On January 3, the Trump Administration was warned by the CDC of an emerging pandemic in China. There’s a well-established playbook for what happens next, commonly summarized as test, trace and treat. Elements of that plan, with specific, detailed steps for execution, were laid out in a 2016 National Security Council report. The Administration didn’t follow the plan. It still hasn’t.
That blueprint is still our only way out of this unnecessary, man-made crisis, but executing that plan gets more difficult, expensive and painful with each new day of dysfunction. Thanks to our delayed response, we can’t safely emerge from lockdown until our government is ready to test hundreds of thousands of people a day, about 10x where we are today, March 26.
There are three steps to an effective pandemic response, test, trace and treat. Spotting the disease through testing is the essential first step for reasons which should be obvious. Imagine what you’d have to do to fight a fire where the flames are invisible, and you can’t smell the smoke. Absent an effective testing regimen, that’s the situation responders face in coping with a pandemic.
Implement a strategic testing program when you have a dozen cases, as most Asian countries did, and the challenge of comprehensive testing and tracing is much simpler. Think for a moment about the task of tracing every contact of a coronavirus patient across a two-week history. It’s a lot of work even with a single case. At ten cases it becomes pretty time consuming. Wait until there are a thousand cases and this becomes a nearly insurmountable challenge. The impact of any pandemic hinges less on the biology of the pathogen than on the speed and effectiveness of that society’s response.
Treatment is the lowest initial priority in this playbook, because in many pandemic scenarios there’s either no established treatment, or the disease is so severe (like Ebola) that treatment is ineffective as a means to contain the outbreak. It’s not that treatment isn’t important, but in a severe outbreak treatment isn’t how the pandemic will be contained.
COVID-19 became a pandemic because officials in the Chinese city of Wuhan failed to follow these steps at the end of last December, opting instead to suppress information about the disease. National officials intervened a few weeks later to fix the problem, imposing a lockdown on Wuhan and three other cities on January 23. Having lost control of the disease, that lockdown eventually extended as far as Shanghai and Beijing.
The purpose of a lockdown is to contain the spread of the virus, or as we’ve come to say, “flatten the curve,” to make it easier to implement the first step in the playbook, mass testing. Beyond Wuhan, the lockdown lasted about a month, ending in mid-March, during which time the government implemented a mass testing scheme, making tests free. March 19 was the first day since the beginning of the pandemic that the Chinese government could claim no new locally-transmitted cases.
With enough testing infrastructure to identify patients, and the tracing infrastructure in place to identify everyone exposed to those patients, the need for broad lockdowns fades. Disease is personal. Pandemic is politics. We are on lockdown while citizens of Singapore and Tokyo go on with their daily lives, because we failed to implement the playbook in time. We can’t hope to emerge into anything like normal life until we take those first steps, adopting a response that would have been very simple two months ago, but is becoming more catastrophically difficult with the passing of each leaderless day.
Here in the US, almost three months into this crisis, there is no sign that we’ll have even the first element of a response in place anytime soon, though it isn’t clear why. A German lab had developed and shipped an effective COVID-19 test kit by January 11 and it was approved by the WHO on January 17. They were manufacturing and shipping more than a 1.5 million kits a week by the end of February. New Zealand used the German test, and had a testing scheme available by January 31, a month before they’d see their first patient.
Having experienced their first local COVID-19 case on the same day, January 20, South Korea and the US have taken completely different directions. South Korea immediately launched its track, trace and treat plan. By March 20, South Korea had tested three times as many of its citizens as the US and was able to keep most businesses open. With testing and tracing in place from the beginning, South Korea never needed a lockdown.
Why has our response to this threat been among the worst so far in the world? That’s a subject for another day. What will it take to end the cycle of outbreak and lockdown in the US? We can start to leave our homes safely when we’ve developed a testing and tracing infrastructure that lets us identify and track the infected. That’s it. There’s no other path out of this mess, and there never has been. Pervasive testing, combined with competent tracking of patients’ contacts, is the key that will unlock our homes.
Beyond the end of the lockdown, we may not see anything like full normalcy until we’ve found a way to address the third element of the playbook, treatment. It will take time to develop an effective vaccine for COVID-19, and perhaps longer to identify anti-viral treatments and settle on a treatment protocol. Until that last step is achieved, COVID-19 will be remain a persistent threat, warranting limits on travel and large public gatherings.
For now though, our government and private health care officials have one job. Set up a competent testing scheme. We can’t leave home without it.