Opinion: How to stop spreading coronavirus while also getting people back to work

We certainly need to cap the spread of COVID-19 but we should simultaneously get people back to work in a meaningful, responsible way that will not jeopardize human lives.

SARS-CoV-2, a virus we have had no previous experience with, is wreaking havoc on our communities. Though we have known about coronaviruses for a long time, the exact nature of this particular one is unclear. Yet the similarities of SARS-CoV-2 to other viral isolates from bats and the nature of its transmission to humans is raising a lot of questions.

When human toll causes economic disaster, it is obvious because of the immediacy, particularly if young, working populations are significantly affected. On the contrary, when a suffering economy takes a toll on human life, the impact is delayed and less apparent, typically manifesting as malnutrition, poor immunity, failure to thrive, and death. We often do not envisage the second scenario and, if we do, it is not taken seriously because nobody has ever seen a death certificate with poor domestic or national economy as a cause of death. When a bad economy kills, the first to be affected are those with no financial reserves who unfortunately do not legislate or even drive policy, especially in situations like this pandemic where decisions are made outside of ballots and elections.

In reality, if we lose focus of the economy and concentrate all our efforts solely on the viral infection, a lot more will suffer the fate of many who develop prostate cancer. The immediate response of many people who are diagnosed with prostate cancer is immense worry about the cancer, even though most prostate cancer patients may live with the disease for years and often die from a completely different and unforeseen cause. The only caveat is that while prostate cancer is noninfectious, the current viral pandemic spreads rapidly with a multiplicative impact. If we fail to resuscitate the ailing economy, more people will suffer or die from the under-functioning economy than the pandemic itself because the majority of every given population are those without any financial reserves. This majority drives the economy by sheer numbers and cumulative purchasing power and when the economy dies, it drags this same majority with it.

In New York, where we have the highest prevalence of COVID-19 in this country, the mayor and the governor are at loggerheads over when to get businesses and schools back up and running. The mayor is overly concerned about controlling the disease and its spread, while the governor is dwelling more on the ailing economy. Waiting for the disease to naturally dictate when a functional economy should resume is cautious, but over that idea looms an imminent economic disaster. However, plunging people back into uncontrolled environments when dealing with a ravaging infectious disease risks undoing all the costly lockdowns and quarantines which have been in place for weeks already.

We certainly need to cap the spread of COVID-19 but we should simultaneously get people back to work in a meaningful, responsible way that will not jeopardize human lives. After all, in conventional wartime people do work, at least producing submarines, torpedoes, and other war-related equipment while war rages.

This is what I propose we do, though it may not be foolproof. We currently have rapid COVID-19 testing available. Instead of using it just to identify cases, track down contacts, and manage those who are ill we should aggressively employ this tool to guide communities back to normalcy, particularly in terms of getting the economy back up.

First, we should identify the key sectors of every community’s economy, and test all the workers of say a given factory/business with the rapid test.

Then, split the tested workforce into two halves. One half of all who tested negative should get back to work with masks and other personal protective equipment as applicable, while maintaining the highest standards of hygiene. The other half should wait in lockdown.

After 14 days, we bring in the waiting half following thorough sanitization of the workplace, and the working half goes to lockdown. We may retest both groups depending on test availability to determine prevalence and dynamics of spread in the departing as well as incoming groups. This step may be repeated once before the next.

After 35 days from onset of the process, we should test the whole workforce again and if disease prevalence is low we should leave 75% of the workforce at work and send 25% (half of the group that last worked) back to lockdown.

Following an additional 14 days of work by the 75% work force, another across-board rapid testing is performed. If disease prevalence remains low, 100% of the workforce should work, with continued use of masks, appropriate protective clothing, and maintenance of highest standards of hygiene.

This process may take 6-8 weeks to gradually ease the workforce back in place, keeping down the risk of disease upsurge as businesses reopen, and at the same time building confidence for customers to physically venture into the marketplace where necessary.

Arbitrarily reopening the dormant economy without a concerted effort to rebuild confidence will adversely affect sectors of the economy where customer presence is required for business. Furthermore, relying on COVID-19 abatement to naturally re-open the economy may result in a future too distant for those without financial reserves. In such a scenario, the lockdown risks being infringed upon by disgruntled mobs.

The economy is to human communities as breath is to life. If we take the course of waiting for the pandemic to flatten before we cater for the economy, we could be waiting many months. Besides, we should not deceive ourselves into thinking that when that flattening occurs we will just return to the economy we left behind. We will return into an unchartered economic landscape, and a secondary economic slump could follow the lack of familiarity with this newfound disorder.

At the least, we need to actively guide the current uncertainty to some crash-landing so we can salvage an optimum in a terrible situation.

Theo Addo, MD, FACP, is a board-certified physician and a Fellow of the American College of Physicians in the Dartmouth-New Bedford area.