On Monday, a bipartisan group of public health leaders laid out four principles for the safe reopening of the US economy in a letter to Congress. In it, they argued that the key to reopening our economy would be to test, trace and self-isolate and they asked for an additional $46 billion in congressional funding for implementation.
They introduced the four point proposal by emphasizing that central to reopening is the universal availability of rapid, accurate tests to identify those who are infected and those who are potential sources of contagion. Testing at this scale will require an adequate supply of new, high speed, accurate tests and their approval by the Food and Drug Administration. The letter does not address actions by Congress or the Administration needed to create this necessary capacity.
Once the testing capacity is in place, the bipartisan group recommended four additional steps:
- Expansion of a contract tracing workforce. They calculate 180,000 full time contract tracers would be needed until a vaccine is available. They estimated the cost for this new workforce at $12 billion dollars.
- Establishment of voluntary self-isolation facilities using vacant hotels. They recommend self-isolation for all those exposed to a person who tested positive for COVID-19, thereby eliminating the risk of becoming a source for infection of others. Self-isolation means no contact with others for 14 days. The proposal is to use vacant hotel rooms to house all identified contacts of an infected person. The estimated cost is $4.5 billion.
- Income support for voluntary self-isolation. They propose a $50 dollar per day income support for those in voluntary self-isolation. They calculate such a program would cost an additional $30 billion for the 18 months until a vaccine is available.
- Primary care provider referrals. They call for the creation of a referral code to be used by primary care doctors for COVID-19 patients. Such a code will enable payment for their referral services. The letter does not call for additional funds for such payments.
The letter is a welcome and important contribution to the discussion of how to open our lives and businesses safely. It is unfortunate that at present time we do not have capacity to implement the testing precondition that is necessary to fully implement the four recommended steps. Nonetheless we can make significant progress by implementing steps one to four with the imperfect diagnostics and testing regimes in place now.
The sticking point of the four step program is “the voluntary self-isolation in vacant hotel facilities.” As those who drafted the letter are aware, 14 days of isolation of all those exposed is necessary to reduce the contagion index below one. The contagion index for self-isolation at home with family, even when confined to one room or a basement, remains too high, above one. If this continues, so will the infection continue to spread throughout the community.
The proposed program pins our hopes on the better part of human nature, that the great majority of those exposed will be willing to dramatically change their lives for 14 days, to stay alone in free hotel rooms with free meals and $50 dollars a day, for the good of the nation’s health and economy. Let’s hope we can!