COVID-19 Intelligence Report: The Road Ahead

THE ROAD AHEAD

This is a new periodic feature of the Intelligence Report that highlights publications focusing on the future as we think about what will be needed in the recovery phase of this pandemic and the changes to our health care system and society that will be catalyzed by Covid-19.

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Title: Preparing for a responsible lockdown exit strategy

Authors: Marius Gilbert, Mathias Dewatripont, Eric Muraille, Jean-Philippe Platteau & Michel Goldman

Publisher: Nature Medicine

Publication Date: 14 April 2020

URL: https://www.nature.com/articles/s41591-020-0871-y

Key Takeaways

1. Social distancing measures should be maintained to reduce the overall transmission up to a point at which hospitals can cope with the resultant much lower number of patients.

2. Diagnostic capacity needs to be massively upscaled both for detection of the virus and for the identification of immune people.

3. The human power, procedures, and logistics needed to implement systematic tests and contact tracing at scale need to be put in place.

 

With data in hand, the authors propose that while at first only immunized but virus-free people may go back to their normal lives, when the pandemic subsides, gradually younger people (with age being a key risk factor) who are virus free but not immunized may be considered too. Priority for testing such low-risk people should be given to those operating in sectors considered essential. Such an approach would slowly build up ‘herd immunity’, which could reduce the intensity of future waves of the pandemic. Until a cure or vaccine is announced, the goal should be for everyone to eventually rejoin their normal lives and thereby avoid the stigma of two ‘types’ of citizens: those who are immunized and risk free, and those who are not.

 

Title: COVID 19 and the Long Road to Herd Immunity

Publisher: HUB. Johns Hopkins University.

Publication Date: 30 April 2020

URL: https://hub.jhu.edu/2020/04/30/herd-immunity-covid-19-coronavirus/

Key Takeaways: Herd immunity is still a long way away but may be achievable by: 1) a large proportion of the population either gets infected or gets a protective vaccine. The threshold is likely > 70% of the population need to be immune. There are a few ways that might be achieved.  This can be achieved by multiple strategies--at one end of the spectrum is allowing widespread infection to occur over a short period of time with a high impact to the healthcare sector and with potentially higher death rates, or on the other end using a measured approach that protects those at most risk while allowing community immunity to grow non-explosively.

 

Title: The Ethics of COVID-19 Immunity-Based Licenses (“Immunity Passports”)

Authors: Govind Persad, JD; Ezekiel J. Emanuel, MD

Publisher: JAMA

Publication Date: 6 May 2020

URL: https://jamanetwork.com/journals/jama/fullarticle/2765836

Key Takeaway: As mentioned earlier in the report, the potential for splitting society into two cohorts (immune vs. non-immune) has significant ramifications. This article discusses the use of immunity-based licenses (certificates) that will allow COVID immune individuals to regain some liberty without compromising those who have not been infected.  The article presents the arguments for and against this move and summarizes that the passports do “not violate equal treatment because the factors used to grant a license are not (editor’s comment: should not be) discriminatory, like race or religion, but instead grounded in relevant evidence.”  

 

Title: Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period

Authors: SM Kissler, C Tedijanto, E Goldstein, et al.

Publication: Science

Publication Date:14 Apr 2020

URL: https://science.sciencemag.org/content/early/2020/04/24/science.abb5793

DOI: 10.1126/science.abb5793 

Key Takeaway:  Even in the event of apparent elimination, SARS-CoV-2 surveillance should be maintained since a resurgence in contagion could be possible as late as 2024.

 

Title: From Mitigation to Containment of the COVID-19 Pandemic: Putting the SARS-CoV-2 Genie Back in the Bottle

Authors: Walensky RP, del Rio C.

Publisher: JAMA.

Publication Date: 17 April 2020

URL:  https://jamanetwork.com/journals/jama/fullarticle/2764956

doi:10.1001/jama.2020.6572

Key Takeaway: Before reopening, the U.S. must ensure that this period will end with a course-corrected public health strategy that promises widespread testing, resources for those affected, and a profound appreciation for an impressive, inspired, and tireless health care workforce that helped the US deal with this pandemic.