How Long Will the Coronavirus Lockdowns Go On?
Soon the U.S.A. will be able to do 75,000 tests a day. That will make changes in strategy possible......
First, the bad news: America’s coronavirus epidemic is only beginning, and the suffering will become more searing over the next two weeks. Hospitals in New York City may soon be overwhelmed. New Orleans, Chicago, San Francisco and Seattle may not be far behind.
It will soon be clear why Covid-19 can’t be allowed to rage through the country untamed. The intense restrictions—telling Americans to stay inside in New York, California and other states—are necessary. But so is a path back to a more normal life. Here’s what the priorities should be in the coming weeks, with a focus on preventing new sparks of the virus from turning into the fires of New York and Seattle.
Containment is no longer realistic in some areas of the U.S., but in other places it may still be possible. As public-health authorities learn more about infection rates in different parts of the country, governments can tailor strategies to the facts on the ground. There is a tradeoff between mitigation strategies, which target large populations—such as sheltering in place—and interventions that try to isolate those who are infected or might have been exposed.
The population tactics are blunt instruments, necessary for isolating hot spots like New York City and Seattle. Other places may be able to rely more on individual interventions, which cause less disruption and economic damage. Yet every state should be taking steps such as encouraging social distancing and preparing to expand hospital capacity. Some states and cities that haven’t seen as many cases yet—such as New Orleans—have been too slow to take the threat seriously.
For this to work, the U.S. will need widespread testing to know where and to what extent the virus is spreading. Testing capacity has increased significantly in the past few weeks thanks to relentless efforts from public, academic and private labs such as Quest and LabCorp. Producers of testing kits are also working overtime. A new test developed by Cepheid can be deployed in a doctor’s office.
By the end of next week, the U.S. will have the capacity in place to screen more than 75,000 people a day. South Korea tested 1 in 160 of its people and deployed technology to identify people who were infected and trace contacts. The U.S. should do the same.
Another step: serological surveillance, which means blood tests to detect antibodies developed to fight the novel coronavirus. These antibodies confer immunity and can reveal whether a person has been exposed. If a sizable portion of a local community has some protection, authorities can be more confident in relying on less invasive measures. Once deployed, serological tests are cheap, straightforward, and easy to scale.
Most important is developing a therapy to treat Covid-19 or perhaps prevent people from contracting it. America is home to a vast, dynamic life-science industry. This is its moment. This is why decades of drug investment and development matter so much.
One strategy would be to infuse convalescent plasma—antibodies from the blood of patients who have recovered from Covid-19. This could help boost the immune response in those recently infected. Arturo Casadevall of Johns Hopkins outlined such an approach in these pages last month. Another approach uses antiviral drugs to target the virus and block its replication. Pharmaceutical companies are pulling antiviral drugs off the shelf and testing them rapidly.
Perhaps the most promising option for now is antibody drugs engineered by biotech companies that target features on the virus’s surface. This strategy was used with success against Ebola. These medications can be given as a prophylaxis to prevent infection for doctors or older populations at high risk of exposure, and can also be used on infected patients. Regeneron developed one such treatment against Ebola. The company has a product in the works to target Covid-19 that could be ready as soon as this summer.
Regulators need to innovate as well. The Food and Drug Administration should leverage “master protocols,” which allow providers to test multiple promising therapies in the same large trial. Doctors caring for Covid-19 patients are about to be overwhelmed. They won’t have time to deal with the administrative burdens of enrolling in a clinical trial. This was a problem in China. Regulators should create simple, standardized templates for enrollment and monitoring. Electronic data collection can ease the burden on hospitals.
For the most promising drugs, we should scale up manufacturing before we know for sure if they work. That means producing millions of doses while trials are under way. Sen. Steve Daines (R., Mont.) has suggested adding a provision to this effect to one of the relief bills in Congress. We have to be ready to distribute a drug on a massive scale as soon as it is proved safe and effective.
Unfortunately people will suffer and die in the coming weeks. For many others, the U.S. can still turn the coronavirus into a manageable threat. With the right mix of controlling transmission, expanding testing and deploying promising drugs, American ingenuity can win the battle against this awful pathogen.
Dr. Gottlieb is a resident fellow at the American Enterprise Institute and a board member of health-care companies. He was commissioner of the Food and Drug Administration, 2017-19.