For now, social distancing is the best America can do to contain the Covid-19 pandemic. But if the U.S. truly mobilizes, it can soon deploy better weapons—advanced tests—that will allow the country to shift gradually to a protocol less disruptive and more effective than a lockdown.
Instead of ricocheting between an unsustainable shutdown and a dangerous, uncertain return to normalcy, the U.S. could mount a sustainable strategy with better tests and maintain a stable course for as long as it takes to develop a vaccine or cure. The country will once more be able to plan for the future, get back to work safely and avoid an economic depression. This will require massive investment to ramp up production and coordinate the construction of test centers. But the alternatives are even more costly.
Two types of testing will be essential. The first test, which relies on a technology known as the polymerase chain reaction, or PCR, can detect the virus even before a person has symptoms. It is the best way to identify who is infected. The second test looks not for the virus but for the antibodies that the immune system produces to fight it. This test isn’t so effective during the early stages of an infection, but since antibodies remain even after the virus is gone, it reveals who has been infected in the past.
Together, these two tests will give policy makers the data to make smarter decisions about who needs to be isolated and where resources need to be deployed. Instead of firing blindly, this data will let the country target its efforts.
Here’s a simple illustration of how test data can save lives. Every day millions of health-care professionals go to work without knowing whether they are infectious and might spread the virus to their colleagues. We both have close relatives on the front lines. As soon as one of them developed a cough, she pulled herself out of service. But at that point she may have been infectious for several critical days. If she and her colleagues had all been tested every day, her infection would have been caught earlier and she would have isolated herself sooner.
To be used as a screening mechanism at the beginning of a shift, the test would need to be able to give a result within minutes. Developers are making progress on speeding up these PCR tests—so much so that the aforementioned physician received the results from her second test, conducted five days after the first, before those from the first test. Abbott and Roche, two pharmaceutical companies, are moving forward with tests that can decrease reporting times from days or hours to minutes. Now that the doctor has recovered, an antibody test could help determine when she can return to the frontlines of patient care.
As testing capacity expands, the same tests could be offered to all essential workers, such as police officers and emergency technicians, and then to other overlooked but critical workers—pharmacists, grocery clerks, sanitation staff. The next step would be to test people throughout the country at random to get up-to-date information about who is infected now and who has ever been infected.
For those who are currently infected, governments can provide immediate assistance to make sure they don’t infect anyone else, especially family members. Those infected before who now have antibodies may be less susceptible to reinfection. If that is proved in the weeks to come, they could also return to work.
Putting this system in place will take resources, creativity and hard work. Test developers will have to increase the production rate of kits by an order of magnitude. In his work fighting Ebola in West Africa, Dr. Shah saw how a virus can cause a 30% reduction in economic output. Mr. Romer’s back-of-the-envelope calculation is that the recession caused by the coronavirus pandemic has already caused a 20% reduction in U.S. output, which means the country is losing about $350 billion in production each month. If a $100 billion investment in a crash program to make antibody and PCR tests ubiquitous brought a recovery one month sooner, it would more than pay for itself.
Building this testing system would be complicated and require the best of American science, business and philanthropy working together. But it is the type of challenge that the U.S. has overcome before. It isn’t viable to wait a year or two for a vaccine before getting people back to work safely. To save lives and prevent a depression, testing on a massive scale is essential.