How We Reopen

A month ago I became involved in a bipartisan effort to really understand what it would take to get through the COVID-19 crisis in the US.

My first contribution was helping write a white paper on digital contact tracing. It was inspiring and humbling to work with so many incredible folks jumping in to help and being willing to evolve their thinking as they shared their concerns with each other and as the situation evolved.

And so I’ve thrown everything into continuing to work with this group. Today we have released a Roadmap to Pandemic Resilience that puts together all our previous research into a comprehensive and actionable plan with bipartisan support: https://ethics.harvard.edu/covid-roadmap

It’s a good plan. The basic idea is to massively scale up testing, tracing, and supported isolation (TTSI). We propose a national Pandemic Testing Board to immediately get the supply chain working on this.

 
We can then reopen in 4 phases, starting by supporting those most vulnerable and prioritizing the essential workers who are already out there.
 
Our group already has some connections in politics, but as the situation is changing quickly I hope any of you who feel inspired to reach out to your local and elected leaders will do so. We think this has a real shot of happening, because everyone wants a way out of this that minimizes loss of life as well as economic losses, and we don’t have to choose one or the other.

Supporting materials like in-depth papers on different aspects: https://www.pandemictesting.org/

Some recent press:

https://abcnews.go.com/US/road-map-recovery-report-20-million-coronavirus-tests/story?id=70230097&cid=social_twitter_abcn

https://www.wbur.org/news/2020/04/20/harvard-ethics-roadmap-to-pandemic-resilience-danielle-allen

https://www.washingtonpost.com/opinions/2020/04/20/three-key-ideas-stake-post-coronavirus-future/

https://www.msnbc.com/morning-joe/watch/harvard-report-details-steps-to-pandemic-resilience-82292293667

I am genuinely excited and hopeful. The folks working on this are amazing! I know most of what people hear about on the news is extreme disagreements about two bad plans and which is worse, shutdown until a vaccine or reopen and surrender to the virus, but I have faith that we all want a better alternative. That’s how we’ve already gotten bipartisan momentum. We CAN do this.

I know many of you are probably having a rough time of it right now, and I hope you’re taking care of yourselves. I’ve focused my life around working from home for long enough that stay-at-home orders have impacted me a lot less than many other people. I’m grateful to have a full time job with benefits, and extraordinarily lucky that my organization is supportive of employees spending time on outside efforts during this crisis, so I can contribute to things like this.

On a more personal note, as some of you know, John Conway died of COVID-19 earlier this month. I met him many times, and his comments that Pi should be 2Pi were the inspiration for my first annual Pi Day video 10 years ago. In the blog post for this year’s Pi Day video, which was a PSA on coronavirus, I worried I would be seen as overreacting. I was willing to be seen as overreacting.

I almost didn’t include this sentence, for fear of looking dramatic:

“I have a lot of older friends, relatives, and colleagues, and from what I understand it is likely that many of them will get this new virus in the coming months and years, and unlikely that all of them will live through it.”

I don’t like it. I don’t like it.

There’s a lot about this I don’t like.

There’s a lot about this situation I can’t control.

But there’s things I can control, and those things include how much energy I spend focusing on the things I don’t like and how much energy I spend promoting the things I do. I think it’s healthy and necessary to take time to recognize and have feelings about the sad and frustrating things we can’t control. I have every sympathy for those who don’t have time or energy to spare for anything except anger and blame. I’m in a position to have time and energy to be sad sometimes AND work towards solutions most of the time, so that is exactly what I am going to keep doing.

Please give the video and report a look if you can, I have hope and faith in amounts I haven’t had in years. This will not be easy, but we really can do this.

My best to you,

Vi

—-
Full video script:

So you might see something I’ve been working on in the news this week, a “Roadmap to Pandemic Resilience”. And this is a for-real thing that represents a consensus of people with every political belief and expertise, like, republicans and democrats and libertarians, economists and health officials and ethics and civil liberties folks (and at least one mathematician), all agreeing.

So there’s a few ways we could respond to this pandemic. In the US we already closed down a lot of stuff for a while and it’s hard, but now it looks like the curve is starting to flatten and we know it’s going to keep falling in the near term and all of us want to get back to our lives. We don’t know exactly what this side of the curve will look like, you’ve probably seen versions that are… optimistically symmetric but unrealistic, it’ll probably look less like this and more like this which I modeled off of Spain, ok so say we reopen soon, and… whoops that’s not ideal, ok say less-affected areas can reopen, NY is still closed, then some of us at least get a month of freedom and economic activity before we have to re-shut down and do it all again and again. 

It would be a reopening rollercoaster, and it would at least spread out the cases, but this plan has a lot of unknowns. It wouldn’t be back to business as usual when things are open, because businesses won’t be able to rely on each other to stay open, or on their workers to not all fall sick at once. Anywhere could be the next hotspot. It makes it hard to plan, and hard to feel safe.

So here’s another way to respond, the plan all these folks agree on is to reopen the economy this summer in 4 phases, so that the curve keeps falling and we can stay open, while protecting your health and civil liberties.

There’s three things we need to do this:

Number 1 is testing. We simply need more tests, a lot more, like millions a day. And these tests will be fast, no one wants to wait days for their results.

Number 2 is tracing. Contact tracing is how we let you know if there’s a chance you’ve been exposed, so you can get a test and find out fast whether you should isolate to stop it from spreading further.

And number 3 is supported isolation. Anyone who tests positive, or is waiting for their results, needs support to isolate at home, with health care, supplies, and job protections.

Testing, tracing, supported isolation.

It’s possible, but it takes resources, so we made our plan as epic as we need it to be to get this done responsibly this summer.

Ok so first is Phase 1.

Here’s where we see the curve flatten and fall by giving our essential workers the support and care they need. 40% of the economy is already open, thanks to essential workers like nurses, grocery store workers, utilities maintenance workers, police and firefighters, restaurant and delivery workers. They didn’t ask to be put on the front lines of this crisis, but they have stepped up to the challenges.

So in phase 1 we grow our resources to support our essential workers and turn our current limited-economy into a pandemic-resilient foundation.

We’ll hear from our neighbors and friends who work in delivery and law enforcement that thanks to testing and tracing they don’t have to wonder anymore if they might be spreading this disease without even knowing it, and don’t have to worry about coworkers having it without knowing it. When someone tests positive they get sick leave, they have other worker protections, so no one is worried about getting fired for being sick if they take a test.

We’ll hear from our elders in care facilities that now there’s testing in place to be sure that there’s no chance for this disease to spread out of control. That goes for anyone in frequent contact with essential workers, including folks in jails and prisons.

Some folks will be going through online training to fill in for essential workers. Maybe a teacher you know trains to do in-home childcare to sub in for someone who has gotten ill. And maybe a neighbor who has experience caring for an elderly relative decides to take the course and is ready to fill in.

How and where testing gets done might also depend on the community. We know that the best way to prevent spread is to find out who was in contact with someone who tested positive, so that those people can be tested quickly and have results within 24 hours. Some communities already have networks of contact tracers that people trust to do this work in a way that protects their rights, while in some communities we might hear about people working together to build these networks, maybe some will use technology to help. The better we are at contact tracing, the faster we can move on to phase 2, but worst case we just have to make a lot more tests, ‘cause in phase 1 most of us are still isolating at home so we only need to produce enough tests to keep those essential workers safe.

Meanwhile we’ll hear about all the innovative ways communities and companies are expanding contact tracing and making it work to bring down the number of cases to where we can move to phase 2.

In Phase 2

Now we’ve got our stable foundation of 40%, now we expand essential workers to 70%. Communities will be empowered to put programs in place to train and hire more people in essential jobs, lightening the burden on the current essential workforce. We’ll be able to address supply chain problems, you can find toilet paper in stores and order pasta online again.

We might see one city get more busses on the street and hire more folks to drive those busses, so that expanded essential workers can get to their jobs safely without being in a crowded environment. Another city without busses to spare might invest in hiring a set of workers to build out more public transit infrastructure.

More people will get hired to serve in roles in unemployment and retraining so more people can access support. A doctor who has tested positive and has to isolate might teach courses on how to do a swab test. A contact tracer with 20 yrs experience might partner with their county to start an online training program for contact tracers.

Maybe the Bay Area leans heavily on app assisted contact tracing. Maybe LA partners with an organization like the National Council of La Raza UnidosUS to work with immigrants on community run contact tracing they trust. In a rural county like mine maybe we do most of our contact tracing the old fashioned way over the phone with one of our local figures that everyone already knows anyway, and we can take a test at the old elementary school if we need to. Maybe we apply for funding to expand our tiny hospital, and there’s a demand for construction workers to build it out.

During this phase, which will probably be most of June, we can allow a relaxation of certain social distancing measures for those essential workers on the front lines. We’ll still have to cancel large gatherings, but the group of expanded essential workers can safely visit and support each other. We’ll see restaurants that are currently doing takeout for the general population can be open to serve essential workers on-site. If there’s any question of exposure, there’s enough tests to find out and the health resources to respond as necessary. We’ll see our friends and relatives in essential sectors go from stressed and scared to secure and supported.

Before long, 70% of the population is part of a smoothly working pandemic resilient economy, and so we move on to phase 3.

Phase 3

Phase 3 is short and sweet. It gets our workforce back to 100%, though some of us will still be working from home. It lasts just a week or two, and by the end there will be no corona-induced unemployment.

Phase 3 is where non-essential businesses like hair and nail salons, work that can not be done remotely, will restart with safety precautions like public mask wearing. Maybe a friend reopens his hair salon giving priority to essential workers in his community like doctors and bus drivers. He knows they are able to get testing if there’s a chance they’ve been exposed, so that if any of his clients do test positive he will be informed by a contact tracer that he should get tested too in case. He makes sure to only have one client in his shop at a time and takes special precautions to clean down surfaces between clients. 

Office workers and mathematicians like me will still be working from home in phase 3, and asked not to go out for just this next week or two, but now I can get a home visit from a hair colorist or a massage therapist. I’ll leave the on-location visits for the workers who don’t have the at-home job security I have, just until we’ve ramped up our supplies to where we can move to phase 4.

Phase 3 also increases support for the unemployed, homeless, and under-housed. This phase is probably early July, so I’ll be looking to my county for guidance on whether it’s safe to have a small 4th of July gathering, maybe keeping our distance outside on the porch or following other recommendations.

And then, at the end of July, we enter:

 Phase 4.

The last 20% of workers, still working from home, can start going to the office again. You might start going in just a few days a week after taking a test, covered by insurance, and then working from home for the rest of the week while a different group of workers has in-office days. Some industries might phase things differently, and different offices will make different decisions based on guidance and resources.

We can plan for summer barbecues with our family and friends because we’ll have clear guidance about safety and access to tests. We can go to parks and go shopping wearing a mask without fear that coronavirus is lying in wait on every surface.

A restaurant owner in NY, where tables are usually spaced close together, might have to reduce capacity, but they are happy to have office workers able to dine out again. In my town maybe most restaurants have enough space that folks can keep a safe distance at about the usual capacity. Maybe our local club replaces the dance floor with safely spaced bar tables, and they hire local performers to give live shows so that they can charge a cover to make up for reduced capacity.

In phase 4, Students can go back to school. Well, it’s probably summer vacation for most, but some school districts might have summer classes where students can get out of the house and catch up on what they missed in spring. Summer sports teams might have to get creative. Football, hockey, and basketball coaches will be inventing and sharing drills that have reduced contact. Parents might take turns attending games so that they can fill every other bleacher seat to maintain distance. There’s enough tests that professional sports organizations can pay to have players tested every day to identify cases before they can spread, meaning we can expect to see televised sports again.

We’ll have enough tests for educational institutions to be able to get additional testing support, like maybe my cousins’ college dorms are pretty crowded so they can expect to test more frequently if they want to stay there.

In phase 4, life enters a comfortable new normal for the year before a vaccine, with communities receiving up to date information on what’s safe and the economy coming back into full swing. Things won’t be quite the same. We’ll be wearing masks in public, moving large events online, and keeping a bit more distance than usual. But some of our investments will benefit us in the long term, like expanding our public transportation and health infrastructure. Our economy will be pandemic resilient not just for this pandemic, but ready to hold strong against future attacks.

Throughout these four phases, we’re going to see communities being empowered to find creative ways to reopen in ways that are safe, legal, and supported with the healthcare infrastructure they need to do testing, trace those who have been exposed, care for the sick, and support those who must isolate at home.

So you might be wondering, how do we get these resources available for states and local governments to use? Basically we need a national Pandemic Testing Board with strong but narrow powers to get the supply chain moving, with $50-500 billion in funding over two years, depending on how effectively we do contact tracing, plus an expanded Health Reserves. It’s a war-time-level investment that we are more than capable of, and it costs a lot less than repeatedly shutting down the economy, in both lives and money. We’ve done our homework on this so check it out along with the body of supporting work if you’re interested.

And people across disciplines and ideologies agree on this plan. We can do this. You can do this. Connect with your communities, look for ways to be involved or create them where you are, this is for real and I’ve never felt so encouraged and hopeful. Everyone I’ve worked with on this project has jumped in to say what can I do, how can I help. People who disagree on everything else and who would ordinarily refuse to be in a room together are working together on this in ways I would never ever have expected possible, it’s kind of miraculous, and I wanted you to know. I wanted you to know it’s real, that if you see it on the news with some big institutional names attached claiming all this good stuff about partnership and cooperation, I’ve been in the room with these folks, (I mean, virtually in the room but y’know), and it’s true. People are working together, they are deciding together that we can do this. And we can.

If you’re the hashtagging profile picturing type, lemme tell you, hashtag, HowWeReopen. We’ve got icons too, see links below like pandemictesting.org. Let people know, including your local leaders and elected officials, that they should take a look at this report sooner rather than later. I mean we’ve already got a lot of momentum but things are moving so fast with this pandemic, we could use all the momentum we can get, and I’m pretty sure time isn’t obeying the laws of physics right now so yeah, your help would be appreciated.

Ok, that’s all for today, I send my best to you and I’m looking forward to seeing the future you help create.