s social distancing

Even with more testing, the plans generally agree, or at least imply, that there will not be a return to normal anytime soon. At the very least, building the testing capacity required will take weeks if not months. Getting Covid-19 cases down to a safer level, without that testing, will require weeks if not months. The ultimate point of relief will be a vaccine, which is likely at least 12 to 18 months away.

Even once testing is scaled up, the CAP and AEI plans agree that the country will need at least some level of social distancing until a vaccine or effective treatment is developed. Both make it clear that, for instance, gatherings of 50 people or more should be restricted or banned, and people who are more vulnerable to coronavirus, like older adults or those with underlying health conditions, will have to remain vigilant and continue social distancing.

One way to think about the plans: They’d likely let you visit friends or family in small gatherings in their homes, but you probably won’t be able to go to a stadium, concert, or movie theater anytime soon, even with these plans in place. Restaurants and bars will likely operate at limited capacity. Schools could open as well, but with some physical distancing measures in place.

CAP’s proposed air travel rules are instructive: “Airline passengers must download the Contact Tracing app, confirm no close proximity to a positive case, and pass a fever check or show documentation of immunity from a serological test.” So air travel would technically be possible, but it would look very different from how it worked before Covid-19.

Still, all the plans do suggest easing social distancing to at least some degree as time goes on. The difference is how, exactly, this is done.

AEI calls for a soft reopening, with specific goals that have to be hit, including 14 days of a reduction in new reported coronavirus cases and enough capacity to test all people with Covid-19 symptoms, to move to the next phase. It suggests states will need to slowly build up contact tracing and health care capacity to ease social distancing. They should also be ready, the plan indicates, to shift back to stricter social distancing if Covid-19 cases rise. This gradual move toward less social distancing will play out state by state — and eventually the whole country should be able to fully open back up.

CAP calls for a soft reopening that similarly relies on more testing and health care capacity. But CAP puts more emphasis on digital surveillance, particularly a phone app that would track people’s movements to help notify them if they’ve come into contact with someone infected with the coronavirus. (Apple and Google recently partnered to help make such an app possible.) CAP acknowledges that this could raise significant civil liberties issues in the US, outlining several safeguards — like putting a nonprofit group in charge and automatically deleting data after 45 days — to mitigate those concerns.

The AEI and CAP plans also offer ideas for making it easier to social distance when it’s necessary. For example, they both suggest repurposing hotels, dormitories, and other currently unused living areas to offer space to people who don’t want to risk infecting family members when they get sick.

Generally, the AEI and CAP plans — which are the two plans put together primarily by public health experts — follow a similar structure: scale up testing and contact tracing; build health care capacity; ease social distancing over time; and remain vigilant for another wave of Covid-19 cases. They caution that at least some level of social distancing may be needed for as long as 18 months.

The Safra Center’s plan calls for millions of tests each day — far more than CAP or AEI explicitly propose — and a kind of wartime economic mobilization to confront the outbreak.

The goal of the mobilization is to minimize the economic damage of social distancing, do things to help take on the outbreak now, and address longstanding social and public health issues elevated by the pandemic. It includes, for example, a dramatic buildup of the health care workforce, production of personal protective equipment (such as masks), more digital infrastructure (to allow better surveillance and working from home), widespread cleaning and sanitation services, and support for elder care.

“Freezing in place idle workers, empty spaces, and unused equipment at a time of such acute need would be costlier not just in narrow economic terms, but also in our ability to support and perform the most critical lifesaving functions,” economists Glen Weyl and Rajiv Sethi wrote.

Romer’s plan, meanwhile, focuses entirely on testing — tens of millions of tests every day. He envisions the US running more than seven times the Covid-19 tests in a single day than it has during the entire duration of the coronavirus pandemic as of April 13.

Using an economic model he developed to gauge the effects of widespread testing, Romer argued a very high level of testing would make it possible to stop most if not all the current social distancing measures.

The idea: If the US tests just about everyone, and retests people every one or two weeks to make sure their conditions don’t change, the nation would be able to isolate a much smaller fraction of the population — just those confirmed to be infected — instead of taking blanket social distancing measures. Romer’s model accounts for false negatives and false positives, which he finds aren’t a real drawback if testing is aggressive enough.

The catch here, of course, is this requires dramatically scaling up testing — to roughly 150 times the current capacity. This is, to put it lightly, extremely ambitious; Romer compared it to building the US’s interstate highways, which took years. Testing at such a level would also take a massive investment in labs and supplies. Even if it’s possible down the line, it’ll take time — months, if not years — to scale up to that point, during which at least some level of social distancing measures will be necessary.

But if Romer’s modeling is to be believed and if such a level of testing proves possible — and those are very big ifs — it’s a way out of widespread social distancing even before a vaccine or other treatment is widely available. At the very least, it shows how valuable it would be to simply test many, many more people.

It’s unclear if any of these plans are politically feasible

There is good empirical evidence that doing what these plans are calling for would work. One of the big lessons from the 1918 flu pandemic, which was linked to up to 100 million deaths globally and about 675,000 deaths in the US, is that early, aggressive, and layered social distancing works — not just to save lives, but to help economies recover after a disease outbreak. In a modern context, South Korea managed to control its coronavirus outbreak with the kind of aggressive testing-and-tracing strategy that all these plans propose.

What’s less clear is if any of these plans are practical or sustainable.

These plans require at least weeks of extreme social distancing, followed by months of reduced but still significant social distancing and potentially new waves of lockdowns if coronavirus cases rise again. In total, people could be forced to do a year and a half — or more — of at least some social distancing. That’s … a lot.

Less than a month since states issued stay-at-home orders, there have already been cracks in the process. Trump backed down from his hopes of reopening the country by Easter, but he has reportedly continued to push opening the economy soon, even as his experts advise against it. In the middle of an election year, Trump seems particularly eager to get the economy back on track.

The general public and other leaders may come to side with Trump as social distancing drags on for months and months. “I don’t think people are prepared for that and I am not certain we can bear it,” Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security, previously told Vox. “I have no idea what political leaders will decide to do. To me, even if this is needed, it seems unsustainable.” She added that while she may just be feeling pessimistic, “it’s really hard ... to imagine this country staying home for months.”

Further complicating matters is that the benefits of social distancing are largely invisible while they’re occurring — because there’s no clear indication when a coronavirus case or death is avoided. “It’s the paradox of public health: When you do it right, nothing happens,” Tara Smith, an epidemiologist at Kent State University, previously told me.

It’s the kind of situation that requires clear leadership from the top. But the US is dealing with this in a fragmented federalist system, with states largely on their own when it comes to public health policy and particularly mandating social distancing. Trump could offer some guidance here, but between denying that coronavirus was a major threat early on and more recently calling for a return to normal, he hasn’t shown he can reliably do that. (To this end, both West Coast and East Coast states have been forced to put together their own regional plans in lieu of a federal strategy.)

All of this is likely to fuel greater demand to end social distancing, especially among risk-averse politicians eyeing their reelections. We know the risks: Cities saw resurgences in flu cases in 1918 when they pulled back social distancing measures, and several countries in Asia are seeing second waves as they’ve eased restrictions. But people can be very good at convincing themselves, especially when they’re already suffering, that maybe this time will be different.

Meanwhile, the only plan that offers a quicker solution is Romer’s, but it proposes a level of testing that’s hard to imagine. The US has taken months to get to 150,000 tests a day. To get to 20 million would require a massive investment in labs, machines, and testing supplies — which Romer himself compared to building the interstate highway system, one of the most expensive infrastructure projects in US history. It also requires retesting people every two weeks, which a lot of the population just might not be up for.

No federal policymaker has called for this level of testing — and some experts are skeptical it can happen. “I’ve talked to some people who want to do 5 million [tests] a day,” Jha, of the Harvard Global Health Institute, said. “I’m like, ‘Okay, let’s calm down.’ I would love to do 5 million a day too, but let’s learn if we can walk before we can run.”

That’s the unsatisfying conclusion from reading these plans: While the US can do things to make the situation better, things likely are not going to be okay or normal for months and months. How the country deals with those circumstances and all the uncertainty involved isn’t something any plan can predict.

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