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How to start up the start-up nation

The plan to keep everyone safe, and also let people resume their lives begins with full quarantine for the vulnerable, and ends with intense testing to know who that is
Source: Pixabay
Source: Pixabay

Short of a miracle drug (and hydroxychloroquine isn’t it) or vaccine (probably 9-12 months away) the current state of the world will not get any better. Loosening up isolation rules will result in an increase in cases with their attendant hospitalizations and mortality. Biology is highly predictable. It carries no surprises and is numbingly relentless. Open up the spigot and the flood starts again. The hope that we can open it enough to restart life, but not too much to cause a flood of illness is, I believe, fraught with uncertainty and unnecessary risk. After all, nobody has ever been here before. What if this coronavirus isn’t as seasonal as other coronaviruses? What if the current mitigation efforts just mean more people will get infected in the summer. There are no experts or answers, just educated guessers.

But there is a way to get back to normal with limited risk, at least in a controlled environment like Israel. Here’s how.

Everybody falls into 1 of 3 groups, based on the results of 2 tests: the COVID-19 antibody test and the COVID-19 virus test. One group is COVID-19 antibody positive. This 10 minute fingerstick blood test, if positive, means you have been exposed to COVID-19 and are now probably immune. You can neither get sick again from COVID-19 or transmit it to anybody else. If you are COVID-19 antibody negative, you are vulnerable or may even be carrying the virus. Probably, the majority of people carrying the virus never have symptoms. The body silently defeats the virus.  About 14% of healthy pregnant women who recently delivered at Columbia Hospital in New York were COVID-19 positive without any symptoms! A Florida developmental center tested all their residents and staff and of the 33 who were COVID-19 virus positive, 22 had no symptoms. So, the question for the antibody negative group is whether they are currently carrying the virus or not. The COVID-19 virus test result determines the next step. If a sample is taken properly and the result is negative, you don’t have the COVID-19 in your system. But if the COVID-19 virus test is positive, you have the virus and can transmit it to others.

There are only 3 possible results: antibody positive, virus positive or virus negative. Once we know your status, the next step is clear. If you are antibody positive, go about your business and don’t worry. You can’t get it or give it. If you are antibody negative but virus positive, go into strict isolation and eliminate all contact with all susceptible individuals. After 2 consecutive negative virus tests or a positive antibody test, you may go about your business as usual. If you are antibody negative and virus negative, you haven’t contracted the virus. Since the all the positives will be in isolation, you may go about your business as usual and not worry about catching the disease. In view of the fact that no system is perfect and some virus positives might sneak into the population, this strategy requires that a virus negative person repeat the virus test every 2 weeks. The algorithm is easy.

  • Antibody positive = Normal life, no further testing
  • Antibody negative and virus negative = Normal life and biweekly virus retest
  • Antibody negative and virus positive = Strict isolation and weekly testing until negative.

Success of this approach depends on 2 critical factors: full quarantine and intense testing. The former can be accomplished by hospitalization of the sickest and forced residence in secure quarantine hotels until cleared. The testing challenge is really the biggest obstacle and has stymied all efforts to open up the US. Only a minute fraction of the total US population has been tested and they haven’t even begun to test asymptomatic people. This is a massive human and technical engineering challenge. Seven million Israelis would need to be initially tested for antibody and virus and a diminishing but large group every 2 weeks thereafter. As more and more of the population converts to antibody positive, fewer people will need testing. The biweekly testing must continue until a vaccine is available. That’s about 500,000 tests a day to start! A formidable undertaking.

Where does one get the personnel and supplies to do all these tests reliably? How will all this information be coordinated and monitored? How will testing and quarantine be enforced? How can this be seemingly Herculean task be accomplished? It’s time for the Start Up Nation to rise to the challenge and start up.

  • Every active duty soldier, Sherut Leumi volunteer and Hatzala volunteer will be trained to properly take a sample and perform both tests. The test must give a result within a maximum of 3 hours. If each team of 2 testers can together sample and test 40 samples a day, we will need 12,500 teams of 2 people each, distributed throughout Israel to test and test and test the entire country. Testing priority will be given to health care workers and eldercare aides.
  • Half a million virus test kits and antibody test kits a day must be purchased or manufactured. The entire country must dedicate all its resources to this task. We will have to figure out how to do something nobody else in the world has done, and fast.
  • All the data will be managed on a single data base operated by our vaunted computer experts in conjunction with military intelligence. The virus status of every single person living within the borders of Israel will be linked to their TZ or foreign passport number.
  • Police and the military will enforce the above guidelines.
  • Allow visitors to Israel but anybody entering the country must be tested and treated as above before leaving the point of entry into the general population. Currently, one cannot get out of Hong Kong airport today without waiting for a test result. Border Patrol agents will be trained to administer the test.
  • After Week 2, when the entire country has been tested and all the virus positives have been quarantined, open up the country and allow everybody but the COVID-19 virus positives to go about business as usual. Repeat the process over the next 2 weeks and so on. Starting Week 4, open up the country for tourism and continue to apply the above procedures at the ports of entry. All tourists will be subject to the same biweekly testing regimen.

All of this sounds impossible. But the Jewish people’s and Israel’s very existence can only be described as impossible! We are not afraid of the impossible because we’ve been there and done that.

The above strategy will restore Israel to normalcy and assure residents they will remain safe. If successful, Israel will be the only country in the world that can offer such security. Visitors from all over the world will flock to Israel knowing they are safe and can live a normal life. The tourist industry will see a prolonged and intense recovery. Aliyah will see a major boost.

And we pay for this with a multibillion dollar Keren Corona Israel Bond that will undoubtedly be supported by the world Jewish population.

If you think the above cannot be done, then prepare for another 9-12 months of some variation of what we are now living through. But of you believe in Start Up Nation, now is the time to prove it. And if we try the impossible, and pray for success, we can hope that God will shine his countenance upon us and bring a solution speedily.

About the Author
Allan I. Jacob, MD is a Board Certified Internist and Nephrologist with more than 40 years experience in both clinical and administrative medicine. He currently serves as Chief Medical Officer of Physicians Dialysis, a medium size US dialysis provider.
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