End the coronavirus lockdown for those who've recovered

They're a crucial resource in this crisis

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President Trump is growing so worried about the economic impact of covid-19 that he's talking about drastic action, including ending the lockdown in states that haven't seen lots of infections. He's right to be worried and right to be looking for dramatic solutions. He may even be well-served in this case by his skepticism about giving government public health experts the last word on fateful economic decisions, for reasons I'll discuss. But ending the lockdown in states with low infection numbers is the wrong answer when we haven't tested widely; many of these states almost certainly have an underground contagion that will explode as soon as the lockdown is lifted.

There are, however, responsible alternatives that might address the underlying concern.Instead of easing the lockdown state by state, we could do it person by person.  Specifically, we could end the lockdown for people who have already recovered from COVID-19. These people offer something we badly need right now:  A workforce that probably can't get infected and probably can't infect others. I say probably because there is plenty we don't know. But there is reason to believe that people who recover from the coronavirus pose much less risk of infecting others and face less risk of being reinfected themselves. There's still much uncertainty on both counts, but that's the way to bet.

Which means that recovered coronavirus patients could be a vital resource for public health and for the economy. They can work directly with people still fighting for their lives in hospitals. They can tend to the elderly without fear of spreading the disease. Indeed, it's possible that their blood plasma can be used to treat the sick. And, as their numbers increase over coming weeks, they can take on other jobs that call for close interactions with the uninfected – grocery and pharmacy sales, Uber drivers, and the like. They'll suddenly be in high demand, and just in time, since many of them have been thrown out of work by the mass lockdowns. Instead of living off stimulus payments, they'll be earning good money, performing critical jobs, and free to go out and spend it without fear.

By itself, ending the lockdown for those who've recovered from the virus won't end the economic crisis. They are a tiny population in the US right now, but one that's growing about as fast as infections did last month, which is to say it should be more or less doubling every few days. (In Italy, a couple of weeks ahead of us, there are 8300 recovered patients.) Ending their lockdown would allow both a real and a symbolic step toward economic normalcy, not to mention the public health benefits it would offer at a time when we need as many safe caregivers as we can muster.

What would it take to free up this resource?  Three things.

First, we cannot simply presume recovered patients are safe. We need the best available public health data about recovered COVID-19 patients, to get answers about when they stop being contagious and their resistance to reinfection. It is important to note, that even with more data, we are unlikely to get complete certainty on either point, and even the recovered will need to take precautions while out and about. But the decision to end their lockdown—in the face of some degree of uncertainty—should take into account economic, as well as health, risks.

This is where the President's famous suspicion of expertise might do him some good. The government's public health officials are indeed experts, but only in one part of the crisis we now face. They are ruled by the same incentives that govern all bureaucracies, as the recent CDC and FDA testing failures should remind us. And the bureaucratic incentive for public health officials is to maximize public health.

As professionals, they'll be judged by their success in suppressing the virus – not by their role in restoring the economy. To ensure that the desperate state of the economy gets proper weight, it's entirely appropriate for the President to force a decision now, using public health officials' best guess about infection and reinfection risks – even if the uncertainty makes them uncomfortable. The stakes are higher here than usual, but this is the kind of call we have Presidents for.

Second, we need good ways to identify the recovered. Tests for the virus identify people who have the infection; we also need to identify recoveries by testing for the antibodies that show the virus has come and gone. Those tests are on the way, but they're caught up in FDA approval processes. The administration should be pushing the FDA to act faster. Because until we have those tests, we're going to have to rely on doctors to write letters identifying patients who have recovered from the virus.

Third, this system requires a mechanism to enforce rules that end lockdown for some people and not others. Because we will need to rely on physician letters at the start, we should set uniform standards for representations from doctors. And the government should make clear that false claims of recovery can be criminally prosecuted as fraud. (If this proves insufficient, states and the private sector could issue 3-D barcodes to help stores, hospitals, and lockdown enforcers verify claims of recovery using a mobile phone. Similar systems are currently used across Asia.)

Most importantly, if we want this to work, we need to do all of these things now, and as impatiently as possible.

Which, of course, is where President Trump comes in. We've never needed his famous impatience more—as long as he can keep it well-targeted.

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  1. Umm, Stewart, you do realize that there are only about 350 or so “recovered” cases we know of. That’s not going to make any dent on the economy and I don’t think anyone would oppose them going out now. I am sure there are tons and tons more and that is WHY smart people – not Trump but Cuomo and many others – have been calling for developing a test to find out who has recovered.

    https://nymag.com/intelligencer/2020/03/why-testing-for-coronavirus-antibodies-will-matter.html

    1. Actually, 394 recovered cases (in USA only).

    2. Oh come on, he addresses both of those points in the article.

      “They are a tiny population in the US right now, but one that’s growing about as fast as infections did last month, which is to say it should be more or less doubling every few days.”

      “Second, we need good ways to identify the recovered. Tests for the virus identify people who have the infection; we also need to identify recoveries by testing for the antibodies that show the virus has come and gone.”

      1. There is no data for the number of infected people. How would we know how many are recovered?

    3. Actually, there is a lot more — but no, we don’t barcode people. NO WAY!!!

  2. I would be the first to sign up to get the disease, and there would b many more. Its an opportunity in this stinted world and would kill the suspense of when the lockdown would end for me. Liberty, baby!

  3. This article is so stupid and irresponsible that it proves that the writers here should stick to legal topics.

    1. No, it’s not irresponsible or stupid at all. Stop your knee from jerking.

  4. This is where the President’s famous suspicion of expertise might do him some good. The government’s public health officials are indeed experts, but only in one part of the crisis we now face.

    Ah. The case for stupidity.

    Does Baker really think that the CDC and various epidemiologists, doctors, etc. don’t understand the issue of immunity? Who do you want to bet on, Trump or Fauci?

    Or is this another example of one of the world’s dumbest arguments: “Experts are wrong sometimes, so they are wrong this time.”

    Moronic post.

    1. Yes, they understand the concept of immunity. The fact that they haven’t told bernard11 exactly what he wants to hear isn’t proof that they disagree with Baker. And nowhere in Baker’s article does he say anything about what the experts know or don’t know.

      Like I said to the last guy: stop your knee from jerking.

      1. No, bernard’s position is aligned with the experts. That’s the point.

  5. So there are topics that Stewart Baker knows less about than Information Security.

  6. By way of background: I am an MD (UMd), MPH (Hopkins), JD (Georgetown), a diplomate of the ABPsych&Neuro and a diplomate of the ABPreventive Medicine.

    Now, “This is where the President’s famous suspicion of expertise might do him some good.” Stewart, you really imagine that to be the case?!

    I wouldn’t take the time and space to got into the details of why this is the very worst time to go with those decisions that rely on Trump’s “gut.” Trust me, though, he and his gut should not be trusted here. And that opinion is based on a great deal more than my strong antipathy to him on so many grounds; it is based on what he says about this crisis medically, scientifically, socially (there will be more deaths from suicide than virus if we don’t do what he wants to do), ethically, etc.

    Give everyone who has had a proven diagnosis or covid-19 and let them go about their business. They will be too few in numbers to effect the continued spread of the contagion (human-to-human) of this virus. And the effect on the national economy of making special accommodations for the “recovered” will be negligible (MIT, SB in economics).

    Trump’s interests, self always first, and presently that is re-election, do not line with America’s interests.

    1. So Neurodoc’s left his (her?) entire medical training in the background in service to bashing Trump. And in doing so, he/she misses the ENTIRE POINT of the article.

      When people get this disease, and recover from it, are they immune to it or not? If so, then why on EARTH should they be sequestered as well? This was the point. Baker only alluded to the fact that it would take Trump to make this point, because in fairness, no one else would have the balls to do it.

      Talk about missing the forest for the trees…

      1. Neurodoc has been on here before. I don’t think he’s a trump-basher primarily.

        Given the paucity of tests still going on (It’s being used diagnostically not epidemiologically) I’m not optimistic the population with confirmed cases that recover will be much of a fraction to matter. And I don’t want to encourage people who are super sure they got it and recovered to think they’re part of that cohort.

      2. When people get this disease, and recover from it, are they immune to it or not?

        We don’t know. Making the rest of the argument silly even if it weren’t silly for other reasons.

    2. Yes, let’s let economists run the economy, doctors manage our healthcare…oh wait, these groups have a proven track record of being terrible at making these decisions for themselves.

      I will seriously be shocked if you actually have even half those credentials, but if you really do have all those degrees, then you’ve proven that all the educational in the world doesn’t mean jack shit. We all should just trust your personal assessment of Trump’s motives because reasons and an appeal to authority.

      Baker has an interesting point. I’m not sure we should do it yet because of reports from China that people are becoming re-infected (perhaps they were never treated properly) and dying, but if people do become immune, then they certainly should get out and help as soon as possible.

      1. Oh, just call someone a liar based on your disagreeing with them. Nice engagement.

        And way to gainsay his experience by just…uh, being angry, I guess?

  7. I would love it if getting the virus means you can’t get it again, but I don’t think we know that for sure yet.

    The most important thing we can do about the virus right now, aside from researching a cure or better treatments, is to increase mask production to the point where everybody worldwide can have them. The only real reason to discourage the public from using them is the temporary shortage, which is being solved.

    Three weeks of forced idleness is enough. If we’re not all back to work by April 15, it’s time to stop complying before we’re all ruined.

    Then it’s time to investigate just who imposed these outrageous limits on our freedom for a hazard that hasn’t killed 1/10 as many people as the average annual flu bug. Officials who don’t have the perspective to see that it wasn’t called for, shouldn’t be in office.

    1. A mask for everyone world wide to wear for 1 year until there is a vaccine. That means at least 150 billion masks or more. Even if the world can produce 1 billion N95 masks a day,How could that many masks be delivered in a day.

      Such ideas may sound attractive until one does the numbers and works out the logistics. Similar remarks can be mad about proposals to test every American at least once.

    2. re: we don’t yet know that you can’t get this virus again

      Well, we do know that it’s true for every other coronavirus that we’ve investigated over the years. (Remember that this is merely a new variant of a family of viruses that have been around basically forever.) Do you have any scientific reason to think this one is different?

      1. That’s not true, from what I heard. Some coronaviruses produce less reliable immunity than some other viral infections.

    3. “I would love it if getting the virus means you can’t get it again, but I don’t think we know that for sure yet.”

      That is what I have heard specifically from a medical professional working on coronavirus cases.

      1. To be less ambiguous, I have heard nobody knows if you can get it again or not and that positive cases who recover should continue to practice distancing.

        1. Yeah, that’s crazy from what I learned – your body’s immune response to a virus includes tailored antibodies and those remain accessible so the very act of fighting off a virus should mean you can’t get reinfected for quite a while.
          Bacteria are more clever, but virii are too small for many tricks.

          But who knows what biochemical trixery is possible. It’s something to watch – I’d be interested in the 101 of how it’s possible if it proves true.

  8. It seems likely the number of people pretending to be cured so they can move around would vastly outnumber the number to true recovered cases and would be virtually impossible to enforce. This is leaving aside whether or not those who have the virus and recover are actually immune from getting infected again. Past history says they would be, but there’s been some dispute on the subject.

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