Here is the blunt fact about a new, deadly, infectious respiratory disease that spreads from person to person, often by people without symptoms: If “we” reopen the economy without a workable plan to keep infected people in isolation, we will see cases rise again and hospital capacity overloaded. Then more people will die, not only because of the disease, but from lack of adequate care. And more doctors, nurses, and other health workers will get sick and risk death because they are overworked, overexposed, and working without adequate gear.
But wait. Isn’t it true that even in hard-hit New York cases never surpassed hospital capacity? That hard-hit Seattle built an emergency ward and then took it down without treating a single patient there? That Colorado’s positively tested cases (9,433 as of April 17) and deaths (411), although horrible, remain a minuscule fraction of the state’s population of nearly 5.8 million? That some doctors are actually getting furloughed through this?
Yes, all those things are true. But they don’t alter the dynamics at hand. As Rich Lowry explains for National Review, it is not a valid move to observe the victories achieved through social distancing and conclude that social distancing wasn’t needed. Imagine if someone told me I needed to eat right and exercise to avoid certain health problems, so I did, but then I concluded that I didn’t need to eat right or exercise after all because I never developed those health problems.
It is also true that people need to eat, pay their mortgage or rent, keep the power on, and so on. People need to socialize and engage with the world. People can die from a virus, sure, and they can also die from poverty, substance abuse, and depression-induced suicide. Life in lockdown is not sustainable. We are talking about a possible Second Great Depression here, made worse by large scale breakdown of social ties.
So we have two desperate needs: First, to keep spread of the disease within hospital capacity, and, second, to substantially reopen the economy and social life. How do we accomplish both goals at once?
Every serious plan I’ve seen to start to reopen the economy involves widespread testing. As oncologist Ezekiel Emanuel and economist Paul Romer (a Nobel winner and the son of our former governor, Roy Romer) put the point, “Without more tests, America can’t reopen.”
So here is my basic question: Where are the tests? No tests, no recovery. Colorado’s COVID-19 web page reports that, as of April 17, 44,606 people have been tested, a figure that (annoyingly) “may not include all negative results.” That’s less than one percent of the population.
More importantly, testing seems to have stalled, not expanded. Testing peaked on April 11 with 2,688 tests. On April 17 there were 1,728 tests, a 36 percent reduction from the peak and fewer tests than were conducted on March 25. (Again, these numbers are not complete, but they’re the only ones released.)
Colorado’s stay-at-home order is set to expire on April 26. So where are the tests that will enable Colorado to partially reopen safely? We can’t wish ourselves out of this crisis. We need a viable plan, and a viable plan includes massively ramped up testing. Again: Where are the tests?
How much testing do we need? Emanuel and Romer argue that nationally we need at least half a million tests per day, and perhaps 30 million or more tests per day. The higher figure translates to nearly ten percent of the population tested daily, which corresponds to over half a million Coloradans. To reiterate, to date Colorado has tested less than one percent of its population, total.
Obviously there are huge problems with the plan to test ourselves out of the crisis. Emanuel and Romer outline some possible ways to expand testing, but we need actual tests, not hypothetical ones. Moreover, testing nationally has stalled too, they point out. And, so far, they add, mostly the wrong people are getting tested, specifically those with serious symptoms.
It may sound counterintuitive that we need to mostly test people without symptoms, but that’s the logic. “If we want to control the spread of COVID-19, the United States must adopt a new testing policy that prioritizes people who, although asymptomatic, may have the virus and infect many others,” they write. So, they say, we need to test first responders, “critical” workers, people with many social interactions, and “all those who are planning to return to the workplace.”
To be sure, testing is far from the only part of a viable strategy. Voluntary social distancing, contact tracing, targeted restrictions of large-crowd events, increased telework, increased social sanitation and mask-wearing, and increased hospital capacity all will play important roles in the Great Reopening. I’m intrigued by the idea of economist Robin Hanson to enable a subset of the population to seek variolation: controlled, intentional infection. And of course effective treatments might substantially reduce the death toll, and an effective and widely distributed vaccine would solve the problem. But a vaccine is probably years away.
During his April 20 media conference, Governor Jared Polis basically gave up on testing our way out of the problem. He said the disease is too widespread, there aren’t enough tests, Colorado can’t keep its borders closed, and there’s not enough capacity for follow-up contact tracing anyway.
His plan is to reopen the economy a little and to continue to maintain high levels of social distancing. He said social distancing can loosen up a bit from current levels of 75–80 percent to a “new normal” level of 60–65 percent. Schools will stay closed for now; restaurants will stay closed at least until mid-May; retail will shift largely to curbside delivery; businesses will run with limits on in-facility staff; large-crowd events will remain banned. Frankly I’m not sure what else he’s supposed to do. It’s not like he can pull millions of tests out of the air.
Will the limited reopening that we will apparently have to live with indefinitely be enough, despite the extraordinary consequences to the economy and to people’s lives? I guess it will have to be.