The way out

To release everyone back to life/society there can be a few solutions:
1. “Mass (Viral) Testing” – i.e. Find and isolate the sick.
This is the strategy that worked for countries like Taiwan and South Korea. It requires the ability to mass test millions of people and it needs to happen early on in the course of the disease introduction. Beyond this, there are a number of other problems with relying on mass testing as a reintroduction measure.
– Volume of testing – we do not have enough materials to produce this many tests. Especially since in this scenario, we would need repeated testing to be sure people are not coming sick to their workplaces or schools.
– Frequency of testing – alluded to above. Testing negative once does not mean you are negative forever. To catch those who are in the early phase of illness we would need to do this even daily.
– Rapid turnaround – the results of these test would need to be available within minutes or at least hours which requires new quick testing or more labs and lab workers.
– Reliability of testing – False negatives are a real problem. Even if they are only 5% and 95% testing correctly identifies those without the disease (which is generous), that 5% x 9 million people in Israel x 10% of the population infected (for example) means that 45,000 would potentially be spreading COVID having tested negative and allowed to return to work/school.
As you can see, this alone is not a feasible solution.
2. “Antibody Testing” – i.e. Find and release those who are theoretically immune (protected with positive antibodies).
In this scenario however, we would release people who are antibody positive indicating they are recovered from the virus. By some estimates, this may be only 10% of the population. Without a mass economy and school to return to, the release of this small part of the population does not do too much. And there are other outstanding issues:
– Other 90% of the population – how can we get them out of quarantine? We need another strategy, and cannot just wait until everyone gets sick.
– How long (if at all) do these antibodies protect? We do not have evidence yet how long immunity lasts, or in fact if having antibodies ensures you immune at all. Related viruses like SARS and MERS antibodies do however confer immunity, so it reasonable to hope they do.
– False positives – similar to the above issue, there may be around a 5% false positive rate to these tests. Meaning thousands of people could be released into the workforce or school who are actually vulnerable.
3. Release everyone and deal with the consequences.
This raises the same issues as before: Not enough ventilators or intensive care doctors, no known medical treatments. To take this position is to accept thousands of potentially preventable deaths in order to hopefully return to a normal daily routine.
– There has been talk about there being medications to treat COVID now. This is not the case. Many medications are being studied right now in the hopes they will help, but there are no reliable studies yet that any medication improve outcomes.
– Also being discussed are such last-ditch measures of ventilator sharing. These are short-term stop-gaps and not solutions which will reliably save lives.
– If something is found that helps, it could change our analysis.
4. Vaccinate the population widely.
This is the only solution which seems like it could return our lives to a semblance or normalcy. It is at least one year away. Large foundations like the Gates foundation are setting up many vaccine development sites to try and speed up the process of discovery. But even if found, a vaccine needs to be tested in labs, then usually animals, then finally people, before figuring out if it works and is safe. It takes time.
The practical solution:
A combination approach is needed. We can identify those with positive antibodies and release them from quarantine along with those who test negative for the virus on a daily or weekly basis.
– With this approach we need to accept the false positive/negative rates, meaning that that there will still be thousands of people sick with COVID.
– Healthcare delivery must change to free up the resources to care for these people. We will need to purchase more ventilators, create COVID hospitals, and provide plenty of protective equipment to our healthcare providers.
– Workplaces needs to be more flexible, allowing work from home periods. There will need to be financial relief for the decreased productivity we must expect.
– As a society we may need to accept the continued use of masks for a while, and continue our aggressive hand-washing and strict isolation when at all ill.
– World governments will need to invest in research toward a more permanent vaccine or treatment solution.
It will take time for the machinery of this combined approach to get all the pieces in place. In the meantime, we should make any adjustments we can to keep fit, mentally healthy, and connected. We need to look at our daily schedule as one that we may need to continue for a while, while keeping faith that there is a way out.
About the Author
Dr Roth is a US-trained family physician with specialties in research and global health. She made aliyah five years ago to Ra'anana, and is mother to four young children. Dr Roth currently practices both in Israel and to the US via telemedicine, and directs the Clinical Reasoning Course at Sackler Medical School (Tel Aviv University).