How this ends

The more nuanced question is: How do things get back to some semblance of normal in the meantime?

Widespread shutdowns within the economy were a last resort after the coronavirus arrived and caught the nation completely off-guard. The United States had virtually no capacity to test for the virus in the early stages of the outbreak, and by the time testing started ramping up, there were more than 100,000 cases nationwide, and New York City hospitals were on the brink of collapse. Extreme social distancing has offered the only hope of slowing the spread to give the nation’s medical system a fighting chance.

But this shutdown is only a short-term approach. There is simply no way to keep the economy in hibernation without destroying even previously thriving businesses and bringing despair to tens of millions. Closing schools indefinitely would have enormous consequences for parents left alone to educate their children while trying to hold down full-time jobs. Sustained social isolation can lead to serious mental and physical health problems. People cannot be expected to stay locked up for the next few years waiting for a vaccine. They simply won’t do it, so it’s not a sound basis on which to plan.

What public health professionals must focus on is creating ways for people to ease back into their lives without triggering another massive outbreak during the intervening period. It’s unrealistic to put everybody’s lives on hold until there is zero threat from the virus. The goal should be to reduce the viral threat to an acceptable level at which it no longer endangers the medical system and then try to return to our lives as much as possible.

Yuval Levin of the American Enterprise Institute framed it this way: We need a hard pause, followed by a soft start. His AEI colleague, former Food and Drug Administration Commissioner Scott Gottlieb, co-authored a paper that laid out a three-phase plan to get back to normal. The first phase is the current effort to slow the spread through enforced social distancing. The second phase would see states gradually ease restrictions by employing better strategies to prevent new outbreaks. Eventually, in the third phase, the paper envisions removing all restrictions once a vaccine is available and most people have had the shot. Most forecasts assume that the number of cases will peak by late April or at some point in May, so we’re at least a month away from starting to see restrictions ease.

Although thinking in terms of stages is a natural approach to a more sustainable strategy, it should not distract from the fact that to be successful, the U.S. will have to be working on aspects of all three phases simultaneously. Even while overseeing shutdown orders and dealing with current medical crises, there will have to be planning for the gradual reopening, and also, there will have to be testing of vaccines and a plan to manufacture and administer a successful one rapidly across the population once one is proven to work.

Perhaps a better way of thinking about the question of how the U.S. returns to a semblance of normal is to divide what’s required into two broad categories. One involves better implementing some of the strategies that have already proved successful in other countries. The other involves medical breakthroughs, some of which could come within months rather than the years before an effective vaccine is widely administered.

On the first front, even dismissing statistics from China as unreliable, it’s clear that Asian countries have done a better job than we have of keeping things under control. One thing South Korea, Japan, Singapore, and Hong Kong have in common is the widespread wearing of masks in public.

Owing to a shortage of masks for medical professionals, officials aggressively discouraged the public from wearing them early on. This is now widely viewed as having been a mistake. The truth is that wearing a mask significantly reduces the transmission of germs. If it became common during the crisis for people to wear masks when outside of their homes, it could greatly slow the spread of the virus. But because doctors and nurses are now sterilizing and reusing masks, or relying on makeshift solutions, widespread use of masks cannot be officially advocated. However, if manufacturers increase production rapidly and the public is instructed to make DIY masks from household materials, it could help.

Other countries, such as South Korea and Singapore, have also employed a sophisticated system of broad testing and surveillance of cases. People who test positive are quarantined, and their contacts are tracked down using measures that include GPS technology, and those contacts are notified and also monitored and isolated.

The U.S. has made great strides in testing capacity after early failures, but more needs to be done. Abbott Labs recently announced it had developed a test that could be deployed at doctors’ offices and deliver results within minutes. That could help immensely. But testing won’t be as effective without finding a way to isolate cases and trace contacts. The tricky part is to do this while respecting privacy rights that are jealously guarded in the U.S. In an effort to balance these requirements, MIT researchers have developed a location tracker app that can be voluntarily installed on cellphones. If anybody using it tests positive, they can press a button, and the app alerts all other users who would have been close to the infected person while keeping that person’s identity anonymous.

In addition to masks and more effective testing, the U.S. could monitor people’s temperatures more aggressively. Singapore does this not only at airports but also to test teachers and students daily to keep schools open. Perhaps there’s a near future in which temperature checks become as ubiquitous as bag checks after the Sept. 11 terrorist attacks. Another strategy that has been employed elsewhere that could be adopted is for crews to spray large public spaces regularly with disinfectant.

Beyond looking at what other countries are doing, the U.S. would be in a better position to ease social distancing rules if there were effective medical remedies. If there were a drug that could prevent vulnerable people from getting infected, or alternatively, could treat infected patients so they don’t become more severely ill, it would significantly reduce the need for intensive care, which has been the biggest problem for hospital systems.

The good news is that there’s a realistic chance that some such treatments will be available well before a vaccine. One antiviral candidate, remdesivir, is being tested in several trials, and the results are expected by late April or early May. In the coming months, we should also know whether the much-publicized malaria drugs hydroxychloroquine and chloroquine can help treat symptoms (though many scientists are skeptical). Even if these both fail, there are other candidates.

Medical researchers are also innovating in other ways. One thing being tried is known as “convalescent plasma.” The idea is to take antibodies that have developed in people who have recovered from COVID-19 and give them to infected patients in the hope that the antibodies will enable the patient to stave off infection.

Something else that could be important is the development of serology tests that can detect the presence of antibodies. Scientists don’t yet know how long immunity to COVID-19 lasts, but they believe there is at least temporary immunity for those who have recovered. If these tests can be more widely employed, it would mean that anybody who has the antibodies can be cleared to return to normal life because they are not at risk of getting reinfected or infecting others. Germany is experimenting with widespread antibody testing and considering issuing certificates to those deemed immune, allowing them to reenter society. Given that there are mild or asymptomatic cases of COVID-19, it’s possible that many more people have antibodies than the confirmed case count would suggest.

The U.S. needs to pursue all of these strategies at full speed. The quicker they are in place, the more officials would be able to loosen restrictions in the absence of a vaccine. More testing and effective monitoring would be good, but it would be even better when combined with universal mask-wearing, regular temperature screenings, and disinfection of public places. The ability to open things up would be yet greater if medical breakthroughs are added to the other prudent measures.

Ramping up production of ventilators and protective gear that helps keep medical workers safe at work would increase our medical system’s capacity, allowing hospitals to handle more extreme cases. Slowing the spread of the virus would limit demand for critical care, and addressing shortages would increase the system’s capacity to provide that care.

Precisely when things could start loosening up is hard to pinpoint, for cases are still rising quickly. Gottlieb and his co-authors suggest that if the U.S. adopts the prevention and monitoring strategies discussed here, some states could start loosening restrictions once they see two straight weeks of decline in the number of cases. That could happen in May.

Whenever that point comes, however, it will be important to keep in mind that the nation isn’t going to go instantly from lockdown to fully open. It will be a slow transition that would involve gradually increasing the number of people allowed to attend gatherings. Senior citizens and those with poor health will probably have to be more risk-averse and remain separated as much as possible from the rest of the population.

Just as, a few months ago, it was hard to imagine that most of the public would be trapped at home living without readily available toilet paper, it may seem difficult now to imagine a way out of the current crisis. But with hard work, planning, innovation, and some luck, we’ll get there.

Philip Klein is the executive editor of the Washington Examiner.