National Coronavirus Response A ROAD MAP TO REOPENING Scott Gottlieb, MD Caitlin Rivers, PhD, MPH Mark B. McClellan, MD, PhD Lauren Silvis, JD Crystal Watson, DrPh, MPH MARCH 28, 2020 AMERICAN ENTERPRISE INSTITUTE National Coronavirus Response A ROAD MAP TO REOPENING Scott Gottlieb, MD Caitlin Rivers, PhD, MPH Mark B. McClellan, MD, PhD Lauren Silvis, JD Crystal Watson, DrPh, MPH MARCH 28, 2020 AMERICAN ENTERPRISE INSTITUTE AMERICAN ENTERPRISE INSTITUTE Contents Executive Summary ......................................................................................... 1 Slow the Spread in Phase I ........................................................................................................................1 State-by-State Reopening in Phase II ......................................................................................................2 Establish Immune Protection and Lift Physical Distancing During Phase III ...............................2 Rebuild Our Readiness for the Next Pandemic in Phase IV ...............................................................2 Phase I: Slow the Spread ..................................................................................3 Goals ..............................................................................................................................................................3 Thresholds for Action ................................................................................................................................3 Trigger to Begin to “Slow the Spread” ..................................................................................................3 Trigger to Move to Phase II ....................................................................................................................3 Steps Required in Phase I .........................................................................................................................3 Maintain Physical Distancing ................................................................................................................3 Increase Diagnostic Testing Capacity and Build Data Infrastructure for Rapid Sharing of Results. ... 4 Ensure Functioning of the Health Care System ................................................................................... 4 Increase Supply of Personal Protective Equipment ..............................................................................5 Implement Comprehensive COVID-19 Surveillance Systems .............................................................5 Massively Scale Contact Tracing and Isolation and Quarantine .......................................................5 Offer Voluntary Local Isolation and Quarantine ............................................................................... 6 Encourage the Public to Wear Masks ................................................................................................... 6 Trigger for Moving to Phase II ................................................................................................................ 6 Phase II: Reopen, State by State .........................................................................7 Goals ..............................................................................................................................................................7 AMERICAN ENTERPRISE INSTITUTE Thresholds for Action ................................................................................................................................7 Trigger to Lift Physical Distancing Measures ..................................................................................... 7 AMERICAN ENTERPRISE INSTITUTE i Trigger for Returning to Phase I, “Slow the Spread” ......................................................................... 7 Trigger for Moving to Phase III ............................................................................................................ 8 Steps Required in Phase II ........................................................................................................................ 8 Implement Case-Based Interventions ................................................................................................... 8 Begin to Relax Physical Distancing Measures. ....................................................................................... 8 Special Care for Vulnerable Populations .............................................................................................. 8 Accelerate the Development of Therapeutics ........................................................................................ 8 Identify Those Who Are Immune .......................................................................................................... 9 Trigger for Moving to Phase III ............................................................................................................ 9 Phase III: Establish Protection Then Lift All Restrictions ........................................ 10 Goals ........................................................................................................................................................... 10 Thresholds for Action ............................................................................................................................. 10 Trigger to Begin Manufacturing Scale-Up and Vaccine or Therapeutic Prioritization Planning ....10 Trigger for Switch Toward Mass Vaccination ...................................................................................10 Steps to Take in Phase III ....................................................................................................................... 10 Vaccine or Therapeutic Production .....................................................................................................10 Vaccine or Therapeutic Prioritization—When Supply Is Still Limited. .............................................. 11 Mass Vaccination or Therapeutic Distribution—When Supply Is Abundant ................................. 11 Global Vaccine Scale-Up and Vaccination .......................................................................................... 11 Serological Surveys to Determine Population Immunity................................................................... 11 Phase IV: Reopen, State by State ..................................................................... 12 Develop Vaccines for Novel Viruses in Months, Not Years .............................................................12 Modernize and Fortify the Health Care System .................................................................................12 Establish a National Infectious Disease Forecasting Center ...........................................................12 Governance ...............................................................................................................................................12 Acknowledgments ........................................................................................................................................12 About the Authors .......................................................................................................................................12 ii Executive Summary his report provides a road map for navigating 2) Improvements in state and local health care Tthrough the current COVID-19 pandemic in the system capabilities, public-health infrastructure United States. It outlines specific directions for adapt- for early outbreak identification, case contain- ing our public-health strategy as we limit the epidemic ment, and adequate medical supplies; and spread of COVID-19 and are able to transition to new tools and approaches to prevent further spread of the 3) Therapeutic, prophylactic, and preventive treat- disease. We outline the steps that can be taken as epi- ments and better-informed medical interven- demic transmission is brought under control in dif- tions that give us the tools to protect the most ferent regions. These steps can transition to tools and vulnerable people and help rescue those who approaches that target those with infection rather may become very sick. than mitigation tactics that target entire populations in regions where transmission is widespread and not Our stepwise approach depends on our ability to controlled. We suggest measurable milestones for aggregate and analyze data in real time. To strengthen identifying when we can make these transitions and our public-health surveillance system to account for start reopening America for businesses and families. the unprecedented spread of COVID-19, we need to In each phase, we outline the steps that the federal harness the power of technology and drive additional government, working with the states and public-health resources to our state and local public-health depart- and health care partners, should take to inform the ments, which are on the front lines of case identifica- response. This will take time, but planning for each tion and contact tracing. Finally, we must expand our phase should begin now so the infrastructure is in place investments in pharmaceutical research and develop- when it is time to transition. ment into COVID-19 and promote the rapid deploy- The specific milestones and markers included in the ment of effective diagnostics, therapies, and eventually report for transitioning our responses are judgments a vaccine. based on our current understanding, with the goal of facilitating