Commentary
There is a relatively simple way to stop the coronavirus dead in its tracks. It might sound impossible at first, but it’s well within our capabilities, and it’s far less costly and disruptive than what countries around the world are doing now.
To give you some perspective on the issue, let’s go back in time to the AIDS crisis that was emerging in the 1980s. When AIDS was first identified in 1981 (HIV, the virus that caused it, wasn’t identified until 1984), the disease was spreading mainly among gay males and intravenous drug users. Because carriers of the virus might be asymptomatic for years, however, it was only a matter of time before it jumped into the mainstream population, thus putting the entire population at risk.
In 1988, U.S. Surgeon General C. Everett Koop did something both unprecedented and outrageous to try to get the AIDS epidemic under control: He sent an explicit eight-page pamphlet about AIDS to all 107 million households in the United States. The pamphlet talked about every possible kind of sex act, and, so there could be no misunderstandings, it mentioned the word “condom” 20 times.
We can stop the spread of AIDS immediately, Koop said, by changing our behavior, and he was remarkably frank about what behavior that was. It wasn’t until 1996 than an effective cocktail of medicines was developed to extend the lives of AIDS sufferers, and we still don’t have a vaccine, so Koop’s gambit, although controversial at the time, is now seen as heroic.
Like HIV—and unlike the common cold or SARS—the coronavirus can be transmitted by asymptomatic carriers, which allows it to spread rapidly and without people’s awareness. In some respects, however, the coronavirus is far more dangerous than HIV, because HIV transmission requires risky sex or an infected needle, whereas the coronavirus can be passed along merely by a cough or a sneeze, or even by the remnants of a cough or sneeze on a surface.
Because the coronavirus can be transmitted so easily, and because virtually all of the asymptomatic carriers of the virus have no idea they’re carrying it, the number of people suffering from COVID-19—the sometimes fatal illness caused by the coronavirus—is, at this writing (March 25), doubling worldwide every six days.
Even more disturbing, the number of COVID-19-related deaths is also doubling at this rate, and in some countries, the rate of doubling is even faster than the worldwide rate. In the United States at the moment, the number of COVID-19-related deaths appears to be doubling about every three days.
Both China and South Korea began implementing drastic measures to slow the spread of COVID-19 within weeks of having identified the problem: massive testing for the virus, restrictions on in-person interactions, large-scale quarantines, the closing of businesses and factories, and so on. As a result, the doubling time in South Korea has slowed to about 13 days, and, if we can believe the numbers China is reporting, transmission there might now have stopped completely.
Other countries have failed to stop transmission for a variety of reasons, among them: a lack of resources, poor leadership, poor discipline, and an inability to control misinformation.
In the United States, some of our leaders—among them President Donald Trump and Texas Lt. Gov. Dan Patrick—understandably concerned about the devastating impact the coronavirus is having on our economy—are now beginning to talk about reversing some of the restrictions that were put in place to try to slow the spread of the virus.
Without measures in place to slow the spread, researchers at the University College London recently estimated that the virus could cause upwards of 2.2 million deaths in the United States within a few months. Although that number might seem impossibly high, that’s just how doubling works.
If 100 people died today from COVID-19—a milestone in the United States which we in fact reached on March 23—and if a doubling time of three days persisted, then the number of deaths would increase each day until we hit 200 on March 26. Three days later, we would be at 400, then 800, 1,600, 3,200, and so on. Just 30 days of this kind of doubling would result in an astonishing 393,581 deaths.
The sad and very disturbing truth is that we hit that next doubling milestone—200 deaths—a day early. We hit it on March 25. That could mean the doubling time is actually faster than three days, which means that huge number I just showed you might be too small.
Whatever the actual growth rate turns out to be (no one knows for sure, because this virus is new), the hodgepodge of ways in which we’re currently trying to slow the rate of transmission is causing enormous confusion, reflected, among other things, in a calamitous drop in stock prices. As more people lose their livelihoods and the number of deaths continues to increase, we risk societal collapse, or at least widespread panic.
Yet there is a relatively simple way to halt the spread of the coronavirus fairly rapidly—or at least on a pace we can control. The solution to the coronavirus problem is to test everyone, and then for people who are infected to self-isolate.
This solution was demonstrated on a small scale in study reported a few days ago in The Guardian. Researchers at the University of Padua tested all 3,300 residents of the Italian town of Vò and separated those carrying the virus—both symptomatic and asymptomatic—from those who were virus-free. Transmission stopped immediately.
Could we test all 329,425,643 men, women, and children in the United States? It sounds like a tall order, but it’s not much different than taking the census, and the only bodily fluid needed is a small amount of nasal mucus (yes: snot). Because of economies of scale, the per-unit cost of 300 million tests will likely be less than a dime, but even if, taking administrative costs and the usual inefficiencies into account, the total cost of each test turns out to be $20, the $6.5 billion price tag for Universal Coronavirus Testing will still be $600 million less than we’ll be spending this year alone on the Census.
Just today, it was announced that researchers at three universities in the UK have developed a cheap coronavirus test that people could administer at home, although it will still take a $100 machine to analyze the results. They’re exploring now how to mass-produce the necessary hardware. Also promising: On March 28, the FDA approved a 15-minute test for use in the United States.
And here’s an interesting possibility: With 334 million tests on the line in the United States alone—perhaps even billions over time—the same companies that manufacture those cheap at-home pregnancy tests might quickly develop a dirt cheap, self-contained, at-home test. Just shove it up your nose, and, seconds later, a plus-sign on the device says you’re carrying the virus, and a minus-sign says you’re not. Disposable devices of this sort could even be used to screen people entering venues where it’s especially important that infected people not mingle—the White House, perhaps?
And how about dividing people up? The doubting Thomases among you are undoubtedly imagining entire U.S. Army regiments, tanks and all, tearing up your suburban lawns, but in reality, the vast majority of us will divide ourselves up.
I know this not just because I’ve been a psychologist for a long time but because two of my own children, having barely made it out of Madrid recently, quarantined themselves in their bedrooms a week ago. They wiped down the doorknobs and railings with antiseptic wipes after they came home, and I haven’t seen them since. We text and Skype frequently, and I leave their favorite foods and drinks outside their doors every few hours. (I just left chocolate chip cookies.)
They’re each in college, and their courses are all online, so they’ve got plenty to do. All in all, it’s not a bad arrangement.
If my kids were still little, I’d go into quarantine with them and take my chances. Many uninfected people will make similar choices when Universal Testing is underway.
The vast majority of virus carriers will choose to self-quarantine, and the government can sweeten the deal with financial incentives; that will help immensely with people who can’t report to work because of their infection.
Since some people also need sticks, virus carriers who knowingly expose uninfected people to the virus could be penalized with fines or even jail, but I think social pressure—plus those financial incentives, of course—will likely reduce the number of inconsiderate jerks to near zero.
As for that proposal to have only elderly people isolate themselves, all I can say is: WTF. Isolating seniors won’t slow the spread of the virus one single jot. It’s not elderly people who need to self-isolate, it’s the people who are carrying the virus.
Perhaps the extraordinary benefits of Universal Testing—or just Testing, if you will (that’s Testing with a capital T, because there’s testing, and then there’s Testing)—have already crossed your mind. Here are four that stand out for me:
First, by depriving the virus of its hosts, Testing will soon obliterate it. Unlike HIV, which can wreak havoc on a person’s body over a period of months or years, most cases of COVID-19 are mild, and people typically recover within 10 to 14 days. Serious cases might still result in death, of course, but at least there will be no new cases.
Doubt me if you like, Thomas, but if Testing is done right, it could, for all practical purposes, banish the coronavirus from human bodies in a matter of weeks, and that’s sans vaccine or cure. (You can’t work this kind of magic with HIV, unfortunately, because it attacks the immune system itself, so people with AIDS can’t kill the virus and recover on their own.)
Second, it will greatly reduce the likelihood that our hospitals and medical resources will be overwhelmed. This is because we will know, fairly precisely, how many people might need those resources, and, of course, because the number of carriers will stop its exponential growth. In fact, with transmission having stopped, the number of people needing medical attention will rapidly decrease, and it will do so in an orderly and predictable manner.
Third, Testing will end the confusion and fear. Right now, everyone is afraid of everyone else, because no one knows who’s carrying the virus and who isn’t. We don’t even know whether we are carriers. Universal Testing solves that problem.
And fourth, Testing will end the financial crisis—perhaps within days of when Testing begins. It will immediately end the uncertainty that has been plaguing the stock market because it will get the virus under control. It will also allow virtually all of those closed schools and businesses to open their doors again—even the theaters and restaurants. Why? Because there are currently 65,564 confirmed cases of the virus in the United States (click here for the latest count), which means that a half million people are probably infected—hell, let’s say it’s 2 million. That still leaves 332 million people who are now free, once again, to go to stadiums, attend classes, sit at actual tables in restaurants, and fly from Charlotte to Chicago.
The census costs U.S. taxpayers money. Universal Testing has the potential to save businesses and taxpayers trillions of dollars, as well as to rescue thousands of businesses from bankruptcy.
So much for the United States. How do we rapidly end the coronavirus pandemic worldwide?
You already know the answer.
Koop’s 1988 flyer didn’t end the AIDS epidemic, but at least he was thinking Big—at least he was thinking Everyone. Let’s think even bigger now and get rid of this damn virus.
Robert Epstein, a former editor-in-chief of Psychology Today, is senior research psychologist at the American Institute for Behavioral Research and Technology. The author of 15 books and more than 300 articles, he is working on a book called “How Google and Facebook Ate Your Brain, and How You Can Get a New One.” Follow him on Twitter: @DrREpstein. To read Epstein’s other new article about the coronavirus, click on “The Doubling Problem.” The article explains how rapidly the virus will spread unless drastic measures are taken.
This article has been updated to note the approval of a 15-minute coronavirus test by the FDA.
