NEJM Editorial Says US Can Eradicate COVID-19 by Early June

The United States can eradicate coronavirus disease 2019 (COVID-19) in 10 weeks through a forceful and focused campaign, according to an editorial published in The New England Journal of Medicine.

Harvey V. Fineberg, MD, PhD, chair of the National Academies Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats in Washington, DC, and president of the Gordon and Betty Moore Foundation in Palo Alto, California, outlined a way to not only flatten but “crush” the curve in 10 weeks. In a video interview with Contagion^® Editorial Director Allie Ward, he explained his motivation for penning the article (see video).

He wrote that China was able to accomplish this in Wuhan, the center of the novel coronavirus outbreak, and America can do it as well in 6 steps. This can be accomplished by early June, he added.

“With enough intelligence about the enemy—where the virus lurks, how quickly it is moving, where it is most threatening, and what its vulnerabilities are—we can begin to re-energize the economy without putting additional lives at risk,” he wrote, adding that somewhere from thousands of more than a million of American lives may be jeopardized by this outbreak.

Fineberg summarized his plan:

1. “Establish unified command.”

Fineberg wrote that the President should appoint someone who has his full confidence to report directly to him. This person would not coordinate agencies responses, he said, but instead carry the power and authority of the president to “mobilize every civilian and military asset needed to win the war.” Additionally, Fineberg suggested asking governors to do the same, but on a state scale. “The diversity of our nation and the various stages of the epidemic in different regions allow us to target responses to specific places and times, deploy and redeploy limited national supplies where they can do the most good, and learn from experience as we go,” he said.

2. “Make millions of diagnostic tests available.”

Fineberg, citing South Korea as a successful example, said to gear up to test millions over the next 2 weeks, though not those without symptoms. Anyone who screens positive should be referred for further evaluation. Without these diagnostic tests it will be impossible to track the scope of the outbreak, he wrote. Research labs in the US can be enrolled in this effort. He lauded drive-thru test centers that have started to appear and said that clinical test sides that are physically separated and distanced from care centers should be organized in every community.

3. “Supply health workers with PPE and equip hospitals to care for a surge in severely ill patients.”

“We wouldn’t send soldiers into battle without ballistic vests; health workers on the front lines of this war deserve no less,” Fineberg wrote. He said that every health care worker who is caring for patients and testing for infection should have an ample supply of PPE. He also said that ventilators and other equipment should be distributed from the national stockpile to hospitals with the greatest needs. Available equipment and supply use will have to be evaluated using crisis standards of care so that ethically sound yet unavoidable decisions can be made.

4. “Differentiate the populations into 5 groups and treat accordingly.”

Fineberg divides the population into 5 categories for the purposes of proper treatment and care.

A. Who is infected

B. Who is presumed to be infected (those with COVID-19 symptoms despite a negative test)

C. Who has been exposed

D. Who is not known to be exposed or infected

E. Who has recovered for infection and is adequately immune.

Those with high risk or severe disease should be hospitalized, and those with low risk or moderate disease should be treated at pop-up care centers like those in empty convention centers, for example. Hotels can additionally be used as quarantine centers for the exposed to separate those people from the general population.

But it’s the fifth group, Fineberg said, that could alter the course of fighting the outbreak.

“Being able to identify the fifth group — those who were previously infected, have recovered, and are adequately immune — requires development, validation, and deployment of antibody-based tests,” he wrote. “This would be a game-changer in restarting parts of the economy more quickly and safely.”

5. “Inspire and mobilize the public.”

Everyone has a part to play in reducing the risk of exposure during this period, Fineberg said. If everyone wears a mask, there is no stigma; that is, of course, after health care workers have the masks they need, he said. The US Postal Service and willing private companies should be enrolled in delivering surgical masks and hand sanitizer to every American household, he added.

6. “Learn while doing through real-time, fundamental research.”

Fineberg stressed the need to explore “every plausible avenue” when searching for an effective antiviral treatment, similar to the efforts put forth with HIV. Decisions about public health responses should be “guided by science,” he said, including questions about returning to work, schools, and normal activities.

“If we do this, we can relieve Americans of avoidable grief and loss, play our part in the global struggle against COVID-19, and be in a stronger position to help other countries,” Fineberg concluded. “If we persist with half-measures against the coronavirus, we risk saddling the economy with a long-term and avoidable burden of anxious consumers, illness, higher medical costs, and constricted business activity… Rather than stumble through a series of starts and stops and half-measures on both the health and the economic fronts, we should forge a strategy to defeat the coronavirus and open the way to economic revival. If we act immediately, we can make the anniversary of D-Day on June 6, 2020, the day America declares victory over the coronavirus.”