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Time for the “Shoe-Leather Epidemiologists”

Test-and-Trace is the only real issue now.
April 30, 2020
Time for the “Shoe-Leather Epidemiologists”

Social-distancing has worked—so far. We are past the peak in deaths from COVID-19, both nationally and in most states, though we’ve still got a few weeks before we go down the other side of the curve. It’s natural for people to be restless and to be eager for re-opening.

But the question isn’t “Should we reopen?” The question has always been “How do we reopen?” What conditions will make it possible? Reopening too quickly and with inadequate preparation just raises the prospect of a second wave of infection, with more deaths and more shutdowns in the future. That’s what happened with the Spanish Flu in 1918.

The past six weeks of shutdowns have certainly bought us time—but time for what?

A lot of conservative pundits are angrily asking that question—but not spending any time thinking about the answer. Because there is an answer.

One of the early messages of the pandemic was learned a little too well: the exhortation to “flatten the curve.” The idea as stated early on was that the goal was just to slow down the spread of the virus—that it would infect just about everyone eventually, but we had to pace the impact to avoid overwhelming the hospitals. 

But if everyone is going to get COVID-19 anyway, if we’re going to keep going until we arrive at “herd immunity,” then what’s the point? It’s all pain for the foreseeable future—pain in the form of more deaths, and pain in the form of more economic shutdowns.

But this does not have to be the future. Look at South Korea, which never had such severe shutdowns, but which isn’t headed for herd immunity, either. In fact, a country with one-sixth our population, which had its first confirmed case on the same day as the United States, has one percent as many confirmed cases and less than one percent as many deaths. 

The daily number of new cases being identified in South Korea is trending down into the single digits. That’s the equivalent of only 60 new cases a day in the US, with deaths at a rate of maybe a dozen a day.

If we could reach those numbers, we would be reopening, too.

Clearly it is possible to do more than just slow the spread of COVID-19. We can reduce it and bring this disease down to minimal levels.

How did South Korea do it? By massive testing and “contact tracing”: finding infected individuals and tracing anyone with whom they had significant contact. This allowed South Korea to quarantine only those who were specifically identified as being at risk, so that the entire country didn’t have to lock down.

South Korea has still been practicing aggressive hygiene and social distancing, mind you, including bans on large gatherings. But its limitations on the public’s movement have been far less draconian than in the US. The sweeping lockdowns and strict social distancing we’ve had to do here in America—whether government-imposed or voluntary—are blunt instruments we used to slow down the spread of the virus because we had failed to implement the South Korean approach early on. So far, this blunt instrument is doing what it was supposed to do, and if it continues to work, it could bring us to the point where a South Korean-style system would work. 

Testing and tracing is nearly impossible when you have tens of millions of people exposed, as we almost certainly do. But if the lockdowns can bring the number of active cases down into the thousands, then test-and-trace has a chance.

If we want to reopen, only one thing matters: building the infrastructure for test-and-trace. All other debates are, quite frankly, a waste of time.

Test-and-trace will require paying premium prices for the rapid production of enormous numbers of new tests, mobilizing the people and equipment needed to administer the tests, and recruiting a small army of “contact tracers.” What does a “contact tracer” do? They talk to people who are identified as being infected, figure out where they’ve been and who they’ve seen, and then track down other people they might have infected.

Colorado is ramping up a system intended to be able to track 500 cases a day. The Colorado Sun refers to these contact tracers as “shoe-leather epidemiologists,” which sounds a whole lot more useful than all of the armchair epidemiologists who have been clogging our airwaves and social media.

New York is going to need a much larger effort, and last week Andrew Cuomo announced the formation of a “tracing army” with help from Michael Bloomberg—who is doing something far more useful than his ill-conceived run for president. “‘You don’t have months to plan and do this,’ Cuomo said. ‘You have weeks to get this up and running.'”

The state has about 500 tracers and will add thousands more, working with universities to draft medical students, Cuomo said. The efforts will be coordinated between the state and municipalities. New York City and other localities also will be hiring their own independent people, Cuomo said.

For all of President Trump’s bluster about reopening, there is, as far as I can tell, no national test-and-trace plan. He prefers to spend his time blathering about miracle cures and attempting to troll the media. His daily vaporings are increasingly coming across as just another Boomer on Facebook complaining about what other people should or shouldn’t be doing—a confession of his own irrelevance at a time of national crisis.

A federal effort on this would be particularly helpful given the ease and frequency of travel across state lines. No state can simply seal itself off from the rest of the country and test and trace within its own borders. So two prominent former federal officials have joined together to call for such a plan. They want Congress to appropriate $46 billion for it—a far smaller and far more effective expenditure than the trillions we have already been poured into “stimulus” boondoggles.

The goal of test-and-trace is to allow a return to the established, limited quarantine powers of government: the power to identify specific individuals who are contagious and require their isolation for a specific period of time. As Colorado Governor Jared Polis put it, the goal is “testing, quarantining, and isolating individuals instead of quarantining an entire society.”

Yet much of the conservative commentariat has trapped itself in a debate about ending the “totalitarian” lockdowns, while ignoring or dismissing the actual effort required to do so. They are attempting to shoehorn this crisis into the pre-existing mental template of Complaining About Big Government, with themselves in the role of freedom-fighters taking on “the elites.” There is a well-established business model in the conservative media of pandering to inarticulate populist resentment, and I suppose people in that industry want to keep their businesses going during the pandemic. But reopening the country is going to take more than owning the libs.

What is actually required right now is the competent execution of one of the legitimate powers of government. There are, of course, a great many questions about how a test-and-trace system will be implemented. Many states are still short on the number of tests they will need, and there are questions about the reliability of the tests we have. Low-tech contact tracing starts with just talking to an infected person and asking him to recall where he’s been, while higher-tech options that involve tracking cell-phone data raise privacy concerns. But the point is that these are the questions we need to be talking about.

If, in the next few weeks and months, we manage to reopen the economy without experiencing a rebound of COVID-19 in a vicious second wave, it will be primarily because the state governors managed to create a test-and-trace system that reduced the number of cases to a very low level and kept them there. That’s what a return to normal, or at least semi-normal, will look like.

That’s the only issue that really matters right now, and everything else is noise.

Robert Tracinski

Robert Tracinski is editor of Symposium, a journal of liberalism, and writes additional commentary at The Tracinski Letter.