The Phased Reopening Plan, a Blueprint for a Pandemic Rebound

Are we making progress against the Covid-19 pandemic? We don’t really know except for one historical fact: the flu pandemic of 1918 was considered to be over long before it was resolved, and it rebounded with catastrophic consequences.

Predictably, having traded in denial for a strategy of self-isolation in dealing with this modern pandemic, we now have reached the inevitable argument about when it is time to reopen Virginia. When should we drop the recommendations for self-isolation and get back to “normal”?  We are hearing the argument, “We have flattened the curve, so it is time to reopen Virginia,” which someone on social media reminded was equivalent to saying, “The parachute has slowed our rate of descent; we can take it off now.”

Parenthetically, let me hasten to point out that self-isolation is merely a recommendation, both by the Federal government and by the various states that have adopted it. There is no civil or criminal penalty for ignoring the recommendation; the wails of citizens being falsely imprisoned by government authorities are simply nonsense.

Take for example, Jared Kushner and Ivanka Trump who blissfully ignored the recommendation against non-essential travel to visit family in the greater New York City area by Presidential motorcade to celebrate Passover. Having said that, people have been threatened with civil and criminal penalties for breaking quarantine when diagnosed with Covid-19 symptoms or creating other public nuisances, such as hosting large parties with no attempt at social distancing.

The Sovereign Citizen in North Carolina, who was arrested (after two previous warnings from the local sheriff) for hosting a beer-bash bonfire party with 65 guests in attendance, is a good example of the latter. Good luck trying to beat that in court. As for government-ordered closures of non-essential businesses, operating a business is a privilege under our system of laws and not a Constitutionally protected right, just like driving a motor vehicle. Otherwise there would be no health inspections for food service businesses, no business licenses, and no fire and safety requirements to meet in order to operate a business.

But have we really flattened the curve?

No one knows. We have no way of knowing if we have flattened the curve because of issues with testing limitations, tracking, and unknown characteristics of the virus, such as whether you get permanent immunity once exposed or once a vaccine is available.

The rebound of the 1918 pandemic during 1919 is a historic example we would do well to heed.  More people died during the rebound than during the initial pandemic.

Testing is the key weakness in these phased reopening plans. To date, reported cases of Covid-19 positive test results have been limited to a small population of people who display symptoms. There has been no random-sampling testing and many, if not most, infectious disease experts estimate we may have identified as few as 10% of the infected population.

Given the known geometric progression of the disease because, 1) infected persons can transmit the virus to others long before they become symptomatic, and 2) because the incubation rate of the disease, if the infected person actually becomes symptomatic at all, can last 14 days or longer. In short, we don’t know where the curve is now, and we have even less information on what the curve will look like in two weeks or in two months.

Our inability to conduct statistically valid and reliable testing is an insurmountable obstacle to the phased reopening approach. If we cannot identify infected carriers then how can we possibly isolate those they may have passed the virus to with contact tracing?

This is not at all dissimilar to the dilemma we faced in the early 1980s with HIV, an infectious virus that Dr. Anthony Fauci and Dr. Deborah Birx were personally involved in identifying and isolating as the cause of AIDS. The AIDS epidemic grew so quickly because, once a victim was identified, the virus had been transmitted to second-, third-, and even fourth-tier contacts.

An additional flaw in the phased reopening strategy is the idea of monitoring population groups who have ended self-isolation and reentered the work and social environments. Then, if the epidemic reemerged in any such group, they would return to self-isolation. But without wide-spread testing with instant results and contact tracing before the virus is retransmitted to second- and third-tier contacts, how will we prevent a 1919-style rebound?

As Dr. Fauci said earlier this week, “We’re not there yet.”

The most disturbing aspect of this reopening problem is the flagrant politicization of the arguments. This is not about re-starting businesses, going out to bars and sporting events again, or attending big family gatherings. It is a matter of choosing between political expediency and winning elections and the life, health, and safety of Americans.

As my colleague and our editor-in-chief Lynn Mitchell remarked recently, “Rational voices need to be heard during this time, and by that I mean voices that have nothing to gain from it and are only interested in the welfare of the country and her citizens. Politics is playing WAY too big a role in what is going on.”

Those who advocate this phased reopening plan are playing with forces that are far too complex for any of us to fully comprehend. That is stupid, but to do it for political gain is criminal.