This piece was originally published in The New York Times on June 29, 2020.
The coronavirus is still raging, particularly in states like Texas, Arizona and Florida. We already know what it takes to beat it. We just need to do it.
As infection rates rapidly rise in many red states, Senate Republicans can and should legislate to protect their constituents and their country. It’s good politics to save lives while saving the economy. They can start by taking a page from other advanced market economies that managed to turn the corner on the pandemic and safely restore normalcy. In addition to mask-wearing, these countries have all adopted a strategy to test, trace and isolate the virus out of circulation.
Taiwan was the first country to use it effectively. Applying lessons gleaned from SARS, which emerged in Asia in 2002, Taiwan immediately traced (and closely studied) its first 100 cases. It was able to avoid community spread altogether — topping out at 447 total cases — without a lockdown. South Korea was slower, but eventually suppressed its outbreak to fewer than 13,000 cases without a widespread lockdown. Germany, Australia and New Zealand have all adopted the same strategy to avoid reinstating their lockdowns. By detecting and containing new outbreaks before they spread, these market economies plan to stay open, resilient and competitive, while America’s economy loses ground amid new waves of infection.
Many Republicans think that market incentives and private-sector spending will be enough to drive innovation in diagnostics and therapeutics and to spur manufacturers to finally churn out enough tests. But this is wrong. The private sector alone can’t contain Covid-19.
Stopping disease spread is a classic collective-action problem. Relying on businesses and institutions like churches and possibly schools to stop the spread of an infectious disease is akin to relying on private security to stop terrorism. The well-to-do have the means to protect themselves with defensive testing, but the rest of us will be left on our own, potentially leaving the disease free to spread through vulnerable communities.
Private institutions then need to spend even more — digging their moats deeper, building their walls higher — to stave off the virus. It’s the worst possible outcome: The disease continues to rampage, costs for defensive testing pile up, social inequities deepen and our sputtering economy never takes off because no one really feels safe.
Private testing, like private security, is inefficient because private institutions lack the intelligence and authority to strategically target and subdue threats beyond their walls.
The proven strategy for virus suppression relies on contact tracing through communities. The bulk of testing is initially aimed at symptomatic individuals in health care settings and likely hot spots, with additional testing in “critical contexts” like nursing homes, prisons and meatpacking plants susceptible to disease spread. All contacts of anypositive case are traced until the chain of transmission yields zero positives. In a successful suppression surge, contact tracing turns up the vast majority of positive cases.
The U.S. strategy should start by breaking states down into colored zones, representing levels of outbreak: green is the safest, followed by yellow, orange and red. The counterintuitive trick is to focus on lower-incidence yellow and orange zones before higher-incidence red zones, because lower-incidence zones require less testing and tracing to stop community spread and can stay open with safety precautions during a surge.
Within a state, just a few months of surging testing and tracing can result in green zones — which means less than one new daily case for every 100,000 people. Once a zone falls into the green, people no longer have to fear outbreaks at school, church or work. To stay green, states maintain a minimum level of testing and tracing to identify and quash new infections before they spread.
But can’t we just muddle through until we get a breakthrough vaccine next summer? In short: no. Even if we could compress the slog of vaccine development into a year, we’d still face long odds: Only one in 10 clinical trials succeeds in identifying an effective drug or vaccine without unacceptable side effects. There is no vaccine for any coronavirus. It’s possible a Covid-19 vaccine may resemble a seasonal flu vaccine, which confers immunity to only a few strains, rather than a one-time polio vaccine. Furthermore, widespread fears about vaccines may stall progress toward herd immunity.
Suppressing the virus requires Congress to adequately fund states to the tune of $43.5 billion to do the work of testing, tracing and supported isolation. Contact tracing is a fundamentally local activity; community trust and connection are no less important than a contact tracer’s professional training.
State public health departments have already begun activating civil society and building this local infrastructure of trust. New legislation should not supplant but scale these existing tracing efforts up to achieve suppression. By empowering every state to stop community spread, Republicans can show that federalism is a strength, not a weakness.
But states can’t do the work of suppression without tests. So far Congress has appropriated $35 billion for testing, which has supported a defensivestrategy of mitigation across states and helped “flatten the curve” with hundreds of thousands of tests a day. But to really bend the curve, we need to adopt an offensive strategy of suppression. That requires millions of tests a day and a network of regionallabs with 24-hour turnaround times.
We can get there with regional interstate compacts — which would each include several states — authorized by Congress to procure $25 billion worth of tests. Test production is growing with inefficient private-sector testing, but not fast enough. Fiscally straitened states can’t fill the demand gap. Moreover, states might use an infusion of federal cash to fill holes in their budgets rather than buy tests.
Compacts solve all these problems. Pooling demand from several states would generate huge purchase orders for tests that rapidly increase production while ensuring that federal funds for fighting the virus don’t bail out state pension systems.
The state compacts would also accelerate innovation in technology that can rapidly detect anynovel pathogen. One next generation sequencing facility can process a million tests a day. Crispr tests have the potential to yield results within minutes at home. Compacts issuing guaranteed “off-take” contracts would give firms the incentive to make more capital investments in breakthrough technologies by guaranteeing a market for tests.
The Senate should seize the opportunity to fund suppression now, while it’s still cheap. Consider Arizona. As cases grew nearly tenfold between May 1 and June 25 (to 3,056 from 314), so have the costs for suppression. “Had we implemented a strategy of suppression in May,” said Dr. Thomas Tsai of the Harvard Global Health Institute, “it would have cost roughly 7,850 daily tests and 1,500 contact tracers to achieve suppression. Today, it will cost roughly 76,400 daily tests and 15,280 contact tracers, among countless lives.”
We cannot restore our economy and protect lives unless we stop community spread. Senator Bill Cassidy, a physician and Louisiana Republican, agrees. On July 2, he will co-host a “round table” with Senator Tina Smith, Democrat of Minnesota, to advocate a strategy of suppression.
We have seen how other countries have saved their citizens lives, liberties and livelihoods. Now it is our turn.