We Don't Need Testing To Re-Open America
The current debate in America recognizes that our worst hit region, New York, appears to be peaking (at least for now). “The worst is over,” said governor Andrew Cuomo, as reported 2 days ago by MSN:
“We can control the spread: Feel good about that,” Cuomo said at his daily briefing on Monday. “The worst is over, if we continue to be smart going forward. We have a hand on the valve, if we turn the valve, you’ll go right back.”
There is general agreement, too, that we aren’t out of the woods: relaxed restrictions will likely increase the spread of the virus sufficiently to stress hospitals and put us right back into our homes. So we’ve got to be able to monitor the situation well enough to know when we’re advancing and when we’re falling back.
But everything I read online assumes that in order to monitor the situation we need universal, or widespread, testing. That widespread testing is the only way for us to maintain “situational awareness” and be ready to head back home and bake some more bread.
But our choice to impose severe, crippling strictures on American life and the American economy was not based on widespread testing — which was not, and is not, available — but on measures of how the virus was affecting our healthcare system.
The ever-present refrain of “flatten the curve” didn’t rely on testing, remember: the idea was to delay possibly inevitable infections in the population to reduce the stress on the healthcare system — which after years of economic competition has little to no extra capacity to handle surges in, for example, ventilator patients. We didn’t know at that time, a few short weeks ago, how many untested cases we had in the community. We assumed they were many.
Our goal was not to stop the population from being infected. It was to slow down the process whereby the population would be infected, allowing the healthcare system time to process.
This means that in order to re-open we also don’t need to wait for widespread testing to know how many cases there are. We need to know how cases are stressing our healthcare system.
Right now many American cities, including Washington where I have been working with the District government on the response, have a better idea of their “percentage of ICU beds occupied” and “percentage of ventilators used” than possibly ever before. We can therefore re-open gradually and use our healthcare metrics (e.g. beds, ICU beds, and ventilators) to see if symptomatic cases are accelerating or decelerating — rather than a hugely expensive and difficult and unproven system of universal testing.
The plan should be to move from our current, locked-down state to fewer restrictions as soon as possible — and definitely within two more weeks. That may involve allowing workers to return to offices wearing masks, and will certainly involve special measures — like targeted testing and contact tracing — to protect the most vulnerable among us, including the elderly and immunocompromised, but the details are not as important as the idea that we will reduce restrictions . . . and that will increase spread of the virus, almost certainly.
But we aren’t primarily worried about spread of the virus, remember: we’re worried about how the healthcare system is handling that spread. When widespread testing becomes available, it will be a useful tool to help us get back to normal. But it isn't our only tool, and we don't need to wait for it.