As we look forward out of the COVID-19 pandemic,

governors in some states are already talking

about reopening some businesses, and a few states

have already started reopening.

[tense music]

[electric razor buzzing]

Social distancing must continue,

but our economic shutdown cannot.

South Carolina's business is business.

People wanna work, they need to work.

We will allow gyms, fitness centers, bowling alleys

to reopen their doors.

But rushing to reopen too early

could lead to a deadlier second wave.

[tense music]

The first and the biggest mistake we can make

is ending physical distancing too early.

[tense music]

If we rush to reopen, it could lead

to the uncontrolled spread of the virus all over again.

It won't be safe to reopen until we see a dramatic decline

in the number of cases.

There isn't a magic number in terms of how big

that decline in cases needs to be,

and different countries are handling that differently.

The White House is saying that states should be looking

for a decline in cases for 14 straight days,

because that's the virus' incubation period.

But China didn't allow cities like Wuhan and Nanjing

and others to reopen until intense surveillance

detected zero new cases for 14 days.

Overall, a second wave in China seems

to be pretty minimal at the moment.

Here in the states and in some countries in Europe,

the virus is still reaching its peak.

We're still waiting to see an overall decline in cases

in the states, signaling that the virus spread

is slowing, and that the potential

for future outbreaks won't overwhelm hospitals.

It will take several more stages

until we return to some kind of normal.

Some experts predict that we could see some level

of physical distancing continue for years.

[tense music]

The next big mistake would be not preparing hospitals

for another surge.

We've seen this happen in the past.

Take the 1918 Spanish flu pandemic

that killed an estimated 50 million people, and many

of those didn't die in the first wave of the pandemic.

They were killed in the second and third waves.

Given that another surge of COVID-19 is likely,

we need to make sure that hospitals have three things.

The first is medicines that are proven to treat this virus.

Right now, in some cases, doctors

are using experimental treatments, but we need antivirals

that specifically target this new coronavirus.

Second, we need the right amounts

of personal protective equipment, or PPE,

for first responders and our healthcare workers

so that we're not seeing a situation like we are now

in this first wave, where people are having

to reuse PPE, or having to use expired masks.

It's so important that our front line healthcare workers

have that protective equipment to make sure they're safe

while caring for others and to limit the spread

of the virus through healthcare facilities.

And third, we need to make sure that hospitals

have sufficient resources and equipment.

That means everything from enough beds, enough staff,

and ventilators to treat the sickest patients.

[tense music]

The third critical mistake would be

to reopen without ramping up testing dramatically.

The need for accurate, widely available,

and quick turnaround testing could

be the most important factor in reopening the country.

Without accurate testing, we just have no idea

of how far and wide this virus has spread,

and also it means we can't diagnose people quickly

and treat them appropriately.

This is especially important, given as many

as one in four people who has the disease

doesn't show any symptoms, and in that context

of asymptomatic spread, it means we need

to continue testing, even as the number of cases declines.

And we may need to test people multiple times.

One of the challenges of this new virus

is we don't know how long immunity lasts for,

or what the likelihood of reinfection might be.

So far we've tested four million americans,

and are running between 130,000 to 160,000 tests a day,

but we should be running 500,000 to 700,000 tests a day.

But ramping up testing to this extent

could cost billions of dollars.

Add to that the challenge that you're asking lab technicians

to suddenly do many, many more tests on top

of their existing work, so you're taking away resources

from other areas in the healthcare field.

And at the exact same time, the entire world

is also demanding access to these resources.

[tense music]

The next big mistake we could make

is letting the virus spread without tracking it,

so basically not doing contact tracing.

Contact tracing is where we find each person

who has the disease, find out when they were contagious,

and then trace their steps to find out where they went

and who they had contact with while they were infectious,

and then you have to follow up with each and every one

of those contacts to make sure

they're quarantined or isolated as necessary.

It's an old school public health technique,

but let me tell you, contact tracing

has been the cornerstone

of every major infectious disease epidemic investigation.

A lot of contact tracing is leg work.

You're following up with people, finding out where they went

and who they may have exposed,

but there are new tools that can help.

Apple and Google are working on contact tracing technology

for smartphones, but keep in mind,

as important as contact tracing is,

it really has to work hand-in-hand with widespread testing.

Without knowing who's been infected,

we can't monitor the spread.

[tense music]

And finally, we need to stop

repeating the panic-neglect cycle.

The panic-neglect cycle is what we so often see

in public health where we all freak out

during the crisis, and then soon after,

we forget about it and act like nothing bad happened.

The aftermath of the 2002/2003 SARS pandemic

is a perfect example of this panic-neglect cycle.

A possible vaccine for SARS was being developed,

but then it was abandoned by funders

as the disease tapered off, so then we ended up

with a half-developed SARS vaccine

that was forgotten about in laboratory freezers.

The panic-neglect cycle, especially that panic part of it,

also leads to what we call exceptionalism,

where we target much of our funding and energy

on one disease, but at the cost of other pressing diseases.

I'm hearing of some people losing jobs

at other medical organizations, for example,

those working on dementia, because they're

losing funding during this pandemic.

But dementia's not going anywhere, and so we need

to make sure that we don't lose focus

of all those other diseases that cause so many problems.

Also, ebola is not still fully under control,

and so even though it's not making headlines right now,

we can't take our eye off the ball.

And I really hate that after all the panicking,

we fall into this neglect mode,

because it's really not a matter

of if we'll go through this again,

it's a matter of when will we go through this again,

and we need to be prepared for it,

and we need to learn from this

so that we don't keep repeating our mistakes.

Thank you so much for watching.

Keep dropping your comments here

and contacting me on social media.

Stay home and stay safe, everyone.

[tense music]