Policy

For states satisfying gating criteria:

Individuals

• Vulnerable members shelter in place.
• Maximize physical distancing and no socializing more than 10 people
• Minimize non-essential travel

Employers

• Encourage telework and return to work in phases
• Make special accommodations to vulnerable personnel

Specific Employers

• Schools and youth activities remain closed
• Hospital and Senior Living visits prohibited
• Large venues can operate under strict social distancing
• Bars closed, elective surgeries can resume and gyms can open under social distancing and sanitation protocols

For States/Regions with no rebound satisfying the gating criteria a second time:

Individuals

• Vulnerable members continue to shelter in place. Household members need awareness their activities may carry the virus home.
• Maximize physical distancing and no socializing more than 50 people
• Non-essential travel can resume

Employers

• Encourage telework still
• Close common areas
• Make special accommodations to vulnerable

Specific Employers

• Schools and youth activities can reopen
• Hospital and Senior Living visits prohibited
• Large venues can operate under moderate social distancing
• Bars open, elective surgeries continue and gyms stay if adhering to social distancing and sanitation protocols

For States/Regions with no rebound satisfying the gating criteria a third time

Individuals

• Vulnerable members can resume public interaction but physical distance.
• Low risk populations consider minimizing time-spent in crowded environments.

Employers

• Resume unrestricted staffing
• Close common areas
• Make special accommodations to vulnerable

Specific Employers

• Visits to Hospitals and Senior Living centers can resume
• Large venues can operate under limited social distancing
• Bars may operate with increased standing room occupancy

None Made.

None Made.

None Made.

Slow the spread.

• 14 days sustained transmission reduction
• Capacity to treat all infected
• Capacity to test all with symptoms

Reopen America.

Safely diagnose, treat and isolate cases and contacts.

Reopen schools and businesses, but heighten hygiene/ sanitization and social distancing. Limit gatherings, use masks to reduce asymptomatic spreading.

POC diagnostics fully deployed in clinics. State x state and county x county openings. Isolate confirmed cases for 7 days, those waiting on test results and close contacts identified through tracing for 14 days. Identify the Immune through Serologic testing.

Establish Immune Protection.

Lift physical distancing and other restrictions when mitigating tools are available: broad surveillance, disease therapeutic or a vaccine.

Possible once a robust sentinel surveillance is put in place couled with widespread POC testing and ability to trace, isolate and quarantine.

Serological surveys to determine population immunity.

Rebuild Our Readiness for the next pandemic.

Vaccine in months v years, modernize the healthcare system, establish a national infectious disease forecasting center.

750,000 US weekly tests to move from population mitigation to case-based interventions when paired with contract tracing.

Tools needed to communicate test results and use data for containing future outbreaks.

Massively Scale Contact Tracing, Isolation and Quarantine.

• New cases isolated 7 days at home/hospital.
• Isolation can be enforced using cell phone GPS tracking.
• Close contacts quarantined and monitored for 14 days.

To scale these interventions with thousands of daily cases and tens of thousands of daily contacts requires a task force.

Task force develops and oversees:

• Surge existing public-health workforce for case finding and contact tracing;
• Enable rapid reporting to state/local/ federal health authorities, and electronic data sharing from health care providers and labs;
• Develop a tech approach to rapid data entry, reporting, and support for: isolation, quarantine, and treatment of affected

Implement Comprehensive Surveillance Systems. Monitor incidence trends as reduced physical distancing will accelerate case counts.

A high-performing disease surveillance system leverages:

• Widespread and rapid testing POC molecular testing;
• Serological testing to understand population exposure and immunity.

Inform public-health decision-making about population-based mitigation required to prevent continued spread in an outbreak;

A comprehensive national sentinel surveillance system, with local public-health systems and providers is still small and at a stage in which case-based interventions can prevent a larger outbreak.

ILINet, the influenza surveillance system, is a potential model for SARS-CoV-2 surveillance. To enable rapid and more effective detection and case management, SARS-CoV-2 surveillance will also benefit from data sharing and coordination with health care providers and payers.

• $12b to expand contact tracing workforce.
• Est 180k tracers needed until vaccine.
• $4.5 b to use vacant hotels for infected and exposed without ability to self-isolate to stop the spread.
• $30 billion to offer 18 months of income support
• per-person jury-duty like stipend of $50 a day, for voluntarily self-isolating.

• $12b to expand contact tracing workforce.
• Est 180k tracers needed until vaccine.
• $4.5 b to use vacant hotels for infected and exposed without ability to self-isolate to stop the spread.
• $30 billion to offer 18 months of income support
• per-person jury-duty like stipend of $50 a day, for voluntarily self-isolating.

National 45 day stay at home policy to break community transmission. Review South Korea model of massive testing and proximity to infected notifications. Publicly isolate those in quarantine. Review Hubei province reducing R0 from 2.35 to 1.05 with lockdown.

Move to following: Ramp up Testing and PPE production. Instantaneous Contact Tracing and Isolation.

South Korea model of massive walk-up/drive-up mobile and clinical testing.

South Korea proximity tracing to infected with notifications.

South Korea proximity tracing to infected with notifications.

Proposal requires:

• wave has peaked
• capacity to treat all infected
• testing capacity for all symptomatic and post infection and adequate PPE.

Tests are POC backed by centralized testing.

Emphasizes testing over temperature taking as thermometers are too insensitive.

Allow return to work if:

• recovered from the virus
• demonstrable immunity
• under age 65
• have no complicating medical conditions

The first group includes asymptomatic/ symptomatic patients now virus-free.

The second would need regular repeated tests.

Governors establish advisory task forces and Coronavirus Czar for local/regional decisions.

Decisions based on:

• medical conditions
• health care resources
• testing capabilities
• population demographics
• business priorities

Needs massive testing to better understand infection rates, causes and trajectory towards herd immunity.

Back to work electronic certification on a phone app that provides a time-bound certification of their status.

5m daily tests

• To succeed, isolation must be supported with job protections, resource support, and health care
• Broad quarantine of asymptomatic
• Targeted Isolation
• Universal testing of symptomatic

May

Phased Sectoral Mobilization

• 20m daily tests
• Expand essential workers to include short, medium, long term needs
• Address continued shortages in the essential sector
• Modify social distancing for expanded essential workers

July

End Collective Stay at Home

• Mobilize another 10% of workers to non-essential sectors
• Recruit community orgs and social services to support communities of needs
• Temporarily relax regulations to allow modifications to non-essential sectors

Late July

Full Pandemic Resilience

• Return 20% of at-home workers to offices
• Reopen Schools

August

5m daily tests by June and 20m daily tests by July 20th

Hire 100,000 Contact Tracers

Clear norms of governance and enforcement around peer-to-peer warning apps, including:

• maximal privacy protection
• open source code for independent and regulatory audit
• prohibitions on data use from apps for commercial purposes
• ideally achieved through pre-emptive legislation

• Support for quarantine and isolation in the form of jobs protections and material Support for time in quarantine
• An expanded U.S. Public Health Service Corps and Medical (or Health) Reserves Corps (paid), and addition of Health Reserves Corps to the National Guard units of each state.

Spend $100b for Nationwide Testing

Test essential workers:

• Healthcare and frontline workers most likely to be infected,
• other essentials: teachers, grocery clerks.
• Isolate anyone who tests positive; test their family members and close colleagues.

Offer to test everyone—students, teachers, customers, allow masks

Start with essential workers, such as health care workers, first responders, grocery store employees and transportation personnel, before expanding to others. Isolate the positive.

Spend $100b for Nationwide testing weekly.

• 25m tests per day
• Test and Isolate

A suitable complement to proven containment policies like “test and isolate”, cannot be counted on.

• It requires inherently unreliable data (manually or digitally), does not inspire confidence, is not definitive on who is infected, is not comprehensive (asymptomatic spreaders), is not robust (tech and human capital needed in a surge are immense), is not feasible (not available today and it is unlikely to secure buy-in from key decision-makers due to civil liberties concerns.
• As such, contact tracing cannot be considered a viable option for widespread containment response, but it remains a helpful tool for epidemiological disease surveillance.

Return to normalcy isn’t possible without a vaccine. We can get close with a national “test and isolate” strategy. The approach is simple:

• Test everyone to find out who is infectious.
• Isolate them.
• Continue testing, and continue isolating.

“Test and isolate” improves the lockdown approach: population lockdown works isolating infected. Instead of isolating everyone, we must transition to a case management “identify and isolate” strategy, finding the infected, including asymptomatic carriers, to isolate them.

WHO focuses more on technical guidance for schools, workplaces and institutions v. phased country/city guidelines.

WHO Contact Tracing Guidance

WHO Surveilance Guidelines

Reopen with social distancing

Completely reopen