During yesterday’s daily briefing, President Donald Trump—flanked by Vice President Mike Pence and Dr. Deborah Birx, the coronavirus response coordinator—struck a pose of somber, but hopeful, confidence. The mood couldn’t have been more different just 500 miles away, in Frankfort, Kentucky, where a group of protesters implored Governor Andy Beshear to reopen the Bluegrass State for business. “Let us work,” they chanted. The protest was a microcosm of the cost of America’s aggressive efforts to “flatten the curve” and mitigate the effects of Covid-19: mass layoffs, record unemployment filings, job furloughs, and often-existential anxieties, especially for the growing percentage of Americans (now approximately 33 percent) living paycheck to paycheck.
The drama that has played out between public-health experts and a population increasingly frustrated with stay-at-home orders reflects a familiar struggle. As an epidemiologist who has worked on half a dozen viral outbreaks over the last decade, I know well the risks of incomplete mitigation. An infection that isn’t fully suppressed can easily reemerge. Firefighters, I’m told, often encounter a similar phenomenon when opening doors or windows to an enclosed space that appears to be no longer burning—only for oxygen to rush in and explosively ignite superheated gases. Those of us who work in the realm of emerging viral threats are especially haunted by the cautionary example of the 2018 Zaire ebolavirus, which occurred in the Democratic Republic of the Congo. The outbreak subsided after three months, only to emerge a month later in the country’s war-torn northeastern corner, becoming the second-deadliest ebolavirus outbreak on record.
The best defense against such a rapid “flashover” event is the gradual lifting of public-health measures with assiduous monitoring. Few things could have lent more confidence to the White House Coronavirus Task Force’s ability to do so than Birx’s presentation at yesterday’s press conference, in which she offered the public a glimpse into the pathogenic monitoring and surveillance central to managing an emerging outbreak. For perhaps the first time in the history of public health, decision-making will be supported by real-time surveillance data, derived from hospital reports of influenza-like illnesses through platforms such as the CDC’s ILINet; the identification of syndromic illnesses through reporting from emergency-room visits and sentinel surveillance; and the testing of asymptomatic patients in high-risk populations. Birx’s presentation marks the moment that public health has emerged as a truly data-driven discipline, bringing all the advances of data science, health-information technology, and machine learning to bear on this new crisis.
It should also lend reassurance to both camps—those who wish to reopen the nation for business as soon as possible and those who feel apprehensive about the effects of reopening too early. The granularity of the plan, allowing individual states to set the schedule for reopening, is a recognition of the reality that the U.S. is too diverse for a one-size-fits-all approach. To apply a single quarantine policy to a nation of 330 million people ignores the differences between densely populated, bustling urban areas like New York City—where thousands have died from Covid-19—and small towns like Kingman, Indiana (population: 511), that haven’t yet experienced any cases. A blanket policy would be detrimental to the economy and scientifically unsound.
A targeted, data-driven approach that recognizes the differing conditions of the states, rather than placing them all on the Procrustean bed of a single policy, is the right prescription for this crisis. For the first time, such an approach is not only possible, thanks to the underlying technologies, but has also found vigorous support within the public-health establishment, as well as on the White House’s task force. While it remains true that no strategy survives contact with the enemy, the evidence-based, gradual approach for reopening America is as good a plan for emerging from a pandemic as one can imagine.
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