Public Health

More testing is needed to rebuild trust and remobilize the country

There has been much discussion about what reopening the country would look like as the COVID-19 pandemic continues. With many plans circulating, one proposed roadmap to safely reopen America came from a team of experts at Harvard University’s Edmond J. Safra Center for Ethics in Cambridge, Massachusetts.

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When the COVID-19 situation was ramping up, Danielle Allen, PhD, director of the Edmond J. Safra Center for Ethics, reached out to Ezekiel Emanuel, MD, PhD, an oncologist, bioethicist and vice provost of global initiatives at the University of Pennsylvania, to learn how the ethics center could help.

“His answer was that the thing that people were having the hardest time thinking about was how to weigh health objectives and goals in relationship to economic objectives and goals,” Allen said in an episode of AMA COVID-19 Update hosted by AMA Chief Experience Officer Todd Unger. The AMA is providing daily video updates featuring interviews with a wide range of physicians and experts from the AMA and elsewhere who provide real-time insight on the challenge of the pandemic.

“We built a huge multidisciplinary team drawing on experts at the public health school here at Harvard—the Chan School of Public Health—but also trying to integrate that public health expertise with economic expertise,” she said.

The “Roadmap to Pandemic Resilience,” integrates expertise across all domains to create a solution to align what was needed from a health perspective with that of an economic outlook. As an organization, the AMA is not supporting this as the best approach but noting it as one of many plans currently available as discussion of reopening the country continues.

It’s not the sole solution

Beyond physical distancing practices, a bigger program is needed to take practical and appropriate steps forward.

“The most powerful tool that the public health community has in its toolkit for responding to a pandemic is collective stay-at-home orders. And they're extremely effective,” said Allen, who also participated in the AMA’s #SuppressCOVID Tweet chat about safely reopening America. “They can stop the disease in its tracks, and we should all be extremely grateful for that. We needed to use those tools without any question.”

However, these orders have had a “profoundly devastating economic impact,” she said, noting that collective stay at home orders are costing $350 billion a month while a testing, tracing and supportive isolation program would cost $15 billion a month.

The goal is to decelerate the disease continuously over time without needing repeated applications of physical distancing and stay at home orders. But it is important to note, this plan can become challenging to implement if prevalence gets too high because “the gap between testing needs in high prevalence contexts (more than 1% active virus presence) and our current testing capacity may be too great to bridge; high prevalence contexts are going to continue to need stay-at-home orders until they bring prevalence down,” said Allen.

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What it takes to make this plan reality

Rather than asking if a plan can work, Allen recommends asking how “because the fact is there’s no law of physics that has to be broken to be testing in millions of people per day sort of rates.”

“We know how to make tests. We even have ways of simplifying the testing process,” she said, adding that what is needed is a “really sped up, simplified testing process.”

But to do that, there needs to be coordination between economic and political entities with support from the federal government. The other piece is coordination to administer testing and contact tracing programs.

“That's really state and local governments, municipal governments, county public health officials, things like that,” said Allen. “And there, the challenge is that, for many places this would be to run testing and contact tracing programs on a scale they've never done before.

Learn more about four ways Ochsner Health ramped up testing for COVID-19.

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Begin with health care

“Our plan is a phased reopening plan where the first thing you want to do is really build out testing, tracing and supported isolation programs for the health care workforce and other parts of the essential workforce,” said Allen. “Then begin to phase in other parts of the economy as well, supporting them as they're coming back online also with testing, tracing and supportive isolation programs.”

“We need to recognize as we think about reopening the economy is that actually, the economy is open,” she said, adding that “40% of the workforce has not been under stay at home orders because they are part of the essential workforce.”

Health professionals consist of a main portion of the workforce that has remained open, including other essential workers such as public safety officers.

“So, 40% of our workforce has had the virus circulating relatively freely, and we owe it to that workforce that they should be fully integrated in testing, tracing and supportive isolation programs first,” said Allen. “The good news is, if we could actually achieve that, then we’ve actually already stabilized 40% of the population and also that part of the population where the disease is circulating at the highest rates.”

“We really are, in our plan, focused on opening in such a way that we can stay open. We are really trying to figure out how to ward off second and third waves,” said Allen. “The reason for this is very straightforward. Businesses, if they're truly going to come back online, need to plan with clarity that they won't have to face repeated shutdowns.”

The AMA has created a step-by-step physician practice guide to reopening. This guide builds on the AMA’s ongoing efforts to ensure physicians and other health professionals have the most up-to-date information and resources necessary to navigate the rapidly changing landscape of the COVID-19 pandemic.

Other tools and guidance can be found at the AMA's COVID-19 resource center, which offers a library of the materials from the JAMA Network™, the CDC and the World Health Organization.