Ready to reopen? - Barokong - Teknoiot

14 May 2020

Ready to reopen? - Barokong

Are we ready to reopen? No but not for the usual reason.

Once we have testing we can reopen, says conventional wisdom. I doubt that. Who is going to give these tests, and what are they going to do with the information?

Maybe maybe maybe if we had a free test, with instant results, that every American (and person flying in on a plane) could take every day; if almost all Americans were actually willing to take said test; and if people were universally willing to quarantine themselves upon its results, the test might help. But even that's a pipe dream.

We won't have a vaccine, applied to the entire world's population, for a long time. "Herd immunity" seems unlikely. It's not even clear that exposure to COVID-19 confers immunity. (I've been looking for any study of how often people who had it once get it again. Let me know if you see one.) The whole point has been to bend the curve so that the vast majority don't get it.

So, we will have through summer and fall, a pretty susceptible population and a virus ready to break out any chance it gets to.

The point of "testing" and "reopening" is to have a system whereby public health interventions take the place of draconian economic shutdown to keep the reproduction rate under one.

Public health does not mean just lots of tests. It means using the tests to identify small outbreaks and keep them from getting big. And that requires a tooled up, effective, nimble, local, public health bureaucracy. And a bureaucracy that steps on a lot of toes.

Suppose your neighbor gets one of these tests and is positive. What gets done about that? First of all, under HIPPAA, his or her test result is nobody else's business, not even local government. Who forces him or her to self-quarantine? Who forces them to get the test if they know forced quarantine is coming?

In Asia, apps tell you who got tested and the result. You can judge if you had contact. Or state  surveillance tells you that tracking your cell phone and theirs the authorities know you had dinner together last week and you're being isolated now. We, properly, have big laws against all of this! Are we willing to do this? How fast? Will we faintly have the capacity to do it? In a month?

Maybe after weeks of wrangling, local public health officials (which local public health officials?) can use the information to decree there has been a positive test on your block and impose a quarantine on the whole block. The heck with that, say you, proud American. Like me, you've been strenuously distancing for a month, so you know you haven't got it from the neighbor, you're off to the newly opened park for a jog. Obviously, such edicts will have to be enforced, against a restless and resentful populace. Can you really see cops cordoning off apartment houses, blocks, towns, controlling who goes in and out? Do we even have cops to do it? And the method to figure out who goes where?

"Testing" and "tracing" are popular. Do most Americans (and our 10 million undocumented residents!) really want to tell someone from the government every person they've met in the last two weeks? Knowing the government is likely to quarantine them and ask more questions?  Or let them track your phone? Or carry your phone the minute you know they're tracking it?

Birthday parties are just as bad as bars. Are we going to allow health authorities to monitor our cellphones and bust up birthday parties?

A key part of public health is to isolate known areas. Are Americans going to put up with travel bans?  Are there any public authorities with the competence to put in place data-driven nuanced travel bans? Again, for the vast majority of people, the travel ban will be a senseless annoyance.

We will need a robust public health response, to keep a small number of cases from ballooning, and allow the economy to open. We will need the response we should have had in January. "Testing" is one of many inputs to that response. But "testing" is not the response itself. An effective public health response needs a detailed, competent bureaucracy, temporary relief from thousands of privacy regulations -- and swift assurance that those privacies are reinstated when it's over -- and enforcement in order to something useful with the tests. I doubt Americans will put up with the enforcement. I doubt our government has the capacity to put them to that test. I hope I'm wrong as the alternative is waves of lockdown.

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