End Of Quarantine?

With much of the country grinding to a halt in a desperate attempt to slow the spread of the new coronavirus, many people are wondering when the U.S. will be able to “reopen.”

The American Enterprise Institute, a public policy think tank, recently released a report co-written by former U.S. Food and Drug Administration commissioner Scott Gottlieb that offers a four-phase “road map to reopening.” The first phase—which the U.S. is currently in—involves slowing the spread of new infections with physical distancing measures, such as closing schools and having people work from home. In the second step, individual states can reopen when they have the capacity to identify, test and isolate most people with COVID-19 and their close contacts—but some distancing will still be required. In the third, remaining restrictions can be lifted when an effective therapy or vaccine becomes available or when data show widespread immunity. The final stage, after the current pandemic is over, will be to invest heavily in research and health care to prepare for the next one.

Tom Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health—and an expert on pandemic preparedness—provided input for the report and helped to review it. Scientific American spoke with Inglesby about some of the most important criteria the country must meet before it can reopen.

Executive Summary

This report provides a road map for navigating through the current COVID-19 pandemic in the United States. It outlines specific directions for adapting our public-health strategy as we limit the epidemic spread of COVID-19 and are able to transition to new tools and approaches to prevent further spread of the disease. We outline the steps that can be taken as epidemic transmission is brought under control in different regions. These steps can transition to tools and approaches that target those with infection rather than mitigation tactics that target entire populations in regions where transmission is widespread and not controlled. We suggest measurable milestones for identifying when we can make these transitions and start reopening America for businesses and families.

In each phase, we outline the steps that the federal government, working with the states and public-health and health care partners, should take to inform the response. This will take time, but planning for each phase should begin now so the infrastructure is in place when it is time to transition.

To gradually move away from a reliance on physical distancing as our primary tool for controlling future spread, we need:

1. Better data to identify areas of spread and the rate of exposure and immunity in the population;
2. Improvements in state and local health care system capabilities, public-health infrastructure for early outbreak identification, case containment, and adequate medical supplies; and
3. Therapeutic, prophylactic, and preventive treatments and better-informed medical interventions that give us the tools to protect the most vulnerable people and help rescue those who may become very sick.

For many people around the country and around the world, the apartments or homes where we are sheltering have begun to feel like that cramped closet. We begin to imagine a call of all-clear, when we can uncurl ourselves and stretch out into the comfortable world we left behind.

But until we develop a vaccine against COVID-19, we won’t be able to return to the way things used to be. As long as most people lack immunity, resuming our normal activities will bring infections roaring back. When we do finally step back outside, it will have to be a gradual return guided by a concrete plan based on solid science. We need to act right now to put those plans in place and make sure that when that day comes, it arrives as soon and as safely as possible.