The U.S. Chamber of Commerce hosted a fascinating video conference this week entitled “Big Picture: Road Map to Reopening,” with the Chamber’s Suzanne Clark and Dr. William Hanage, an infectious disease epidemiologist at Harvard’s Chan School of Public Health. The full video of the conversation between Clarke and Hanage is below.
The Chamber’s members are understandably eager to know when they can expect to reopen their businesses and under what circumstances. For the moment, though, public health officials are dealing with a great deal of uncertainty. The data that would guide sound decisions on reopening are simply not available yet. Testing for live infections is still expanding, and projects to track the prevalence of post-infection antibodies are just beginning. And even if we knew how many people were producing coronavirus antibodies, researchers still don’t know the degree or length of immunity they confer.
The event did, however, offer some useful observations beyond “more research is needed.” Clark referenced Ross Douthat’s column in The New York Times from earlier this month in which he describes a coming “semi-normal” phase between the current crisis and eventual normality, in which some restrictions on work, travel, and other economic activity are lifted in some places, but during which many limits on social contact will remain. Assuming optimistic estimate about being out of the crisis phase in a month or so (the social distancing and business closure order locally in D.C., for example, is set to expire on May 15), we will likely be in for several additional months of semi-normal during which many businesses will reopen but large scale events like sporting events and concerts will still be off the table.
Dr. Hanage mentioned several important elements of the public health response, many that we’ve been seeing widely discussed:
- More testing for general population
- More contact tracing for people who test positive
- Antibody testing for the general population
- More research on the extent of antibody immunity
- Digital tracking to identify and contain major exposure events
- Return to public places like offices and churches only with masks
Hanage also mentioned a few less frequently discussed points, including that it will be possible to estimate infection (and thus, eventually, immunity) levels by examining municipal sewage. People shed virus particles that make their way into a city’s waste management stream, which can yield important information for public health officials. He also cautioned that while it is an important precaution, mask-wearing is not a silver bullet to prevent transmission. If wearing a mask causes someone to touch their face more often to adjust it, it could be doing more harm than good. He suggested that we will need more public education on effective mask wearing. Post-infection immunity may also be more complicated that many of us are assuming. Hanage suggested that some initial infections may actually leave patients more vulnerable to dangerous symptoms if they’re reinfected at a later date.
Whatever the timeline ends up being for reopening office, stores, and restaurants, it seems that we need to already be planning for smaller scale resurgences. Because there is so little precedent for quarantine on this scale, and because the authority of individual governors will mean different policy responses in different states, it’s obvious that some regions will do better than others, and some will see second-wave infection hotspots in future months. Hanage emphasized the need, as soon as the current level of infections subsides, to invest in rebuilding and restocking medical supply infrastructure, so that we’re not caught with exhausted capacity down the road.
Of course, eliminating #NeverNeeded government restrictions on the health care industry will go a long way toward helping achieve that goal.