Here’s what needs to happen for America to return to “normal”

When will life return to “normal”? It's what parents with kids stuck at home, people out of work, and Americans across the country want to know. What will it mean to live in a post-coronavirus world?

Though President Trump is raring to open the country back up soon, experts warn a few critical things need to be in place for life to return to some version of what it was before the country essentially shut down in March. Even then, life might not be quite the same; many people may alter their behavior and reconsider going to large gatherings that were previously commonplace. 

“If ‘back to normal' means acting like there never was a coronavirus problem, I don't think that's going to happen until we do have a situation where you can completely protect the population,” said Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, during Monday's White House Coronavirus Task Force briefing. “But when we say ‘getting back to normal,' we mean something very different from what we're going through right now, because right now we are in a very intense mitigation. When we get back to normal, we will go back gradually to the point where we can function as a society.”

A “roadmap” report released by the conservative-leaning American Enterprise Institute, authored by former Food and Drug Administration Commissioner Scott Gottlieb, other former FDA officials and experts at Johns Hopkins University, identified three phases:

• First phase: “slow the spread” — this is where the U.S. is now;
• Second phase: State-by-state reopening of the economy; and 
• Third phase: Establish immunity to lift physical distancing. 

Only in that third phase will life return to the closest thing to normal, the report concludes. Gottlieb has served as somewhat of an outside adviser to the federal government during the coronavirus crisis, providing briefings and making the rounds on television. 

The U.S. will only be able to move to a state-by-state reopening of the economy when there is a “sustained reduction in cases for at least 14 days;” hospitals have the capacity to treat all patients without being overwhelmed; everyone showing symptoms can be tested; and the state can actively monitor confirmed cases and contacts. At this point, most states appear to still be weeks away from being able to do this, and the nation is still ramping up testing. 

In Phase II, the AEI report notes, most schools, universities and businesses will be able to open their doors once more, reviving the economy that has been unsettlingly dormant. But some social distancing measures will need to continue, and “high-contact” settings like schools will require more guidance from the Centers for Disease Control on how they should conduct themselves. Mask-wearing will be important, at least for awhile. Testing will need to be widely available in doctors offices, and less physical distancing will demand stricter surveillance measures to identify cases and trace their contacts quickly, the report notes. 

New York Governor Andrew Cuomo, who is working with fellow governors in the tri-state area on a plan to restart the economy, says regional collaboration and testing will be key. 

“It's going to come down to how good we are with testing. You're not going to end the infection and end the virus before you start restarting life. I don't think you have that luxury,” Cuomo said in one of his daily press conferences earlier this week. “How do you start the economy back up, how do you start getting back to work as quickly as possible? It's going to come down to testing. You're going to have to know who had the virus, who resolved the virus, who never had it, and that's going to be testing. And that is an entirely new field that we're just developing now, right?”

Antibody testing, or serology, will also be vital, the Coronavirus Task Force's Dr. Deborah Birx has said. At this point, it's impossible to know how deeply the virus has penetrated the general populace because U.S. testing has lagged, and a significant but unknown proportion of cases are asymptomatic. Antibody testing would allow the U.S. to identify people who have been infected with the virus, and recovered. Birx says the first such test could be available “within this month.” 

Dr. Brett Giroir, an admiral also on the task force, said of the tests that if the NIH and FDA can be sure the tests work the way they're supposed to, “we will have millions on the market by May.” And these tests can be conducted quickly, with “tens and tens of millions of people screened with a finger prick on the spot.”

This kind of widespread testing enables surveillance screening that will help experts understand whether “1%, 5%, 30% of Americans have been infected,” Giroir said. 

Birx said during a recent Coronavirus Task Force briefing at the White House that the antibody tests will bring a “peace of mind that would come from knowing you already were infected, you have the antibody, you are safe from reinfection 99.9%” of the time. 

That third phase, lifting physical distancing restrictions, can begin only when broad surveillance, therapeutics, and ideally, a vaccine are in place, the AEI report says. 

The nation will not return to the closest version of normal until a vaccine is widely available to the public, Fauci concurs. While private companies are racing to be the first to offer a proven, effective vaccine, such a vaccine is likely still at least a year away to becoming available to the public, experts say.  

“If you want to get to pre-coronavirus, that might not ever happen in the sense of the fact that the threat is there,” Fauci said on Monday. “But I believe with the therapies that will be coming online, and with the fact that I feel confident that over a period of time we will get a good vaccine. That we will never have to get back to where we are now. So, if that means getting back to normal, then we will get back to normal.”

But Americans need to be prepared for life to be changed for the near future, Gottlieb said on “Face the Nation” Sunday.

“I think things are going to be permanently changed coming out of this until we get to a vaccine and we can fully vanquish this,” Gottlieb told “Face the Nation” moderator Margaret Brennan. “We're not going to see a V-shaped recovery or a quick snapback absent the ability to get a highly effective drug in the hands of doctors that can mitigate the risk, either used as a prophylaxis to prevent infection in people who get exposed to this virus or treat people who get the virus and are- are likely at a high risk of a bad outcome.”

“We can have that kind of drug by the summer and certainly by the fall,” he continued. “I don't see the kind of deliberate, industrial approach, all hands on deck approach, to trying to get that kind of therapeutic. And there are things that are promising right now that could be brought forward more quickly. But absent that, this is going to be an 80 percent economy. There are things that are not coming back. People are not going to crowd into conferences.”

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