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Roadmap for Pandemic Resilience

By Shlomo Maital  

   Roadmap for Pandemic Resilience: Massive Scale Testing, Tracing, and Supported Isolation (TTSI) as the Path to Pandemic Resilience for a Free Society. Danielle Allen et al.  Harvard:  Edmond J. Safra Center for Ethics, April 20, 2020.

   As the world struggles with growing numbers of coronavirus cases, experts are putting their heads together, to try to figure out an effective strategy for pandemic resilience – living with this vicious virus, adapting to it, adjusting to it – and carrying on. This 56 page book provides ten measures for an effective strategy of pandemic resilience in the US. I believe it holds for other nations too. These steps are do-able!   It requires:

  • Innovation in testing methodologies.   (Speed, accuracy, cost are all vital. And scale!)
  • A Pandemic Testing Board established by the federal government with strong but narrow powers that has the job of securing the testing supply and the infrastructure necessary for deployment. One agency to do this – not 50 states competing!
  • Federal and/or state guidance for state testing programs that accord with due process, civil liberties, equal protection, non-discrimination, and privacy standards. (Let’s have uniform standards for Mississippi, Alabama and New York)
  • Readiness frameworks to support local health leaders, mayors, tribal leaders, and other public officials in setting up test administration processes and isolation support resources.
  • Organizational innovation at the local level linking cities, counties, and public health districts, with specifics varying from state to state. (Cities, counties and public health districts need to work together seamlessly).
  • Federal and state investment in contact tracing personnel, starting with an investment in 100,000 personnel (recommendation from JHU Center for Health Security). (The US has far far fewer such personnel today. Other countries have proved that contact tracing is vital).
  • Clear mechanisms and norms of governance and enforcement around the design and use of peer-to-peer warning apps, including maximal privacy protection, availability of open source code for independent and regulatory audit, and prohibitions on the use of any data from these apps for commercial purposes, ideally achieved through preemptive legislation.
  • Support for quarantine and isolation in the form of jobs protections and material support for time in quarantine and isolation as well as access to health care.
  • An expanded U.S. Public Health Service Corps and Medical (or Health) Reserves Corps (paid service roles), and addition of Health Reserves Corps to the National Guard units of each state. (Harvard’s School of Public Health is in a rundown antiquated building; ever seen the gleaming new business school? Can we get our priorities right here, rather than mopping up the money
  • * National Infectious Disease Forecasting Center to modernize disease tracking.

How many of these 10 commonsense ideas are now in place in the US? In your country? In my country. Very very few…..

University Labs – to the Rescue! Paul Romer’s Plan

By Shlomo Maital

Nobel Laureate Paul Romer, NYU

   I am collecting material on “emergence strategies” – how nations will release citizens from lockdown and isolation, and my sense of doom is growing. In the 1918 influenza pandemic, the second wave killed far far more people than the first, after the first wave subsided and everyone went back to business as usual.

   Muddying the picture further are politicians, who pander to the ignorant and think doing so will get them re-elected. If they are, they will mount the victory podium by stepping on the bodies of hapless victims – a lot of them.

   This is why I believe we should all listen carefully to Nobel Laureate in Economics Paul Romer, NYU, and his plan. (See “Roadmap to Responsibly Reopen America” available at https://roadmap.paulromer.net). )  The bottom line: Employ university labs to produce COVID-19 tests, at scale — millions of them. It IS do-able!

    Romer writes, in the introduction to his Roadmap: “America is confronting two crises: an economic crisis laying waste to our livelihoods and a health crisis threatening our lives. The twin crises are deeply intertwined: our economy cannot be re-opened without credibly addressing fears of infection and resurgence.   The immediate reaction, a national lockdown, was successful in slowing the virus. We must now shift to a plan that balances the need to protect our health and reopen our economy by locking down only those who are infectious. This paper presents a simple, scalable, and credible solution: introduce a comprehensive “test and isolate” policy, making it safe for Americans to return to work and keeping the infection rate below 5% of the population. Until a vaccine is developed and deployed, the simplest and safest path to this outcome is a national testing strategy that marshals our existing resources to test everyone in the U.S. once every two weeks and isolates all those who test positive. It does not rely on any new technologies, is far less disruptive and costly than our current policy, and will work even in a worst-case scenario. Below is a roadmap to a future in which the American people are confident that their health and our economy’s future are protected against this virus.”

   Here are the main elements of his plan:   1. Expand the pool of testing capacity, mainly by establishing a network of university labs, which DO have the capacity to scale up and test effectively; 2. Find a revenue stream that can be used to find those who are spreading the disease; 3. Starting testing essential workers (e.g. healthcare), and expand to, e.g. grocery clerks; 4. Expand to those who need urgently to return to work. 5. Finally, offer tests to everyone…EVERYone!

    The plan calls for testing every person in the U.S., with essential workers taking priority. Anyone who tested positive would be isolated. Tests would be administered “regularly,” with every two weeks the recommendation. That would mean 25 million tests per day.

In order to get testing to those levels, Romer advocates for removing regulatory barriers and establishing a network of university and national labs.   It would also require substantial funding – about $100 billion altogether, including the costs of infrastructure and training.  Those funds would be issued in block grants to the states. $100 b. is a lot – but a drop in the bucket, compared to the trillions the US is spending now on emergency bailouts.

   Romer notes there are hidden costs in NOT testing widely. Under lockdown, Romer says,”the U.S. economy loses $500 billion per month. Lifting the lockdown without mass testing to ease that fear may only reduce losses by about $100 billion.”

   The US has many Nobel Laureates in Economics. Why not bring them to Washington, put their heads together, and work out a well-considered strategic long-range plan for emergence? Including Romer’s?   The economists now serving in the Trump administration are either Wall St. rapacious capitalists (Mnuchin) or low-level cranks (Kudlow). This does not bode well for the US.

Blog entries written by Prof. Shlomo Maital

Shlomo Maital

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