There\u2019s an old \u201ccountry\u201d expression, it\u2019s no good closing the barn door after the horses are out\u201d. The United States original strategy in dealing with the Corona-Virus was \u201cclosing the barn door\u201d. We tried to close our borders and stop travel from China and ultimately Europe to prevent the COVID-19 virus from getting here. But, like the proverbial \u201cbarn door\u201d it was too late. The virus, perhaps in non-symptomatic travellers, was already here.<\/p>\n\n\n\n
Why didn\u2019t we know that? Epidemiologists will tell you, if you can\u2019t \u201cclose the barn door,\u201d then the next step is containing the contagion. Containment is simple: you test until you find the infected, you contain (quarantine) those who are positive, and you trace all of their contacts. Then you test them, and go through the entire process again.<\/p>\n\n\n\n
The key to that is you have to have a test.\u00a0\u00a0If you can\u2019t test, then you are just guessing; guessing that flu-like symptoms are in fact COVID-19, and hoping that everyone who might be asymptomatic recognize they have been contacted.\u00a0\u00a0If this sounds like a lot of maybes and \u201ccould be\u2019s\u201d it is.\u00a0\u00a0The formula is simple: if you can\u2019t test, then you don\u2019t know.\u00a0\u00a0If you don\u2019t know, you can\u2019t contain.<\/p>\n\n\n\n
So what\u2019s the third step? You\u2019re living it: social isolation to slow the spread of the disease, keeping the volume down (mitigating) so that hospitals don\u2019t get overwhelmed with patients. COVID-19 can kill people, even those who don\u2019t fit the age, immunity or underlying issues profile. But many of those who might die could be saved, as long as there is hospital space, equipment and care available. Slowing the spread, or colloquially \u201cflattening the curve\u201d saves those lives.<\/p>\n\n\n\n
There was an alternative:\u00a0\u00a0let COVID-19 \u201cburn through\u201d our society.\u00a0\u00a0Eighty percent are likely to survive without serious consequences.\u00a0\u00a0Out of the rest, many will be hospitalized, and because of the numbers crowding in, many will die.\u00a0\u00a0But by letting it burn through, ultimately a large percentage of the population will have had the disease, and therefore be, at least temporarily, immune.\u00a0\u00a0Then we don\u2019t have to \u201csocial distance\u201d, our society can go on about our economic life.\u00a0\u00a0We will have \u201cherd immunity\u201d.\u00a0\u00a0But many people will die who didn’t have to die:\u00a0\u00a0they would have been sacrificed \u201cfor the common good,” the good of “the herd;” whatever that means.<\/p>\n\n\n\n
Of course all bets are off when there\u2019s a vaccine, but that\u2019s still twelve to eighteen months away. So whatever we\u2019re doing, keep in mind that it isn\u2019t forever. An effective vaccine and we can have herd immunity, and be literally \u201cback in the ballgame\u201d. <\/p>\n\n\n\n
But many aren\u2019t willing to wait for eighteen months to start life back up again. Politically the President can\u2019t stand for it. He has to prove that our current economic and medical condition isn\u2019t anything more than a temporary set back. If he is unable show that, it\u2019s unlikely there will be a second Trump term. That\u2019s a huge consideration in what decisions the President will make.<\/p>\n\n\n\n
Now you could do this, by going back to step two, containment. You have a cadre of folks who have had COVID-19, but we don\u2019t know who they are. Test them, and find out. We have a group who clearly have had the disease and survived. Certify them, and let them out. Those that are still at risk, keep them \u201cdistanced\u201d. But we can\u2019t do this by guessing, or taking temperatures at the front door of the school, or by listening for dry coughs and seeing if you can wake up and smell the coffee. If we don\u2019t test, then we are effectively going to a \u201cburn through\u201d strategy.<\/p>\n\n\n\n
So \u201copening up\u201d our economy without a testing regimen in place is simply \u201crolling the dice\u201d and waiting for the \u201cburn through\u201d to start. Then, it\u2019s social distancing all over again. That is, except for the bodies sacrificed so that we can say we \u201copened up\u201d. <\/p>\n\n\n\n
So, now that we are building hundreds of thousands of ventilators and millions of gloves and PPE, why aren\u2019t we producing the machines to test the hundreds of millions in our country?\u00a0\u00a0We literally put \u201ca man on the moon\u201d and can watch a movie or do the quadratic equation on a box in our pocket:\u00a0\u00a0we surely can build testing machines that can test many millions.<\/p>\n\n\n\n
But if you build all those testing machines, isn\u2019t that admitting that we should have tested in the first place? By making testing the strategy, is this an admission that we missed the opportunity to contain COVID-19 in the beginning? And if this is that admission, then the ultimate question is: who\u2019s to blame?<\/p>\n\n\n\n
President Trump is not interested in that conversation.\u00a0\u00a0He\u2019s not interested in testing, because it raises the question of his original response to the pandemic.\u00a0\u00a0And that response is a campaign issue:\u00a0\u00a0the question of the Presidential competency in the face of an existential crisis.\u00a0<\/p>\n\n\n\n