With only around ten U.S. states that are below the German shutdown threshold of 50 cases per week per 100,000 people (a one-week prevalence of 0.05%), and only one state, Vermont, that is below 0.01%* as of Tuesday, it’s clear that the U.S. is failing to stop the spread of COVID-19 (very droll understatement on my part). We really do need to start all over again, and tighten restrictions.
If we do this, what should we target? Obviously, regular readers will expect me to reject any fourteen-day decline metrics, which were nothing more than mediocre policy foisted on us due to ideological constraints. Here’s what I propose:
- Phase zero. Any region that has either a one-week prevalence greater than 0.05% or a percent positive rate greater than five percent needs to roll back to very strict measures. If the percent positive rate is higher than five percent, then we really don’t know what is going on–other than this region isn’t doing enough testing. This does not need to be a complete ‘lockdown’, which doesn’t seem feasible at this point, but things like group indoor activities (church services, gyms, restaurants, salons) need to be closed.
- Phase one. Regions must have a percent positive rate less than five percent (averaged over a week), or else they roll back to phase zero. The one-week prevalence should be less than 0.05%. Here, some loosening of restrictions can be allowed, but large gatherings, indoor dining, and the like should be prohibited.
- Phase two. Regions must have a percent positive rate less than five percent (averaged over a week), or else they roll back to phase zero–not phase one, but phase zero. The one-week prevalence should be less than 0.01%. At this point, restrictions can be loosened further. Regarding schools, this prevalence (1/10,000) means that a county with 50,000 staff, students, and teachers would likely have multiple cases of COVID-19 every day in its school system, so reopening schools is still a little dicey–and if reopening occurs, there absolutely needs to be the testing and tracing capacity to chase these cases down.
- Phase three (the happy place!). Regions must have a percent positive rate less than five percent (averaged over a week), or else they roll back to phase zero–not phase one, but phase zero. The one-week prevalence should be less than 0.001%. Here, the frequency is low enough, such that most ‘normal’ activities can commence, though mask wearing, social distancing in lines, and so on, still should be encouraged.
While these might seem draconian, this is what it takes to have normal-ish lives. Importantly, these targets are very hard to fudge (probably not impossible though). Everyone knows the target, and public pressure can be brought to bear to lower the prevalence. It’s also critical to have triggers to reinstate rollbacks, or ele they’ll never happen.
These targets appear difficult, but they are achievable, if we are willing to do the things we need to do. Once we factor in the cases we missed early on in the pandemic, D.C. likely had a 30-fold drop in two months–and the ‘shutdown’ was kind of half-assed (though better than many states’ pro-virus policies). If we could get Rt to 0.5, then it would likely take less than two months to completely crush the virus.
Realistically, a Republican-controlled White House and Senate won’t do the things on the economic side to make this viable (and Biden should thank his lucky stars for that), but this is what needs to happen–and it could happen rather quickly, if we had the will to do it.
*American Samoa, with zero cases, and the Northern Marianas Islands are doing rather well.