Harvard public health experts say the White House plan to open up the US is 'thoughtful' but critically undermined by a lack of widespread testing for COVID-19

AP Photo/Alex Brandon

President Donald Trump and Dr. Deborah Birx unveil the White House's proposed plan to ease social distancing restrictions necessitated by the novel coronavirus.

• Public health experts at Harvard University said the White House plan for reopening the country ⁠- something it cannot do without the cooperation of state and local governments ⁠- was thoughtful, but also a display of wishful thinking.
• "The glaring problem with it remains... the issue with testing," said William Hanage, Ph.D., associate professor of epidemiology at Harvard's T.H. Chan School of Public Health.
• To be able to assess the wisdom of relaxing social-distancing measures, public health officials need to be able to test not only those exhibiting symptoms of COVID-19 but those who may appear perfectly fine.
• "In a way, this is wishful thinking," said Barry R. Bloom, Ph.D., a professor of public health at Harvard, "but it is absolutely essential."
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The White House roadmap for returning the US to business as usual is far more qualified and nuanced than statements from President Donald Trump would suggest, but public health experts said Thursday that it is likely still too optimistic so long as testing for COVID-19 remains far from widespread.

"The glaring problem with it remains... the issue with testing," said William Hanage, Ph.D., associate professor of epidemiology at Harvard's T.H. Chan School of Public Health.

"Figuring out what's actually going on in the community is the key part of dealing with this pandemic," he added. "And we are still early on in this pandemic."

The proposed guidelines released by the White House lay out a number of criteria for beginning to loosen social-distancing measures ⁠- which are, and will remain, the purview of state and local governments. Symptoms of COVID-19 and flu-like illness must decline for two weeks, accompanied by a decrease in the trajectory or percentage of positive tests for the coronavirus. And hospitals must also both have the capacity to treat patients, without resorting to emergency measures, and the "robust" ability to test front-line workers.

"It is, I think, a quite thoughtful plan," said Barry R. Bloom, a professor of public health at Harvard. "There are no artificial timelines, no hard-line dates. As they've emphasized, the primary focus is on health data."

The problem, however, is chiefly one of obtaining that data.

The White House, Bloom said, "assumes that testing will be at a level that at the moment does not exist." He also questioned the wisdom of waiting just 14 days to begin loosening restrictions, particularly in the absence of universal testing, noting that could be just a lull. "Two weeks is a very short time."

To be able to open up the nation with any confidence, public health officials need to know not only how many people are exhibiting signs of COVID-19, but how many have already had it and how many are carrying and potentially transmitting the disease without any symptoms.

"In a way, this is wishful thinking," Bloom said, "but it is absolutely essential."

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