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Paul Romer's Roadmap Executive Summary America is confronting two crises: an economic crisis laying waste to our livelihoods and a health crisis threatening our lives. The twin crises are deeply intertwined: our economy cannot be re- opened without credibly addressing fears of infection and resurgence. The immediate reaction, a national lockdown, was successful in slowing the virus. We must now shift to a plan that balanc- es the need to protect our health and reopen our economy by locking down only those who are infectious. This paper presents a simple, scalable, and credible solution: introduce a comprehensive “test and isolate” policy, making it safe for Americans to return to work and keeping the infection rate below 5% of the population. Until a vaccine is developed and deployed, the simplest and safest path to this outcome is a na- tional testing strategy that marshals our existing resources to test everyone in the U.S. once every two weeks and isolates all those who test positive. It does not rely on any new technologies, is far less disruptive and costly than our current policy, and will work even in a worst-case scenario. Be- low is a roadmap to a future in which the American people are confident that their health and our economy’s future are protected against this virus. The roadmap is comprised of the following steps: 1) Expand the pool of testing capacity by working with federal and state governments to: i) Remove regulatory barriers; and, ii) Establish a testing network of national and university laboratories. 2) Identify a revenue stream that the public sector can use to pay for the tests we must give people to find those who are spreading the disease, especially those who show no symptoms. Because this revenue must pay for tests of people who seem healthy, we need to provide a financial incentive to laboratories to do this work. 3) Start testing the essential workers who are already on the job: i) Begin with healthcare and other frontline workers who are most likely to be infected, so we keep one infected worker from spreading the virus to colleagues. ii) As our capacity for running tests expands, start testing other essential workers such as grocery clerks. iii) Isolate anyone who tests positive; test their family members and close col leagues. 4) Extend the tests to those who we want to urgently return to work, teachers for example. 5) Offer tests to everyone—students in the classroom or customers in the grocery store—and give them permission not to wear a mask in public if they have a recent, negative test for the virus. “Test and isolate” is the response that we can commit to now, with full confidence that it will pro- tect us from this virus and from the next. It is the fastest path to a revived economy because it is the simplest and safest path. A strong commitment from Congress to provide states with the resources they need to ramp up a comprehensive testing plan will set us on the path to defeating the virus and responsibly reopening the economy. 1 Introduction The citizens of the United States face a health crisis caused by an aggressive and dangerous viral pathogen. The health crisis caused an economic crisis because people do not consume, work, or invest when they are afraid. In response to the mounting health crisis, U.S. policymakers made the right decision. They stopped the spread of the virus by locking down all nonessential workers. The priority now is to switch to an equally effective and far less disruptive strategy: lock down only those who are infectious. Because we had no way to tell who was infectious, we had to start by locking down everyone who was not an essential worker. We must now make preparations to shift to “test and isolate,” a targeted version of lockdown aimed at limiting the spread of the virus to no more than 5% of the population, saving hundreds of thousands of lives. The simplest way to find and isolate is to test everyone regularly and to isolate the small fraction of the population who test positive. To restore the confidence required to revive the economy, we need a credible plan for keeping the total number infected below 5%. Lifting the lockdown without a plan, surrendering to the virus, and letting it return to its path of exponential growth would be devastating in both economic and human costs. It won’t matter if everyone is free to do anything they want. Fear and uncertainty spawned by surrender will paralyze us all. The simplest way to find those who are infectious is to test everyone regularly. We should make it our highest priority to massively expand the number of tests we can administer each day and to give those tests to people who do not show any signs of being sick. The simplest way to find those who are infectious is to test everyone regularly. We should make it our highest priority to massively expand the number of tests we can administer each day and to give those tests to people who do not show any signs of being sick. The simplicity and transpar- ency of this policy is what makes it credible. It won’t be easy, but we have the tools and we know they work; there is no question whether we can do each of the steps in this roadmap. The only question is whether Congress will commit to rebuilding confidence in the health of our people and economy so we can get started on the path towards recovery. To be sure, we can augment tests with supporting measures and explore other ways to prioritize who gets tested next, but it would be a catastrophic mistake to delay the switch to “test and iso- late” until we resolve all disagreements about how to implement supplementary measures such as contact tracing, including serious concerns about requiring everyone to carry a smartphone with a tracking app. There is a simple roadmap for shifting from locking down all nonessential workers to locking down the very few who are infectious: 1) Expand the pool of testing capacity by working with federal and state governments to: i) Remove regulatory barriers; and, ii) Establish a testing network of national and university laboratories. 2) Identify a revenue stream that the public sector can use to pay for the tests we must give people to find those who are spreading the disease, especially those who show no symptoms. Because this revenue must pay for tests of people who seem healthy, we need to provide a financial incentive to laboratories to do this work. 2 3) Start testing the essential workers who are already on the job: i) Begin with healthcare and other frontline workers who are most likely to be infected, so we keep one infected worker from spreading the virus to colleagues. ii) As our capacity for running tests expands, start testing other essential workers such as grocery clerks. iii) Isolate anyone who tests positive; test their family members and close colleagues. 4) Extend the tests to those who we want to urgently return to work, teachers for example. 5) Offer tests to everyone—students in the classroom or customers in the grocery store—and give them permission not to wear a mask in public if they have a recent, negative test for the virus. There is no question whether we can do each of these steps. The only question is whether we will; and if we will, when we start. Criteria For A Viable Containment Strategy The virus can only do one of two things: exponentially grow, or exponentially decline. Even if the number of infections drops very low (or hits zero), easing containment policies without a viable alternative like “test and isolate” in place would resume exponential growth of the virus, likely bringing us back to our current situation. Our strategy, once implemented, must not only be able to continue for the next 12-18 months (or more) until a vaccine is widely available, but it also must be able to adapt to the unforeseeable challenges that will arise between now and then. To stop the spread of Covid-19 and protect our nation from future resurgence, our containment strategy must: • Instill confidence in the American people: Fear is driving part of the current economic down- turn—fear for our own health and fear of additional lockdowns. Our policy must be simple and feasible enough to instill confidence in the American people that the health crisis is being effec- tively managed; that federal, state and local governments, along with the business and health communities, are working closely together on this policy; and that its implementation will pre- vent additional economic losses. • Use resources that are available now: A national policy that calms fears and moves quickly, two essential features of success against the virus, cannot require yet-undiscovered break- throughs and additional uncertainty. We do not have time to wait for new developments, nor do we need to. This plan does not require new scientific breakthroughs—we must use what we have now with intention and purpose. • Have the resources to continue for an extended period of time: Our policy needs to be sus- tainable so that it can provide continuous support until we have a vaccine. This requires that the policy’s benefits always outweigh its economic and health costs, and that the resources needed to execute the policy have the full backing of the federal government. • Offer a comprehensive solution across different scenarios: The policy must eventually be available to all Americans across the country.
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