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Why Conditions Should Determine When Economies Open, Not A Target Date


President Trump and all 50 governors are facing a tough decision - when to reopen the country. Some governors are talking about lifting shelter-in-place orders as early as the end of this month. Others have them in place indefinitely.

Harvey Fineberg is the chair of the National Academies of Sciences, Engineering, and Medicine's Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats. He has advised the Trump administration on this pandemic. He says we should not be thinking about some sort of target date for when the country can open back up. Instead, we should focus on watching for the conditions that will allow us to do this safely. And he is on the line with us this morning. Dr. Fineberg, thanks for coming back on. We appreciate it.

HARVEY FINEBERG: Good morning, David. It's good to be with you.

GREENE: So what are some of the important benchmarks that you think communities should really be focusing on?

FINEBERG: These conditions that you described are not simply conditions that you wait for. They're actually conditions that you help create. The first and most important of these fundamental conditions is that we are able to do adequate testing in order to do two things - detect anyone who is infected and, secondly, to survey the community to be able to detect any escalation in cases. We're also going to want to be able to determine individuals who have been infected sometime in the past.

These different purposes require different kinds of tests. The PCR RNA virus test that is familiar to anyone who's been tested with the swabs - that's the test that detects someone who's newly infected. But serology, or blood tests for antibodies, is the test that surveys the community and determines who has been infected. That's No. 1.

No. 2, every community that is going to relax the conditions needs to have both a capacity to contain any escalation and an ability to treat newly ill patients. The capacity to contain depends especially on the ability to trace the contacts of anyone who is newly recognized as being infected. So putting those capacities in place in the public health department and in the health care and hospital facilities to treat the sick - with, of course, adequate personal protective equipment, adequate intensive care, adequate ventilators for treatment - that is the second critical condition.

The third critical thing is to get the number of cases down to a low enough number so that if it starts to escalate, we can still control it. If you get it down to a hundred cases, for example, and you could contain, let's say, 300 - but you multiply three times three times three over the course of one to two weeks, and all of a sudden you've got 2,700 - that's very different than if you started with 10 and you only had 270 still containable. So that's the third thing that has to be in place.

GREENE: I mean, I have to ask. Are there any places in the country that are getting close to meeting all of these kinds of conditions? Put a different way, is there any place in the country that should be thinking, like, wow, we're almost through this?

FINEBERG: There are a number of places that are early enough in the pandemic that they do have the number of cases down to a pretty low level. The problem in most of those places is that there has not yet been enough testing in the community to be confident that they're not already seeding cases in the community and just waiting for them to express themselves in another week or so. So starting with the testing is really crucial. Just recently, there was a community survey in counties in California which gave a pretty good picture of the fraction, which was a few percent, of the people who had already been infected. So that's a very important start.

GREENE: I just want to play a little bit of sound from the White House yesterday. This is Vice President Mike Pence talking about testing capacity.


VICE PRESIDENT MIKE PENCE: We believe we have the testing today around the country that would allow any state in America to move into phase one if they've met the other criteria.

GREENE: This is, of course, phase one of the president's plan to begin reopening certain parts of the country. You suggested that the testing is not widespread right now. Where - why does there seem to be a disconnect here between what we're hearing about testing from the federal government and from state officials?

FINEBERG: One of the reasons is that there is capacity for testing in, for example, university laboratories or other research laboratories that is not being fully utilized for clinical purposes. Part of the reason is long-standing regulation that separates research from clinical care. But also, part of the problem is that hospitals do not have the standard operating procedures, the transport systems, the billing and connections to their information on medical records that would allow them easily to use nontraditional sources of testing. So that's a part of the problem. The second part is that testing is not distributed, you know, even enough way to be available yet everywhere. That is a serious concern for many communities.

GREENE: As you step back and think about all of this, I mean, do you have some advice for the people who are in the difficult position of making these decisions?

FINEBERG: Absolutely. I would say, No. 1, to do things in a systematic way that prepares you to ratchet up or ratchet down, as the conditions will change. Don't promise or overpromise that you're only going to move in one direction forever. Secondly, and this is really another very important condition - everyone who operates a business, who runs a school, who has a restaurant - anyone has the opportunity to begin to put in place the conditions in their setting that will enable safe activity and interaction - maintaining physical distance, changing the way in which tables are laid out, for example, in the restaurant, keeping the number of people down, having people wear masks, perhaps checking temperatures. This is really critical.

GREENE: Dr. Harvey Fineberg is an infectious disease expert who has advised the Trump administration. Doctor, thanks so much.

FINEBERG: It's my pleasure to be with you. Transcript provided by NPR, Copyright NPR.