A plan by the Lamont administration to ease the state and its economy out of self-imposed COVID-19 hibernation is a month or more away, but what is under discussion already would require an unprecedented investment in an array of testing for the virus and measures to track and perhaps even confine those determined to have it.
It also is likely to provoke discussion about privacy rights.
Gov. Ned Lamont is looking at a variety of models that would move the state away from social isolation and may talk about them at his briefing today, a staff member said. One of the models getting a close look – a report by medical experts affiliated with the American Enterprise Institute – calls for an extensive medical surveillance program, along with enforcement of what is called “voluntary” quarantines of those who test positive for the virus and their close contacts.
The so-called voluntary quarantines could be enforced with mobile telephone technology, the report suggests.
“Home isolation can be enforced using technology such as GPS tracking on cell phone apps,” the widely discussed report concludes. “Also, the close contacts of confirmed cases as defined by the CDC should be quarantined and monitored daily for 14 days. Monitoring of international travelers is also recommended.”
One of the authors of the report is Westport physician and former commissioner of the U.S. Food and Drug administration Dr. Scott Gottlieb. Lamont has mentioned Gottlieb repeated in recent weeks and on Monday appointed Gottlieb to his Reopen Connecticut Advisory Group, one of two committees the governor created to navigate the state toward normalcy.
The advisory group will help decide how to reopen businesses while the state participates in a complex, virus surveillance program designed eradicate the inevitable COVID flareups as society reopens. The group will collaborate on a reopening plan with neighbors New York, New Jersey, Massachusetts, Rhode Island, Delaware, and Pennsylvania – a regional approach promoted by Gottlieb and his co-authors.
The American Enterprise Institute report contends that a medical surveillance program, combined with the extensive collection and exchange of data, is essential to guarding against a renewal of the community spread of the virus that threatened to overwhelm hospital systems in Connecticut and elsewhere just weeks ago.
Physicians who have been working in Fairfield County, on the front line of the fight against the virus, have said it is too early, perhaps by months, to begin easing restrictions of social interaction and allow public-facing businesses to reopen. But once easing occurs, they said wide-spread testing and an effective quarantine system will be essential tamping down new outbreaks.
“Confinement is going to have to be a component of any plan,” said Dr. Steven Choi, Chief Quality Officer for the Yale School of Medicine and Yale New Haven Health System.
Controlling the virus
Lamont has said – and the report’s authors agree – that it will be a month or perhaps longer before the state meets certain milestones that will signal relaxation is possible. At the top of the list of preconditions is control of community spread of the virus, which resulted over recent weeks in sharp spikes in infection rates.
The governor’s office and the authors also say hospitals – some of which are still operating above normal capacity – must have enough bed capacity, critical medical equipment such as ventilators and personal protective gear to handle another steep outbreak. And, they said, the state must contribute to a federal data network that would support an unprecedented testing regime for both new infections and immunity.
Gottlieb has said the U.S. must have a national capacity to administer 750,000 tests for COVID-19 infections weekly in order to control new outbreaks when social distancing is eased.
Just meeting milestones to begin to relax social distancing is proving to be a challenge for Connecticut, Lamont’s office has said. Demand has so outstripped supply in recent weeks that the state is still struggling just to get the supplies necessary to operate hospitals effectively – notably the masks, gowns and other protective equipment for medical workers. Obtaining materials to test for both infection and immunity is equally difficult.
“The supply chain is so screwed up and the supply and demand is so out of whack globally for all this stuff that it is going to take some time for the private sector to supply all the tests, the swabs, the reagents, the kits, the test tubes everything,” a state official said. “It will get caught up eventually. But that is going to take some time.”
Testing for the virus and immunity to it, surveillance and data collection will likely involve cooperation by agencies at opposite ends of the health care spectrum, from municipal health departments in rural Connecticut to the federal Centers for Medicare & Medicaid Services at the U.S. Department of Health and Human Services.
“None of these people think that you would even begin to start taking action until the infection rate starts to die off and you are kind of coming down the down slope of the hospitalizations and infections,” the official said. “And no one thinks that’s less than a month or a month and a half away. So you have that kind of time horizon to get that infrastructure in place. Still, it is going to be a massive amount of work.“
Massive contact tracing
Once infection rates slow enough to stop community spread of the virus and begin to relax social distancing, the American Enterprise Institute authors call for a massive investment to trace the close contacts of every individual who tests positive for the virus under the expanded testing regime.
Massachusetts has already made a big investment in contact tracing, allocating $44 million and hiring 1,000 people to track the contacts of people who are infected.
“The single biggest challenge we’re going to have is giving people confidence and comfort that we know where the virus is,” said Massachusetts Gov. Charlie Baker.
Under the strategy advocated by Gottlieb and his colleagues, every new positive test result would result in isolation of the patient – in a hospital, at home or in the case of patients whose family circumstances don’t permit in-home isolation, at a facility such as “repurposed” hotel room provided at government expense.
Following a positive test result, Gottlieb and his co-authors recommend that people who were in close contact with the patient should be quarantined and monitored two weeks.
The contact tracing necessary to identify close contacts of those who test positive would require a massive expansion of the public health system. In Connecticut, most of that work would be done by municipal health departments.
The report recommends that a federal task force be created to develop a network that would collect data from all the testing, contact tracing and quarantining. Such a network would “enable rapid reporting to state, local, and federal health authorities, through the public-health workforce and electronic data sharing from health care providers and labs” and “develop and field a technological approach to enable rapid data entry, reporting, and support for isolation, quarantine, and safe community-based treatment of affected individuals.”
Reporting from the New York Times was included in this story.
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