“Our Goal Should Be to Crush the Curve”

“Our Goal Should Be to Crush the Curve”

A doctor-scholar who studied the 1976 mishandling of swine flu says the president is wrongly choosing between saving lives and saving the economy.

Here’s what Harvey Fineberg thinks government officials should be doing…

We are in a desperate situation where the economy has tanked and hundreds to hundreds of thousands or more Americans’ lives are in jeopardy.

The choice is not one or the other.

The choice is what is the mix of policy and strategy and execution that optimizes the best outcome, given where we start today with both a serious pandemic and a fractured economy.

From an economic point of view, ironically, there is an optimal choice. There is a dominant choice, and that choice is based on experience in other countries that we can adapt — and based on the as-yet incomplete commitment to solve this problem.

Our goal should not be to flatten the curve. Our goal should be to crush the curve.*

We should be mobilizing under the leadership of a supreme commander who has the full confidence of the president and can act with the full power and authority of the presidency, to mobilize every resource of the federal government, civilian and military, to win this war against the coronavirus. We should set a goal of achieving victory in 10 weeks. We should make this year’s D-Day victory over coronavirus day.

First, we need to have adequate numbers of tests available and distributed for diagnosis.

We do not have that in place, and it must be within two weeks.

Second, we need to provide protective personal equipment to every health professional who is going to be caring for patients.

We would not send soldiers into war without body armor. We should not ask our health professionals and attendants to serve without adequate protection.

Third, every citizen in the United States has a part to play. We should all be mobilized.

Everyone should be maintaining a physical distance. In public, everyone should now be wearing a surgical mask. Surgical masks should be delivered to every American household by the U.S. Postal Service, perhaps also mobilizing and utilizing the Amazons, Walmarts, Costcos, CVS, Walgreens and other major distributors.

All should be mobilized to get those surgical masks and hand cleaner in the hands of every American household.

The surgical masks do not prevent you from receiving the virus. But if everyone wears them, they will diminish the spread from those who are unknowingly infected to others.

Next, we need to test enough to be able to classify every American as documented infected, suspected infected, exposed or not yet known to be either exposed or infected.

Each of those classes of Americans needs to be treated appropriately.

Everyone who is infected or presumed infected — because the test, by the way, is not perfect — should be separated into dedicated clinical facilities. Serious cases and those at highest risk should be hospitalized.

Every convention center in every major American city should be converted into an infirmary where presumptive cases and documented cases with mild illness can be cared for and segregated, both from the general community and from other patients with emergent and urgent needs that are not infected.

Everyone who has been exposed to an infected person should be placed in quarantine.

All the hotels that are now empty in our cities could be mobilized with the staff retrained on appropriate sanitation procedures to be able to house, in comfort, dignity and appropriate care, those who need to remain in quarantine for a two week period of time, which would allow 99% of those who are going to develop symptoms to already have expressed symptoms.

If we take these steps and we simultaneously work on new treatments, a vaccine — which, by the way, will not come online in 10 weeks but will be available as a further deterrent after the acute victory — we can turn the tide and defeat coronavirus.

This is totally different from the response to the 1976 swine flu when no epidemic appeared. But this is the kind of radical approach that actually would bring together intelligent political decision making with expertise that can solve the problem from a scientific and public health point of view.

And by the way, if we do this, it is the best way to get the economy moving again. Because if we eliminate the threat of coronavirus in the space of 10 weeks, the economy can be sparked into action.

If we proceed in ways that are half-measures, incomplete approaches, gradual and not effective, we will persist with people falling ill, with people fearful, with workplaces disrupted, with an inability to get the economy humming again.

National coronavirus response: A road map to reopening

This report provides a road map for navigating through the current COVID-19 pandemic in the United States.

It outlines specific directions for adapting our public-health strategy as we limit the epidemic spread of COVID-19 and are able to transition to new tools and approaches to prevent further spread of the disease.

We outline the steps that can be taken as epidemic transmission is brought under control in different regions. These steps can transition to tools and approaches that target those with infection rather than mitigation tactics that target entire populations in regions where transmission is widespread and not controlled.

We suggest measurable milestones for identifying when we can make these transitions and start reopening America for businesses and families.

In each phase, we outline the steps that the federal government, working with the states and public-health and health care partners, should take to inform the response. This will take time, but planning for each phase should begin now so the infrastructure is in place when it is time to transition.

The specific milestones and markers included in the report for transitioning our responses are judgments based on our current understanding, with the goal of facilitating an effective path forward.

The epidemic is evolving rapidly, and our understanding of best responses will evolve as well. The broad set of tasks described here requires and will receive high-level, ongoing attention, and it should be updated and refined as additional evidence, context, and insights about the epidemic become available.

To gradually move away from a reliance on physical distancing as our primary tool for controlling future spread, we need:

  1. Better data to identify areas of spread and the rate of exposure and immunity in the population;
  2. Improvements in state and local health care system capabilities, public-health infrastructure for early outbreak identification, case containment, and adequate medical supplies; and
  3. Therapeutic, prophylactic, and preventive treatments and better-informed medical interventions that give us the tools to protect the most vulnerable people and help rescue those who may become very sick.

Our stepwise approach depends on our ability to aggregate and analyze data in real time.

To strengthen our public-health surveillance system to account for the unprecedented spread of COVID-19, we need to harness the power of technology and drive additional resources to our state and local public-health departments, which are on the front lines of case identification and contact tracing.

Finally, we must expand our investments in pharmaceutical research and development into COVID-19 and promote the rapid deployment of effective diagnostics, therapies, and eventually a vaccine.

Slow the Spread in Phase I.

This is the current phase of response. The COVID-19 epidemic in the United States is growing, with community transmission occurring in every state.

To slow the spread in this period,1 schools are closed across the country, workers are being asked to do their jobs from home when possible, community gathering spaces such as malls and gyms are closed, and restaurants are being asked to limit their services.

These measures will need to be in place in each state until transmission has measurably slowed down and health infrastructure can be scaled up to safely manage the outbreak and care for the sick.

State-by-State Reopening in Phase II.

Individual states can move to Phase II when they are able to safely diagnose, treat, and isolate COVID-19 cases and their contacts. During this phase, schools and businesses can reopen, and much of normal life can begin to resume in a phased approach.

However, some physical distancing measures and limitations on gatherings will still need to be in place to prevent transmission from accelerating again.

For older adults (those over age 60), those with underlying health conditions, and other populations at heightened risk from COVID-19, continuing to limit time in the community will be important.

Public hygiene will be sharply improved, and deep cleanings on shared spaces should become more routine. Shared surfaces will be more frequently sanitized, among other measures.

In addition to case-based interventions that more actively identify and isolate people with the disease and their contacts, the public will initially be asked to limit gatherings, and people will initially be asked to wear fabric nonmedical face masks while in the community to reduce their risk of asymptomatic spread.

Those who are sick will be asked to stay home and seek testing for COVID-19. Testing should become more widespread and routine as point-of-care diagnostics are fully deployed in doctors’ offices.

While we focus on state-by-state reopening of activities in a responsible manner and based on surveillance data, we note that states may move forward at a county or regional level if these conditions vary within the state and that coordination on reopening among states that share metropolitan regions will be necessary.

Establish Immune Protection and Lift Physical Distancing During Phase III.

Physical distancing restrictions and other Phase II measures can be lifted when safe and effective tools for mitigating the risk of COVID-19 are available, including broad surveillance, therapeutics that can rescue patients with significant disease or prevent serious illness in those most at risk, or a safe and effective vaccine.

Rebuild Our Readiness for the Next Pandemic in Phase IV.

After we successfully defeat COVID-19, we must ensure that America is never again unprepared to face a new infectious disease threat.

This will require investment into research and development initiatives, expansion of public-health and health care infrastructure and workforce, and clear governance structures to execute strong preparedness plans.

Properly implemented, the steps described here also provide the foundation for containing the damage that future pathogens may cause.

https://www.aei.org/research-products/report/national-coronavirus-response-a-road-map-to-reopening/National-Coronavirus-Response-a-Road-Map-to-Recovering.pdf (521.0 KB)

Country by country coronavirus case trajectories graph – 29/03, 19:00 GMT

An informative portal on hospital capacity vs. projected needs for COVID-19.

Referenced in a White House press briefing as the “Chris Murray Model,” IHME’s COVID-19 projections show demand for hospital services in each state.

Doctors told The Wall Street Journal that the US Food and Drug Administration’s “unprecedented flexibility” for test developers — which has so far authorized 20 tests — leaves some providers lacking total confidence in their efficacy.

When will this crisis end? It feels like it never will.

Every crisis of evil in human history creates it’s impression of endlessness.

The soldiers in the trenches in ww1, the mothers and wives at home in ww11, the people in NI during the troubles, the great depression of the 20’s, the dark days of the 3 day week in the UK 70’s - and so on.

But end they did and end this one will - the human body can sometimes be weak but the human spirit is a different matter.

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Check out the phases above in the earlier post. That’ll give you a good idea of what it’ll take.

Thank you so much for the uplifting words. I needed to see that.

I wonder, what happens after the initial outbreak eventually dies down? Lockdowns have to be lifted eventually, how are they going to prevent the whole thing from happening again? Obviously we can’t stay in them until a vaccine is found, not to mention it’d take a long time to be produced in sufficient quantities to vaccinate all of humanity. Do we do it the Chinese way, with total surveillance?

The Irish govt follows closely the WHO advice - test test test and isolate.

They closed the schools long before the UK - recognition that children although not in the ‘at risk’ category nonetheless are human and therefore potential carriers.

These actions are not the result of fear, rather the outcome of knowledge - know the enemy, it’s strengths and weaknesses.

In this case the virus’s strength is it’s ability to jump from person to person - but it has a weakness - it needs to live within our body, outside of that and it WILL die.

On the outside it will cling to it’s life but a clean wash with water and soap or even the lapse of time and it dies.

It has another weakness - it cannot penetrate our skin - it has to get in via an opening - guard those and it has a problem.

Being in the ‘at risk’ group I am careful but not fearful. A doctor recently commented that it’s not waiting outside our front door to pounce - if everyone within our family, and our community and also our country is equally careful this this enemy will most assuredly die.

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This is known as the “coronovirus trilemma”…

“So countries are faced with what one might call the “coronavirus trilemma”. They can pick two of three things but cannot have them all: limit deaths, gradually lift lockdowns, or uphold cherished civil liberties. Not all countries are facing up to this reality – the US remains a notable laggard – but most will have to eventually. Those countries that have recognised the choices before them are picking the first two options at the cost of the third, bio-surveillance. It is a choice that has most clearly been made in east Asia. But it is coming to much of the rest of the world too – and will transform the role and reach of the state.”

It does seem to be working in Asia - or at least it works in South Korea, coupled with extensive testing and isolation. It’s supposedly working in China too, but can one trust their official information?
And Western societies are so used to cherishing certain freedoms, I am not sure how we’ll agree to such surveillance on a scale wide enough for it to work.
I know that Czecia is trying to implement this system in Europe and I really hope it keeps them safe.