Matt Smith / Keystone Crossroads
The recent flattening of the state’s coronavirus case count must stay on course.
By David Wenner/PennLive
(Harrisburg) — Gov. Tom Wolf said this week “the draconian steps we’re now taking cannot go on forever.”
Yet the big question remained: When can we start re-opening businesses and schools and otherwise returning to normal?
While lacking exact answers, Wolf this week showed a roadmap of how we might get there. Two experts interviewed on Tuesday said the route seems sound.
For the near-term future, Wolf says, we’ll have to continue with the full-fledged closings and social distancing to enable the healthcare system to fully prepare for whatever surge of patients might hit. The recent flattening of Pennsylvania’s coronavirus case count also must stay on course.
Then we’ll reach a fork in the road. Whether we’ll be able to choose the route to normalcy will have much do to with the availability of antibody testing. Antibody testing, according to a growing consensus, may take us well down the road to normal even before the arrival of a vaccine, which is expected to be a year or more away.
Antibody testing is different than the test that tells whether someone has COVID-19. It involves detecting the antibodies that occur after someone is exposed. The hope is that people who have been exposed develop a strong and reasonably long-lasting immunity. Based on other diseases, scientists have reason to think that might happen. But they still don’t know for sure.
If it does, it will enable health care workers to work without fear of getting sick. It could give people confidence they can return to work or school without getting sick. And depending on the level of immunity in the general population, it might pave the way to a gradual reopening of businesses and schools. Beyond that, there’s reason to hope that blood plasma from people who have been infected can help others recover from COVID-19. Antibody testing could help find them.
“Broad testing is the only thing that can give us the confidence to get back on our feet again,” Wolf said.
Antibody testing has suddenly become the focal point of the national effort to reopen.
Dr. Anthony Fauci, one of President Donald Trump’s key advisers, a few days ago said such testing could become available within about a week. But many questions remain about when it will become available enough to have a major impact.
Presently, there is no federally-approved test. However, the federal government has suspended the normal approval process, allowing a host of companies to move forward with tests.
Dr. Raghavendra Tirupathi, the medical director for Keystone Infectious Diseases and chair of infection prevention at WellSpan Chambersburg Hospital, says antibody testing is “more simple technologically” than the test for COVID-19 that has been so unevenly available.
He says it’s one that can be developed and carried out at any number of government, hospital and commercial labs.
“I’m looking at four to six weeks for it to become available at the grass-roots level,” he says.
Still, the test will need to be available at hospitals, health centers and doctors’ office across the state. Further, the government must remove all cost barriers. “The last thing you want is for people to stay away from the testing for financial reasons,” he said.
But the level of testing needed to begin returning to normal will involve broad access to both the antibody test and the COVID-19 test, said Matthew Ferrari, an epidemiologist and researcher at the Center for Infectious Disease Dynamics at Penn State University.
Ferrari warns that because of the unknowns about immunity from the COVID-19, antibody testing tells us little about whether an individual is safe from infection.
However, it can provide valuable information about the prevalence of the new coronavirus throughout a region and a population. In a best-case scenario, he said, it would show that more people had been exposed than previously thought, meaning the illness is less lethal than previously known. That would bolster confidence that some restrictions can be safely rolled back.
Ferrari believes major forward progress will require widespread availability of both antibody and COVID-19 testing. The antibody testing will give us information about the overall prevalence and consequences of the coronavirus. Fast access to the COVID-19 test will enable us to immediately know who has it. Those people can then be isolated, and their contacts can be traced, so we know who else might be carrying it and who should therefore be quarantined.
With that level of testing in place, the restrictions could focus on individuals, rather than the shutdowns and other restrictions imposed on everyone.
When might Pennsylvania be able to begin reopening businesses and schools?
Tirupathi stresses the factors that will drive the decision can change daily. His best guess is that, if we continue to get good results from the present restrictions, Pennsylvania might be able to consider starting to ease restrictions sometime in June. He expects it to begin slowly, in “staggered” fashion, probably with reopening of businesses that don’t involve large gatherings of people, such as construction or online sales. If that doesn’t trigger a substantial rise in cases, progressively larger businesses can reopen. If that goes well, schools might reopen, and so on, according to Tirupathi.
Ferrari, the Penn State scientist, resists naming a specific number of weeks or months. Rather, he says, “I think we should all be looking to the health care infrastructure to tell us when we feel comfortable reopening.” That means getting hospitals to the point they are capable of handling every COVID-19 patient and having full availability of tests.
That, he said, will give us the “safety net” which will give confidence to “jump from the cliff” toward normalcy.
The good part, he said, is those are things we can accomplish, and do so quickly through sufficient effort and cooperation. To that end, he said he was greatly heartened by the coalition announced this week by Gov. Wolf and the governors of New York, New Jersey and several northeastern states.
For now, Wolf is stressing that the social distancing is working but warning against complacency. If we become lapse, or ease up on the restrictions too soon, we risk a second wave of infections, which would prolong the human suffering and economic devastation.
On Tuesday, he was asked whether people in parts of the state that don’t have many cases are facing unfair restrictions. Wolf noted there was a time when Philadelphia and surrounding hard-hit counties had no cases. He said the goal is to spare other counties from rising counts. The fact that parts of the state have few cases may well be a sign the restrictions are working.
“All of us have to figure out what is the right cadence, what is the right balance,” he said. “If we don’t do this right, the economy is going to be in worse shape than it is right now.”
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