Along with much of the rest of the world, the U.S. response to the coronavirus pandemic has been largely to shut down. Even with massive federal intervention, the US. economy contracted at a 4.8 percent annual rate during the first quarter and is projected to shrink at a 35–40 percent rate during the second quarter, with the unemployment rate at about 15 percent already.
We must stop this economic bleeding. The economy becomes more difficult to repair and hardships worsen, particularly for low-income people, the longer the lockdowns last. But simply lifting restrictions and hoping for the best is also unacceptable given the risks of rekindling the COVID fire.
The right way forward must include massive levels of testing combined with incentives for people to want frequent testing, such as the ability to mark oneself as COVID-free for some period of time rather than simply identifying and tracing people who test positive. The costs would be high—possibly closing in on $100 billion a year for the necessary scale. But compared to the estimated $20 billion daily cost of the economic shutdown, that would be a bargain.
Although only a small percentage of the population is infectious at any time, no one knows who they are. People therefore assume anyone they come in contact with might be infectious, and are consequently afraid to go to work, eat in restaurants, enjoy sporting events in person, travel and so on. If we knew the infection status of people with whom we come in contact, we would figure out better ways of dealing with the crisis than closing down a third of the economy.
Public health officials hope that more testing and contact tracing, aided by mobile phone apps developed by Apple, Google, groups at MIT, and others, can help solve the problem of not knowing who is infectious. Such apps report who is contagious. The problem is that these apps are good for everyone except the app user. Thus, aside from civic-mindedness, nobody has much of an incentive to download a contact-tracing app and report a positive test result. A recent survey indicates that barely 50 percent would download and use a contact-tracing app even if data sharing were opt-in (which is the case with the Apple-Google app).
Incentives to use such an app could be created through a simple change in what the apps report. Rather than only reporting who is contagious and enabling contact tracing, the apps could combine contact tracing with a “covid-negative safety certification” program. Those with a negative covid test result would be certified “safe” for a period – perhaps two weeks – and then would have to be retested to retain the certification.
Safety certification could also apply to those with positive antibody test results (“immunity passports” being discussed in some countries) when those tests are sufficiently reliable. This certification would presumably not need to be renewed every two weeks.
Safety certification could be loaded on the same app used for contact tracing. Employers, restaurants, airlines, sports venues and other venues where people gather could require this certification for admittance. It could be as simple as it now is to use your phone at a fast food establishment or to get on an airplane.
Such a program would provide a powerful incentive to use an app, get tested and report testing results – an incentive that is lacking if the results are used only if one tests positive – and would address the information problem blocking a return to some kind of normalcy. Tests, of course, can be erroneous, and people could contract the virus during the two-week period between tests. However, people would face strong incentives to be careful so as to retain certification the next time, and not be required to self-quarantine for two weeks.
Testing the entire population – 330 million people – every two weeks implies about 24 million tests per day – a daunting task since the United States currently performs about 1.5-2 million tests a week. But it should be well within our capacity, especially if rapid antigen tests (like flu tests) performed in doctors’ offices become available, as recently suggested by former FDA Commissioner Scott Gottlieb. Nobel economist Paul Romer, focusing on identifying those who are positive, has proposed testing similar numbers.
The annual cost of testing 330 million people 25 times a year at $10/test – a not unreasonable guesstimate given economies of scale – would be around $82 billion. Even if off by an order of magnitude, these costs would still be far less than the costs of an extended shutdown.
Whatever the specific testing technologies, a widely available safety-certification system is needed to make people comfortable returning to normal activities and dramatically reduce the costs of the pandemic while we wait for drug and vaccine development efforts to succeed. It should be a major priority.
Thomas M. Lenard is a senior fellow and president emeritus at the Technology Policy Institute.
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