On May 1, Vermont is scheduled for a limited re-opening of some business interactions, despite the fact that we still have plenty of Coronavirus activity in evidence.
If I correctly understand the logic of this move, it stems from identification of Vermont as one of the nine states which had less than 1,000 identified cases of the virus, ignoring the proportion of virus/deaths to overall population.
I know we are all eager to resume “normal” living, but the testing piece is still far from adequate and the actual number of infections is likely exponentially greater than the 812 confirmed cases, so far.
We are told that there are so many unknowns about this unique virus that it is impossible to predict who might have it, how severe it might be and how it might manifest in any one individual.
I am sure Phil Scott is trying to be a responsible governor despite growing pressure to open the state, but I propose that he make one key demand of the Trump administration before the arbitrary May 1 deadline. It’s a demand that is neither unreasonably large nor without concrete purpose in addressing the information gap for the nation as a whole.
Having the second smallest population of any state, Vermont would be the ideal candidate for full testing of EVERY single resident, and contact tracing of all the resultant positives. If if can’t be done for the 600,000 individuals in our little state, what hope is there of getting a handle on the vast unknown for the rest of the country?
So, Governor Scott, with all due respect, I ask you to make our cautious reentry to business activity contingent on getting help from the Feds to make this happen. The profile on Coronavirus spread that such a state-limited study could yield would be invaluable to the country as a whole.
If ever there was a time to assert your independence while putting Vermont public interest first, it is now.
Sue,
Here’s some friendly pushback.
First, there are 2 kinds of tests. The kind you’re talking about — the kind that’s been in use now for a few months — is diagnostic: it tells you whether or not you have the virus at the time you take the test. It does NOT tell you whether you’ve had it or whether, a day from now, you might test positive.
The second is the antibody test, which tells you whether your body has, at any time, bee exposed to the virus. If not, there will be no antibodies for the virus. If so, there usually are. This has more public health ramifications, because IF (and it remains an unknown if) exposure to the virus provides at least temporary immunity, then anyone who has antibodies should be “safe” after a brief period of further isolation to insure that they do not have the virus NOW. I’m not an expert, but you could probably do a diagnostic test which, if negative, would allow them to forgo the waiting period (or shorten it substantially).
That would mean that people returning to work would be very unlikely to get infected and also unlikely to infect others.
There are at least 2 complicating factors. First. we do not know for sure that the presence of antibodies provides immunity. Most experts think it does, but there have been reports of counterexamples, so the issue has not been resolved.
Second, there are different antibodies and different tests, depending among other things, on when in the disease the antibodies were formed.
And finally, like all tests, there is a range of error.
That all raises a third issue with which I’m sure as an anti-nuker, you’re familiar. We are unlikely ever to achieve 100% safety: e.g. 0 cases. We certainly don’t do that with a variety of other contagious diseases. So we need to make a decision as a political society as to what level of ongoing risk we’re willing to tolerate. That’s especially true because the social and economic implications of social distancing are enormous.
And that leads me to a last point. The steps the governor is taking are baby steps, and seem (to this observer) unlikely to add more than a case or 2 to the mix. Workers must still maintain social distance (6 feet); there can’t be many on a worksite, etc. The opportunity to spread the virus is still greatly reduced from what life as usual would produce.
I guess my own conclusion is this. There are plenty of wrong answers, and Trump seems to be an excellent source for many of them. But there is no single right answer for everybody in all circumstances, and the governor’s cautious trials seem quite reasonable to me.
All the best.
I quite agree that what is currently proposed for Vermont is a rather conservative approach to re-opening and not likely to result in a huge spike in exposures, but I still think that Vermont would be well-suited to blanket testing and follow-up tracing, at the very least. Ideally this regime should include both diagnostic and anti-body tests for all. We have a very small population which skews on the elderly side. In NYC alone, they have already completed over 300,000 tests and barely scratched the surface of their population of well-over 8 million. What I am suggesting is that Vermont could serve as a kind of laboratory in which to observe the behavior of the virus in a closely monitored population.
There are various issues here:
1) As of right now, we don’t have anywhere near enough or either sort of tests in the US to do this, unless every test in the country is going to go to Vermont, which won’t and shouldn’t happen.
2) Even if we did, are you suggesting that we wait for the results before loosening at all? Why? At worst, if we loosen as Scott has and the curve starts trending upwards, we know how to stop it early and it won’t threaten to overwhelm our resources.
3) Consider cost. Diagnostic tests are, according to what I’ve read $50 each, so just the diagnostic portion of what you’re suggesting would cost $30 million in an economy which has been brought essentially to a halt by the pandemic. (I suspect that figure does NOT include paying those who administer the test, but maybe it does).
4) Once you had all that info, what precisely would you know? Presumably, you’d isolate and deal with all those who test positive, assuming we have the resources to do that. Fine.
But how about those who test negative? As I said above. if you test negative today, you may test positive tomorrow. So if you tell them to go back to work, you could be sending out an armada of folks who do not YET test positive, but actually harbor the virus.
Conversely, some of those who test negative today may have tested positive a few days ago, which assuming immunity, means that there is no reason to keep them isolated when they’re chomping at the bit to get back to “normal.” For some of them, it would mean the difference between eating and not eating, or being abused, losing a house, a business, etc. I’m sure you’ve read all that.
Immunity testing costs $15. For the same reason that pollsters get pretty accurate reflections of how people will vote by sampling a very small, but valid sample of the population, so too epidemiologists can get a MUCH better idea of how this disease works by administering antibody tests to a properly selected sample of the population. Such work has just begun in 2 places in CA (Santa Clara and LA).
If you wanted to make doubly certain, you would then administer antibody tests first to emergency workers to either take the sick ones out of the work force or relieve the minds of all the rest. Then everyone who wants or needs to stop isolating. People who have the antibodies could be released, once it’s clear that they are not infected NOW. That could be established either by a diagnostic test or by a further waiting period or some combination of the 2.
This would cost IMMENSELY less than your proposal, actually provide far more useful information., and put large portions of the workforce back to work without risking an exponential curve of new cases.
Just as pollsters aren’t always right (although despite what has become a common meme, they WERE right about Trump v Clinton and well within the margin of error), so too there is the possibility of error here.
But even those who ended up being infected would not be able to spread the virus because those they would be spreading it to would have at least some degree of immunity (we don’t know how much or for how long).
For me, the results of such work, properly carried out, would be “good enough” to use as a sound basis for public policy.
I’m just suggesting that, since there has been no blanket testing of an entire population, so far, we have no “photo” in time of how extensive its spread has been. Surely having that information would better prepare us for a second and possibly third major outbreak before a vaccine can be rolled out, which will have immeasurable costs both to the economy and to human life.
I got that. I disagree for the reasons I’ve already explained.