Lifting lockdowns safely relies on effective testing. Germany surges ahead, but US states are flying blind
(CNN)People in the US state of Georgia can now get their nails done, their hair cut -- even get a tattoo or a massage -- after just three weeks of a state-wide stay-at-home order. That's an awful lot of touching, considering a highly contagious and deadly virus is going round.
These activities may give some people in Georgia a sense that life is returning to normal,
but Governor Brian Kemp's decision to allow such businesses to reopen
on Friday is a risky roll of the dice. In a state that has performed a
relatively small number of coronavirus tests, Kemp is driving Georgia
through this pandemic blindfolded.
Tommy Thomas gives his long-time customer Fred Bentley a haircut in Atlanta, Georgia, on Friday.
As
governments around the world begin easing their lockdowns -- and as new
infections are inevitable -- they will get another chance to get their
responses right.
Many
are embracing that second chance, but some US states are not. There are
now fears that reopening too quickly, or too boldly, could mean a second wave of infections in the US as fierce as the first.
If any one lesson has come out of the rapid spread and sweeping death toll of this coronavirus over the past few months, it's the importance of testing, health experts have reiterated.
Without
a vaccine in sight, what governments need to do to safely lift
lockdowns is test, trace and quarantine, according to WHO spokeswoman
Dr. Margaret Harris.
"We need to
know where the virus is, and then separate the sick from the healthy --
that's why you need testing. You need to check that people who have
symptoms actually have the virus, and then find people who they've been
in contact with and isolate them," she told CNN.
"If you can't do that, then you go back to square one."
In two suggested plans for reopening the US economy, public health experts and economists said that the country would have to perform millions of tests each week before restrictions could be safely lifted.
People wait outside a nail salon in Atlanta, Georgia, on Friday.
The US has carried out 4.69 million tests in total, according to data from the COVID Tracking Project via Johns Hopkins University (JHU). That's a far cry from the Rockefeller Foundation's recommendation,
which suggests having a capacity for 3 million a week within the next
two months. In its plan, to which prominent experts contributed, the
foundation says the country should expand that capacity to 30 million a
week over the next six months.
Another plan, by Harvard University's Edmond J. Safra Center for Ethics, published on Monday,
suggests the country will need to deliver at least 5 million tests a
day by early June to begin reopening, and as many as 20 million a day to
fully remobilize the economy, ideally by late July.
US misses testing benchmark (but so does the UK)
The
way some leaders talk about the level of testing can be confusing.
President Trump had claimed that the US had carried out the most tests
in the world, and while that may be true, per capita, it's not leading.
While
it's useful to look at how widely a country is testing per capita, the
WHO says there is a better benchmark to measure whether a country is
testing adequately. Dr. Mike Ryan, Executive Director of the WHO's
Health Emergencies Programs, said recently that a good benchmark is to
have at least 10 negative cases for every one positive case confirmed.
That means if a state or country carries out testing and comes back with
positive cases of around 9% or under, then it's likely that it is
testing well.
The US has a positive result rate of 18.8%, going by the COVID Tracking Project's figures cited by JHU.
Such
high rates suggest a country is only testing the worst cases, usually
people who are severely ill and in hospital, Harris said.
It's the same picture in individual US states. Georgia has carried out around 101,000 tests, with a positive result rate of 21.6%, even further away from the WHO benchmark.
Elsewhere,
several European countries are also lagging far behind in testing and
will need to catch up to safely reopen their societies.
The UK stands out, with just over 610,000 tests carried out and a positive case rate of 23.4%, worse than Georgia.
The
difference is, the UK government has extended its social restrictions.
But it is looking at when and how to lift its lockdown.
The UK government has set a goal of performing 100,000 tests a day by the end of the month, and while it insists it's on track, it was only able to carry out around 28,500 on Thursday, raising speculation that it will fail to meet its target.
France and Sweden are also performing tests below the WHO benchmark.
Germany lifts lockdown with caution
Germany
makes a good case for comparison with the US. It too has begun easing
its lockdown, and it too leaves much of the decision-making to
individual states. Yet its approach is far more rigorous than what we're
seeing in Georgia, and Germany's states are showing a uniform sense of
caution.
Germany has an enormous capacity to test. At its peak around two weeks ago, it carried out around 400,000 tests a week, according to the Robert Koch Institute
(RKI), the national public health body. It has the capacity now to
perform 730,000 tests weekly, and plans to ramp up the number of tests
as its lockdown eases.
By the end
of last week, RKI reported that Germany had tested more than 2 million
people and has a positive result rate of 7.5%, well above the WHO
benchmark.
Last week, German
Chancellor Angela Merkel laid out a list of steps the country would
undertake to begin lifting its lockdown, and on Monday stores up to 800
square meters in size began reopening, as long as they have hygiene and
social distancing measures in place.
Bookshops,
car dealerships and bike stores can also now reopen regardless of their
size. Restaurants, bars and gyms will remain closed.
Merkel
also announced that the country would ramp up its contact tracing
efforts, deploying a team of five officers for every 20,000 people in
the population to trace people who may have come into recent contact
with every confirmed case.
But
Merkel has repeatedly warned that the situation could quickly reverse
if people do not adhere to social distancing measures, which are still
in place.
On Thursday, the
Chancellor warned Germany was on "the thinnest ice" after many people
flocked to shopping areas and pedestrian zones this week, prompting
German virologists to warn against complacency. While Merkel supports
the reopening decisions made by the federal government and the states,
"their implementation worries me ... they appear to be very bold, maybe
too bold," she said.
Germany only
considered reopening as its reproduction rate -- the average number of
people each person is infecting -- had fallen below 1, to 0.7. According
to the WHO, keeping this rate below 1 means the virus can decline and
eventually die out. On Friday, however, German authorities reported that
rate had gone up to 0.9.
Trump contradicts White House stance
The messaging in the US has been less coordinated and clear.
In
theory, the White House supports the idea of widespread testing,
contact tracing and quarantining. It calls for just that in its "Guidelines for Opening Up America Again."
But Trump, in the face of a staggering increase in unemployment related
to the shutdowns, has at the same time pushed several governors
aggressively to reopen their economies, some of them before May 1.
That's despite a recent model by the Institute for Health Metrics and Evaluation,
at the University of Washington, that shows no state should open before
that date, suggesting about half the states in the country should remain closed until May 25 or later. Georgia is opening around eight weeks too early, according to the model.
Trump has also supported protesters rallying against stay-at-home measures that they say violate their rights.
Kemp,
a Republican governor and staunch Trump ally, appeared to have the
President's support in his plan. But on Wednesday, Trump changed his
tune, saying he "strongly" disagreed with Kemp's approach and that "it's just too soon" to open businesses like hair and salons, and tattoo parlors.
Kemp on Thursday defended his plan, saying on Twitter that his decision was data driven, though he provided no data to support his statement.
"Our
next measured step is driven by data and guided by state public health
officials. We will continue with this approach to protect the lives --
and livelihoods -- of all Georgians," he wrote.
In separate posts, he also said that the state was dramatically ramping up its testing capacity.
Dr.
Anthony Fauci, the director of the National Institute of Allergy and
Infectious Diseases, said Thursday that if he were advising Kemp, he
would tell him "not to just turn the switch on and go."
"Because
there is a danger of a rebound. And I know there is a desire to move
ahead quickly. That's a natural human nature desire. But going ahead and
leapfrogging into phases where you should not be, I would advise him as
a health official and as a physician not to do that," said Fauci, who
is part of the White House's coronavirus task force.
There's plenty of opposition to Kemp's plan in Georgia as well, and many shop owners there said they wouldn't reopen on Friday.
Atlanta
Mayor Keisha Lance Bottoms, a Democrat, told CNN in an interview that
she was "perplexed that we have opened up this way."
"I
don't know how you get a haircut and keep a safe distance from someone
who is cutting your bangs, it just doesn't make sense to me," she said.
And
it's not just Georgia. Oklahoma also allowed "personal care businesses"
like hair salons to open on Friday, in a plan that looks very similar
to Georgia's. Montana will lift its stay-at-home order on Sunday while
most businesses where social distancing can be practiced are allowed to
open. Florida has already reopened some its beaches, in a controversial decision that drew criticism on social media.
All data in this story was accurate at 1p.m. ET on April 24, 2020.
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