Há uma promessa e um perigo em ser pioneiro, e o povo de Hokkaido aprendeu as duas lições muito bem nos últimos meses. Depois que as infecções por COVID-19 na ilha japonesa explodiram após o festival anual de inverno deste ano, as autoridades em fevereiro declararam estado de emergência para controlar a doença. Logo depois, novos casos diários despencaram, e a ação rápida de Hokkaido foi anunciada como um farol para o resto do Japão seguir.
Mas não foram apenas as infecções que caíram; no mês seguinte, os negócios de agricultura e turismo também secaram, e o governador de Hokkaido decidiu diminuir as restrições sociais. No entanto, o cumprimento dos limites de interação social após semanas de sequestro foi mais difícil desta vez. Em um mês, as novas infecções por COVID-19 de Hokkaido aumentaram 80%, e o governador teve que restabelecer as políticas de bloqueio.
Há histórias semelhantes de Cingapura, Hong Kong e Alemanha, e todas servem como lições preocupantes para os tomadores de decisão nos EUA, que estão sob crescente pressão para reabrir o país e reativar sua economia paralisada. A tensão está embutida na pandemia: enquanto as métricas de saúde pública apontam para um maior isolamento social e uma reabertura mais gradual da sociedade, as decisões são tomadas pelos políticos. Alguns governadores estaduais já estão permitindo que empresas como salões de beleza, barbearias e academias reabram para evitar falências e ruínas econômicas.
Como proceder? Os EUA precisam urgentemente reiniciar, mas nenhuma economia poderá funcionar se uma doença infecciosa como a COVID-19 continuar a adoecer a força de trabalho e manter os clientes em risco. Mais de um milhão de americanos tiveram a doença, mas ainda não se sabe se a recuperação pode proporcionar imunidade duradoura ou qualquer. O que significa que grande parte das quase 330 milhões de pessoas do país permanece em risco de infecção pelo SARS-CoV-2, o vírus que causa a doença, em um retorno repentino ao normal. “Mesmo nos locais mais atingidos [nos EUA], menos de 1 em cada 10 pessoas foram infectadas. Portanto, o COVID-19 não só pode voltar a rugir, mas pode ficar cinco vezes ou quase 10 vezes pior do que é agora ”, diz o Dr. Tom Frieden, presidente e CEO da Resolve to Save Lives e ex-diretor dos Centros dos EUA Controle e Prevenção de Doenças (CDC). “O único caminho a seguir é suprimir casos e grupos de casos rapidamente.”
Sob as diretrizes do presidente Trump para a abertura da América novamente, os estados passariam por três fases de afrouxamento gradual das restrições sociais. O limite para entrar em cada estágio em direção à normalidade e declínio no número de novos casos de COVID-19 nos 14 dias anteriores. Academias, cinemas e estádios esportivos seriam os primeiros a reabrir, embora as pessoas tivessem que ficar a 15 metros uma da outra e evitar reuniões íntimas de mais de 10. Em seguida, escolas e bares poderiam reabrir com limitações e, finalmente, se os casos continuando a declinar, a maioria das pessoas poderia voltar ao trabalho. Especialistas em saúde alertam, no entanto, que o retorno à normalidade não pode ser apenas uma progressão direta – se os casos começarem a subir, as diretivas de distanciamento social e abrigo no local terão que ser renovadas.
A única maneira de calibrar essas decisões é saber onde estão as novas infecções. Quando se trata de conquistar uma doença infecciosa, o ditado “conheça seu inimigo” é notavelmente adequado. Ou, ainda mais importante, saiba onde está seu inimigo. O rastreamento de um vírus invisível é a chave para controlá-lo, e a estratégia mais rápida e confiável para isso é criar um sistema robusto para testar qualquer pessoa que possa estar infectada. Para os EUA reabrirem sua economia, “teremos que encontrar as pessoas infectadas e não apenas esperar que elas venham até nós”, diz Barry Bloom, professor da Harvard T.H. Escola de Saúde Pública Chan. “A linha inferior é, está testando, testando, testando – então sabemos onde está a epidemia antes que possamos relaxar quaisquer restrições de maneira gradual.”
O Dr. Anthony Fauci, diretor do Instituto Nacional de Alergia e Doenças Infecciosas e membro da Força-Tarefa de Coronavírus da Casa Branca, disse à TIME: “Precisamos ter a capacidade de, quando começarmos a ver os casos voltarem – e eu garanto que eles irão – identificar através de testes, [e] isolar e rastrear contatos para tirar as pessoas infectadas de circulação”.
Pode levar dezenas de milhões de testes por semana para fazer isso, e o problema é que a capacidade de teste dos EUA ainda não está pronta. “Não há absolutamente nenhuma maneira na Terra, neste planeta ou em qualquer outro planeta, que possamos fazer 20 milhões de testes por dia, ou mesmo 5 milhões de testes por dia”, diz o almirante Brett Giroir, secretário assistente de saúde que supervisiona a resposta de teste do governo.
Here’s How Scientists and Public-Health Experts Recommend the U.S. Gets Back to ‘Normal’
BY ALICE PARK – APRIL 30, 2020 6:15 AM EDT
There is both promise and peril in being a pioneer, and the people of Hokkaido have learned both lessons well over the past few months. After infections of COVID-19 on the Japanese island exploded following its annual winter festival this year, officials in February declared a state of emergency to control the disease. Soon after, new daily cases plummeted, and Hokkaido’s quick action was heralded as a beacon for the rest of Japan to follow.
But it wasn’t just infections that dropped; over the next month, agriculture and tourism business also dried up, and Hokkaido’s governor decided to ease social restrictions. However, compliance with limits on social interaction after weeks of sequestering was harder this time around. Within a month, Hokkaido’s new COVID-19 infections jumped by 80%, and the governor had to reinstate lockdown policies.
There are similar stories from Singapore, Hong Kong and Germany, and all serve as sobering lessons for the decision-makers in the U.S. who are under increasing pressure to reopen the country to reactivate its stalled economy. The tension is built into the pandemic: while public-health metrics all point toward extended social isolation and a more gradual reopening of society, the decisions are made by politicians. Already, some state governors are allowing businesses such as nail salons, barbershops and gyms to reopen to prevent bankruptcies and economic ruin.
How to proceed? The U.S. urgently needs to restart, but no economy can function if an infectious disease like COVID-19 continues to sicken the workforce and keep customers to a trickle. More than a million Americans have had the disease, but it is not yet known whether recovering can provide lasting, or any, immunity. Which means much of the country’s nearly 330 million people remain at risk for infection with SARS-CoV-2, the virus that causes the illness, in a too-sudden return to normal. “Even in the hardest-hit places [in the U.S.], fewer than 1 in 10 people have been infected. So not only could COVID-19 come roaring back, but it could get five times or close to 10 times worse than it is now,” says Dr. Tom Frieden, president and CEO of Resolve to Save Lives and former director of the U.S. Centers for Disease Control and Prevention (CDC). “The only way forward is to suppress cases and clusters of cases rapidly.”
Under President Trump’s guidelines for Opening Up America Again, states would move through three phases of gradually loosening social restrictions. The threshold for entering each stage toward normality is declines in the number of new COVID-19 cases in the previous 14 days. Gyms, movie theaters and sports stadiums would be the first to reopen, although people would have to remain 6 ft. from one another and avoid intimate gatherings of more than 10. Next, schools and bars could reopen with limitations, and finally, if cases continued to decline, most people could return to work. Health experts warn, however, that the return to normality can’t be only a straight progression–if cases start to inch upward, then social distancing and shelter-in-place directives will have to be renewed.
The only way to calibrate those decisions is to know where the new infections are. When it comes to conquering an infectious disease, the adage “know your enemy” is remarkably apt. Or, even more important, know where your enemy is. Tracking an invisible virus is the key to controlling it, and the quickest and most reliable strategy for that is to build a robust system to test anyone who might be infected. For the U.S. to reopen its economy, “We’re going to have to find those people who are infected, and not just wait for them to come to us,” says Barry Bloom, a professor at the Harvard T.H. Chan School of Public Health. “The bottom line is, it’s testing, testing, testing–so we know where the epidemic is before we can relax any stringencies in a stepwise fashion.”
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of the White House Coronavirus Task Force, tells TIME, “We must have in place the capability that when we do start to see cases come back–and I’ll guarantee you that they will–to identify by testing, [and then] isolate and contact-trace to get people out of circulation who are infected.”
It may take tens of millions of tests per week to do that, and the problem is the U.S.’s testing capacity may not be ready yet. “There is absolutely no way on earth, on this planet or any other planet, that we can do 20 million tests a day, or even 5 million tests a day,” says Admiral Brett Giroir, the assistant secretary for health who is overseeing the government’s testing response.
Widespread testing can yank away the curtain that hides SARS-CoV-2, revealing where there are clusters of people who are infected by the virus but not showing symptoms, and thus aren’t aware they might be spreading it to others. That, in turn, will lead to more targeted efforts to isolate anyone who is infectious. And, if all the people who came in contact with an infected person were also tested, it would help local health authorities trace how the virus is moving through a community. It’s basic, boots-on-the-ground disease control.
The U.S., however, stumbled on testing in the early days of the pandemic, and those failures led to a dramatic surge in cases that climbed more quickly than in other countries. Thanks to a combination of contamination issues that delayed the original test from the CDC, and regulatory requirements that prevented commercial and academic labs from immediately developing their own assays, “It’s still the case that testing isn’t nearly as readily available as it needs to be,” says Frieden. As of this writing, just over 1 million tests for COVID-19 are performed in the U.S. each week, which is woefully inadequate, Fauci says.
Public-health experts estimate that the current U.S. testing rate has to triple simply to include all the people who are considered highest priority for testing, including health care workers and nursing-home residents. To fold in all of those who should be tested if gyms and restaurants reopen, the number of daily tests has to increase by tens of millions. Ideally, anyone with symptoms like a cough, fever or shortness of breath should be tested, as should anyone who is sick and living in a group facility like a dormitory, along with any patient admitted to a hospital for any reason. Family members and others with close contact to someone who tests positive should also be tested.
Without widespread immunity, public-health officials can only keep a close watch on new cases as they pop up, and suppress them so they don’t morph into widespread outbreaks. Which means that until the population at large is protected, some amount of social distancing will become a routine part of our lives. Even if a region shows all the right numbers–declining curves of new COVID-19 cases, fewer deaths and more hospital discharges than admissions–that doesn’t mean restaurants, sports arenas, shopping centers and workplaces should go back to the status quo. “Locking down isn’t just to lock down,” says Fauci. “It’s to give you time so that when you open up again, you can come out swinging … when the virus rears its head, you have the capability to identify, isolate and contact-trace and snuff it down before [cases turn into] outbreaks.”
4. THE NEW NORMAL
Especially in hard-hit, densely populated areas like New York City, at minimum, everyone might need to wear face masks in public to prevent the spread of virus-containing respiratory particles; public-transit riders may not be sitting shoulder to shoulder; diners at restaurants might need to be seated 6 ft. apart; and we might significantly cut back on physical contact. “This may turn out to be the death of the handshake,” says Dr. Hilary Babcock, an infectious-disease specialist at Washington University School of Medicine.
Accepting these changes to daily life is accepting the reality that emerging from this pandemic won’t be like flipping a switch. “This is a public-health emergency, and only public health is going to get us out of this,” says Frieden. “The economy, and society, depend on public health getting this right.” And that means not just testing and identifying people who are infected, along with their contacts, but rethinking how self-isolation fits into broader policy decisions. The massive quarantine of these past few months was unprecedented, but more limited isolation, on a case-by-case or family-by-family basis, may become the norm for at least a while. And public-health officials may have to work with local community leaders to accommodate more formal, structured ways to self-isolate in order to effectively balance the public good of such measures with the rights and dignity of individuals. For example, Frieden says, “we should be offering voluntary isolation for every person infected,” in the form of designated hotels or living quarters to support people who cannot stay in their current homes without putting others at risk.
These, of course, won’t be the only new ubiquities in a post-COVID-19 world. Microbial threats like coronaviruses will inevitably move from the bottom to the top of public-health priority lists, and the dangers of infectious diseases will loom larger in our collective conscious. They will have to, if we have any hope of avoiding further drastic lockdowns and forever changing the way we interact with each other.
–With reporting by W.J. HENNIGAN/WASHINGTON and ABIGAIL LEONARD/TOKYO