Social isolation is playing defense. It’s a tool and it’s very effective. It’s the equivalent of taking a sledge hammer to a fight. It buys off time. The curve is starting to flatten in Italy and other parts of the world that have adopted social distancing measures. You can’t get infected if the virus doesn’t know where you are. But there is a problem. Social isolation is half of the battle. A battle has to be fought on multiple fronts. If you don’t know who has the virus, you can’t see where it is and where it isn’t. If you can’t see where it is, you don’t know how to fight it, except by shutting everything down and telling people to stay away from each other. In addition to a sledge hammer we now you need a scalpel. We need to get surgical. Testing in an outbreak gives you data. The data provides two functions. One is to diagnose those who are sick. The other is surveillance: to see where the virus may be lurking, especially in cases where symptoms are mild or don’t manifest at all.
Before we have a vaccine and a victory parade, we need massive testing. The key forward in this battle is testing, testing, and testing. We need to be aggressive on that front. That’s how we will know how wide spread the virus is. Test positive: Hide for fourteen days. Test negative: Go to work. The countries that have tested the most people are also the countries with a better handle on the virus. Why? Because they have data. South Korea and Singapore have been exemplar in their response. Italy is the “what not to do” example and the U.S. is providing serious competition for the title. In Italy the pandemic has turned into a disaster. Italy has only twice as many cases as Germany but almost 50 times the deaths. The Germans have tested huge numbers of people and the Italians have tested only people with serious symptoms. That is, some vast numbers of Italians has had the virus but were never tested, either because their symptoms never sent them running to the hospital or they never even knew they had it. In a matter of weeks (from February 21 to March 30), Italy went from the discovery of the first official Covid-19 case to 11,591 deaths. Within this very short time period, the country has been hit by nothing short of a tsunami of unprecedented force, punctuated by an incessant stream of deaths. This is the world’s biggest crisis since World War II.
We need mass testing for both the affected and the asymptomatic. Social distancing slows the disease to manageable level. That way we ensure hospitals have the equipment and resources they need. We’re going to need other kinds of testing, too, like serology — testing of people’s blood. That way, we can figure out who has already had the disease and is now immune and can safely return to be in contact with others in society. When that happens, we can move to a more sustainable mitigation strategy. Any sustainable strategy against Covid-19 has to balance public health and economics. It will need to be done in phases. You can’t just turn on the economic faucet to full and nuke the health care system. Low risk and younger people will be able return to work. Gradually allow “nonessential” businesses to reopen (prioritize reopening in industries compatible with physical distancing first).
With aggressive wide spread testing we can start to go back to our normal lives, or a new normal, while savings lives. It’s not the case that everything could go back to normal. A new normal includes some level of social distancing measure in place with tracking and isolating cases. No more handshakes and kisses. That’s over for a while.
Stay safe and thank you for reading,