Lack of a coherent plan endangers social fabric

  • 30 million Americans have applied for unemployment
  • Each day 2,000 Americans die of COVID-19

Which fact scares you more? Which one deserves the more urgent attention? Are their solutions mutually exclusive? Does our Government have a plan?

Flattening the Curve is no longer a sufficient plan

Flattening the Curve was never a complete plan for dealing with the pandemic (See post). It was an urgent short term plan to avoid overwhelming our health care system. Had the growth of the infection been allowed to follow its natural explosive growth, large numbers of Americans would have died for lack of critical health care. Social distancing successfully prevented that.

‘If it looks like you’re overreacting, you’re probably doing the right thing’

Dr. Anthony Fauci

Our success at increasing hospital capacity, and implementing social distancing to flatten the curve, may make some people feel as if the whole thing was an over-reaction. But I think the early statement by the Coronavirus Task Force member Dr Fauci was right on the mark. It only looks like we may have overreacted, because we were so successful. Remember, the alternative was something that looked like northern Italy a few weeks ago, were Italian doctors, working 24 hour shifts were having to choose which multiple desperately ill patients would get the needed ventilator.

But for now, the curve is flattened. Projections from IHME at the University of Washington that were used by the US Coronavirus Task force assumed the outbreak would manifest itself as a bell shaped curve, steep up, peak and steep down again, down to zero. But now that some places are at the other side of the peak, we must realize that the infection is not going to mysteriously disappear.

With a vaccine still 12 or more months away, we need a coherent plan from our leaders. Without a clear plan that our citizenry can rally behind we are each choosing which of the two facts at the start of this post are most scary, and attacking those who feel the other fact is more important.

Men with guns and without masks protesting social distancing policies in Michigan.

Social Fabric Starting to Tear

It is disquieting to see armed men on the steps of the Michigan State house protesting against the Governor’s social distancing policies. It is also disquieting that the President has been encouraging them, even while his government puts out science based guidelines for states to open up, that Michigan clearly does not meet.

But it is not only this fringe element chaffing against social distancing. There are other indications that Americans are experiencing social distancing fatigue. For the last couple of weeks, the average daily travel distance of Americas, as reported via anonymous cell phone data has been rising. This was even before some states started loosening social distancing to allow for more economic activity.

In my neighborhood I have noticed that groups of teenagers appear to be secretly meeting in small groups to shoot hoops, turn up the radio and just hang out. The media is full of stories of parents struggling with the natural desire for their kids to hang out with friends. As we have grown accustomed to daily death totals that only weeks ago would have shocked us, it will not be surprising if as we see even small declines in the number of deaths, we will see a tendency to reduce social distancing precautions.

Need to articulate a Coherent Plan:

With the curve flattened, we are now floundering for a plan to get from here to a place where the infection is no longer killing hundreds or thousands each day. The Federal Open Up American Again does contain some science based criteria for when and how states should open up.

Open Up America Again Criteria for States:

  • Downward trajectory of influenza-like illnesses (ILI) reported within a 14-day period
  • Downward trajectory of covid-like syndromic cases reported within a 14-day period
  • Cases
    • Downward trajectory of documented cases within a 14-day period, or
    • Downward trajectory of positive tests as a percent of total tests within a 14-day period (flat or increasing volume of tests)
  • Treat all patients without crisis care
  • Robust testing program in place for at-risk healthcare workers, including emerging antibody testing

In addition to the above criteria, the Open Up America Again plan calls for states to have a set of capabilities prior to opening up including:

  • Ability to quickly set up safe and efficient screening and testing sites for symptomatic individuals and trace contacts of COVID+ results
  • Ability to test Syndromic/ILI-indicated persons for COVID and trace contacts of COVID+ results
  • Ensure sentinel surveillance sites are screening for asymptomatic cases and contacts for COVID+ results are traced

These are significant criteria and capabilities, but it appears they are not really gaining much traction nor attention in the actual opening up debate.

The men in Michigan are not armed with graphs showing 14 day downward trends in new cases, nor are they armed with maps showing the number of sentinel surveillance sites used to screen for asymptomatic cases in their states. Instead they are armed with automatic rifles.

The Open Up America Again plan may not be perfect, but it does contain some sound science. But it seems like no-one is really taking the science part very seriously. If our nation’s leaders would put some teeth into the Open Up America Again scientific advice, and if the media could creatively switch from reporting flattening the curve statistics to metrics that would measure states against the Open Up America Again criteria and capabilities we might be able to get everyone to pull in the same direction. The plan just below the science outlined in the Open Up America Again plan is that of containment through rapid case identification and contact tracing. There are also a number of proposals floating around in Congress relating to funding a nationwide contact tracing plan. Some states are also ramping up more robust contact tracing capabilities.

It’s hard, science can be boring, and just as we are growing tired of social distancing, we may be growing tired of graphs and charts about COVID-19. But our state and national leaders need to shift the narrative from the short term goal of flattening the curve, which is now old news, and mostly over. The narrative should shift to the struggle to meeting the criteria in the the plan to Open Up America Again. That criteria is based on the more long term goal of containment to enable the safe lifting of the social distancing. It needs to be done in a way that engages people whose greatest fear is growing unemployment, and those whose greatest fear is continued deaths due to Covid-19.

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