Recently, the conservative think tank AEI released a plan describing the milestones needed to bring the U.S. back to normal-ish activity, economic and otherwise. It’s worth discussing because, like it or not, Republicans aren’t going to adopt a plan from left-leaning or even radical centrist think tanks–this administration listens to AEI*.
It’s long, so rather than recapitulate it here, I’ll discuss some of its weakenesses and strengths. Let’s start with the weaknesses:
- It moves too quickly from phase I–phase I is essentially where we are now (mostly), with stay-at-home rules. Here are the triggers to move to phase II:
…the trigger for a move to Phase II should be when a state reports a sustained reduction in cases for at least 14 days (i.e., one incubation period); and local hospitals are safely able to treat all patients requiring hospitalization without resorting to crisis standards of care; and the capacity exists in the state to test all people with COVID-19 symptoms, along with state capacity to conduct active monitoring of all confirmed cases and their contacts.
What’s unclear from this is the role of a serological test plays. While the details suggest a test should be available to move to phase II, that’s not enough. We can’t move to the next phase without being able to deploy the test rapidly. We need to know who can move around safely, return to work, and so on. We also need to have enough serological testing to engage in surveillance–taking representative samples (there’s a whole subdiscipline that worries about what ‘representative’ means, so I’ll ignore that here) so we have some idea of what the community level of infection has been. Right now we’re flying blind without surveillance, since we’re really only testing the (very) sick and some people who have likely been exposed.
- Just for emphasis: we need population-based surveillance. That must be available.
- I think any plan will have this problem, but the requirement that “the trigger for a move to Phase II should be when a state reports a sustained reduction in cases for at least 14 days” will run afoul of Campbell’s Law, which is the strong (in this case, overwhelming) pressure to distort the statistics. One suggestion, not by AEI, is to explicitly tie temporary relaxation of quarantines to maintaining COVID testing rates at 100% of requests and suspected cases. It’s a good suggestion, though I would add the surveillance component discussed above too.
- Masks. Masks need to be available for frontline workers–not just healthcare workers.
- The supply chain is fucked in many places. Having people pack into stores to buy various scarce goods–and it’s not just the damn toilet paper (e.g., paper towels, thermometers, cleaning fluids are still short supply)–is not good. Get the supply chains for the basics running in order to cut down on unnecessary travel and social contact. (Oreo Cookies are not a basic, but they do seem in good supply…)
- I don’t like making this state-based, though I realize that’s the level of regulation at which this happens. What happens if New Jersey moves to phase II, but New York remains in phase I? In the D.C. area, there are three states, and there have been days where I have spent time (not just driven/traveled through) in each state. I would prefer using the CDC regions for release, but I’m not sure how that could be implemented, so we might just have to hope the two centuries old strictures of colonial era federalism don’t kill us.
To a considerable extent, I’m not worried about the other phases, since once we enter phase II, the worst is really behind us. Some strengths of the plan:
- We’re not getting out of this for a while. No Easter, or even April 30 bullshit.
- It removes the guidelines for relaxing restrictions from politicians by having measurable guidelines (see the above part about Campbell’s Law though).
- It gives conservatives cover. Most Republican governors have been breathtakingly irresponsible and stupid (Ohio’s Gov. DeWine has been the rare exception). This plan gives them some cover, and it might even inform them.
- From the previous point, if we take multiple governors at their word when they claim they didn’t realize SARS-CoV-2 could be spread asymptomatically, then they and their staffs are horrifyingly ignorant**, and this document will provide them some much needed education about SARS-CoV-2.
So, it’s not bad, but there are some weaknesses. Still waiting for the Democratic-aligned think tanks to get in gear and broach this subject***.
*Which, on many issues, is part of the problem.
**Multiple politicians have said this, including some Democrats, even though it had been well-established by late January that asymptomatic (and pre-symptomatic) spread was a problem. They should not be re-elected to office.
***Obviously, they have more important things to do like attacking Sanders supporters. Kidding aside, too many professional Democrats just don’t seem to like governing.