If we slow the spread, can we return to normal? The United States now has 519,453 COVID-19 cases. That’s more cases than Spain, Italy, China, and South Korea combined. There are still a handful of U.S. states that have not put in place state-wide mitigation plans such as the “shelter in place” orders that other states now require.

People have been wondering when these mitigation plans can be relaxed. When, for example, might retail businesses, restaurants, and Starbucks be open for business? When might students return to school? Play tennis, swim?

The answer is not easy. There is not a single variable that can be used to tell us when we can return to normal. It most likely will not happen at once throughout the United States. It might be determined state by state, or community by community. It’s complicated. For example, people can travel by car, train or plane to exit their community. People are doing this now. If we were to remove “shelter in place” orders, then we increase the number of people who can travel, and risk spreading the virus.

During the 1918 pandemic, some cities lifted the stay at home order too early. This resulted in a second surge or spread of the virus (see Figure 2). So we know that lifting the bans too early could result in further spread.

So, how will we know when stay at home bans can be lifted? When it does happen, it will be gradual and staged in a step-by-step way. It will depend on the level of compliance that has been followed to mitigate the virus.

If you look at the current status of COVID-19 in the U.S., you see that infections are still spreading. There have been more than 20 thousand deaths attributed to the virus. Coronavirus cases have increased rapidly since early March 2020. Figure 1 shows the how cases have increased over the past month per day.

Unless we reduce the number of cases per day to less than 1, we won’t be ready to begin the next stage. That said, here are some variables that health practitioners have considered to determine whether to recommend some level of lifting the ban on staying home. And another thing to keep in mind is that the Federal Government has put the states in competition with each other for needed equipment and research. This is extremely unfortunate. Instead of going forward as a unified country, the Trump administration has refused to bring the states together to fight the pandemic.

However, there are plans to go forward, but as you will see, they are not coming from the White House. Here are some ideas that point to a plan that will get us through this pandemic, as well as prepare for the future. As long as we continue to allow groups to congregate, the virus will spread. The goal is to keep reproduction, or “R,” below one (R<1) – with each case infecting fewer than one other person, on average.

Unified Plan to Shelter in Place

As mentioned earlier, the United States does not have a unified shelter in place plan. There are still some states with no shelter in place plan, and in some other states, religious services, parks, and beaches are still open. Bill Gates put it this way:

The country’s leaders need to be clear: Shutdown anywhere means shutdown everywhere. Until the case numbers start to go down across America — which could take 10 weeks or more — no one can continue business as usual or relax the shutdown. Any confusion about this point will only extend the economic pain, raise the odds that the virus will return, and cause more deaths.

Gates, Bill. “Opinion | Bill Gates: Here’s How to Make up for Lost Time on Covid-19.” The Washington Post, WP Company, 31 Mar. 2020, www.washingtonpost.com/opinions/bill-gates-heres-how-to-make-up-for-lost-time-on-covid-19/2020/03/31/ab5c3cf2-738c-11ea-85cb-8670579b863d_story.html.

Hospitals Ready to Treat All Patients Regardless

Right now in many cities, hospitals are not able to handle the coronavirus cases in their communities. Hospitals need to return to relatively normal operation and have plenty of beds for all patients who need them—not just COVID-19 patients. Normal life can’t proceed until this is in place.

Before this can happen, hospitals and its workers need to be equipped with equipment to keep themselves safe, and be able to treat coronavirus patients. Much more funding is needed to support hospital infrastructure for post-COVID-19 healthcare.

14 Days of Falling Daily Numbers of New COVID-19 Cases

You’ve probably heard that 14 days is an important number in the COVID-19 pandemic. According to physicians, the virus can lie dormant without triggering symptoms for 14 days. Without having this assurance, it would be foolhardy to open the spigot too early.

Scientists are concerned that we must guard against the risk that large outbreaks could reignite once we lift our efforts to mitigate the spread. As I mentioned earlier, there is evidence that letting up on social distancing too soon can be disastrous. Figure 2 is a graph that shows what happened when Denver sent student back to school, and allowed public gatherings for just a week. Notice that the second peak was higher than the first. We risk a repeat of this if we rush in and lift the ban on public gatherings and let kids back to school.

Test Everyone Who Has Symptoms

The United States need to step up its testing for coronavirus. Testing has been spotty in the United States, and it only improved when individual states, led by their governors, initiated testing programs. A good example was in New York with its drive-up testing sites. Figure 3 is a map of risk scores for people who are older (like me) and sicker. Note that the Southeast and states along the East Coast have higher risk scores that the Western part of the country.

We need to be Able to Conduct Monitoring of Confirmed Cases and Contacts

Until a vaccine or treatment is developed, we need to use intervention tools to know about cases and contacts people had if they were infected. This was done successfully in South Korea. Contact tracing has been done in the U.S., but only in isolated cases. In terms of math, if a person is tested positive, who are the people that came in contact with this patient. This is an enormous task, and will take technology to help solve the problem.

However, plans are underway to initiate contact tracing. Here is a plan being developed in Massachusetts. The Governor explained it this way:

In the absence of federal direction, Massachusetts last week unveiled a plan to begin building a contact tracing army.Gov. Charlie Baker (R) partnered with an international nonprofit group based in Boston that has been waging this kind of public health campaign against contagious diseases including tuberculosis in Africa and HIV and cholera in Haiti. The nonprofit Partners in Health quickly put together a plan to hire and train 1,000 contact tracers. Working from their homes making 20 to 30 calls a day, they could cover up to 20,000 contacts a day. The group is paying new hires roughly the same salary as census takers, more than $20 an hour. As of Tuesday — just four days after the initial announcement — the group had received 7,000 applicants and hired 150. “People want to help. They’re tired of just sitting at home and waiting to be infected,” said KJ Seung, strategy and policy chief for the nonprofit’s covid response. “There’s a huge untapped resource of people in America if we would just ask.”

Lena H. Sun, William Wan. “A Plan to Defeat Coronavirus Finally Emerges, but It’s Not from the White House.” The Washington Post, WP Company, 10 Apr. 2020, www.washingtonpost.com/health/2020/04/10/contact-tracing-coronavirus-strategy/?utm_campaign=wp_evening_edition&utm_medium=email&utm_source=newsletter&wpisrc=nl_evening.

Support for Families and Healthcare for All

The United States can move ahead and get past the pandemic. However, it will not be soon, and will take a more unified approach than what we are seeing now.

Furthermore, one of the greatest problems facing the country are the millions of people who are unemployed and without health insurance. The meekly $1,200 per person provided in the $2.2 trillion package is simply not enough. Has anyone received a dime yet? Yes, we’ve increased the length of time for Unemployment insurance coverage, and increased the amount a bit. However, it’s not enough if we take the pandemic seriously. It’s not going to go away soon. People will be out of work for longer than we think. Already, we are seeing thousands of cars lined up to receive food and medicines.

We can get through this pandemic. But, some fundamental issues need to be reckoned with. Healthcare for all should be a fundamental outcome of the pandemic. People, of any income, should not be denied healthcare in the United States. Not only are seniors at risk from the virus, but anyone who has underlying health issues such as diabetes, hypertension, heart disease, COPD, and asthma. People who don’t have regular healthcare are more likely to be at risk with any of these diseases.

Finally I invite you to peruse a course that was just created by medical students at the Harvard Medical School. I grew up near Harvard, but ended up going to Boston University, just down the street. And this is a great course. You might want to check it out.