AEI Authors US Roadmap for Recovery from COVID-19 Pandemic: Public Health Watch

When will it end?

Chances are, if you’re an infectious disease and/or public health specialist, you have been asked this question a lot in recent weeks—ever since the coronavirus disease 2019 (COVID-19) pandemic took hold the United States and forced the implementing of social distancing measures throughout much of the country. Unfortunately, there’s no easy answer, but at least now we have a possible roadmap to follow once life returns to some degree of normal, courtesy of the American Enterprise Institute (AEI).

“We have to get to containment for people to feel comfortable enough to make decisions about reopening the economy,” one of the report’s coauthors, Mark McClellan, MD, PhD, is the Robert J. Margolis Professor of Business, Medicine, and Policy, and founding Director of the Duke-Margolis Center for Health Policy at Duke University, told Contagion®. “Let’s be clear: We’re not going to get back to normal or feel normal for a while, if ever, but if we can establish basic public health systems for extensive surveillance, tracing of contacts, and testing and contain future outbreaks—and if we can develop vaccines and drug treatments in the short- and medium-term—we can begin to relax social distancing restrictions. People need to feel confident that something like this is not going to happen again in order to think about getting back to business, hiring new workers, and investing.”

The public policy think-tank released its blueprint on March 29^th. In addition to McClellan, its authors are some of the leading lights in American health policy: former US Food and Drug Administration (FDA) commissioner Scott Gottlieb, MD; Caitlin Rivers, PhD, senior associate at the Johns Hopkins Center for Health Security and assistant peofessor in the Department of Environmental Health and Engineering at JHU; and Lauren Silvis, former FDA Chief of Staff and Senior Vice President of External Affairs at medical technology firm Tempus.

Through Tuesday, COVID-19 has sickened more than 370,000 Americans, causing death in some 11,000. More than 90% of the country has essentially been on lockdown since late March with schools and all but “nonessential” businesses (eg, supermarkets, pharmacies) closed.

“To gradually move away from a reliance on physical distancing,” the AEI report notes, the US needs:

• Enhanced data on areas of spread and rates of transmission and immunity;
• Significant improvements in state and local healthcare system capacity, public-health infrastructure, outbreak identification and containment, and stockpiles of medical supplies; and,
• Therapeutic, prophylactic, and preventive treatments.

According to the report, states can move on to “Phase II”—beginning the process of lifting social distancing restrictions—when “they are able to safely diagnose, treat, and isolate COVID-19 cases and their contacts.” Although, as McClellan notes, public hygiene will have to be sharply improved, with deep cleanings of shared spaces and use of facemasks in public becoming the norm.

In the end, the report states, Phase III—the lifting of social distancing restrictions—can only be accomplished when there are “safe and effective tools for mitigating the risk of COVID-19,” including broad surveillance, approved drug treatments, and/or a safe and effective vaccine. Ultimately, the US will also have to invest in steps to expand hospital and ICU capacity, increase supplies of PPE, and implement enhanced outbreak surveillance and data-sharing. Special protections for “vulnerable” populations (eg, seniors and those with preexisting health conditions) will also need to be considered.

However, the authors emphasize, states cannot even consider moving to these next phases until there is a sustained reduction in cases for at least 14 days, hospitals are safely able to treat all patients, testing is available for all people with COVID-19 symptoms, and active monitoring of confirmed cases and contacts is possible. Most, if not all, are likely months away from these minimum thresholds—if not longer.

Even when/if the country can move past the current pandemic, if nothing else, COVID-19 has demonstrated that the US needs to be better prepared for future disease outbreaks. This includes modernization of the country’s health system, as well as additional investment to speed the development of new vaccines against emerging diseases. Public health experts have been warning the world about pandemics for decades; the current one needs to serve as an important lesson for all.

“If you don’t have basic level of safety against unconstrained illness, people are not going to get back to business,” McClellan said. “We have to use this as an opportunity to improve our public health infrastructure if we are ever going to return to some degree of normalcy, and a functioning economy. That is going to take a collaborative effort between federal, state, and local governments, as well as public health leaders. We will need to have a very strong foundation not only for preventing the next waves of COVID-19, should they occur, but for future public health crises as well. And we’ll have to right, and in a very modern way, using all of the technology and tools available to us.”