PROVIDENCE, R.I. (WPRI) – Leading public health officials at Brown University say there’s good reason to believe classrooms will reopen in the fall, but they predict life could still look much different as COVID-19 continues to linger.
“There may be certain types of events we can’t do,” said Dr. Ashish Jha, incoming dean of the School of Public Health. “We may not be able to do certain sporting events that bring 20,000 people together in a single stadium or a single arena. Those will be more challenging.”
The Ivy League school last week launched a new panel discussion series on YouTube called “Community Conversations.” The inaugural episode was hosted by Brown University President Christina Paxson and featured Jha, along with former World Bank Group president Dr. Jim Kim, who is now a partner at Global Infrastructure Partners.
“I think life as we know it has already changed,” Kim said. “If you’re watching movies and televisions now and you see people touch each other, it’s like, ‘Oh my God, how are they doing that?’”
The panelists spent more than 40 minutes discussing various issues tied to the ongoing global health crisis, and they explored strategies used in other parts of the world where new cases of COVID-19 are now dwindling. The experiences elsewhere could help inform what will happen moving forward in the United States, they said.
“I think we can agree that we’re still in the early days – that the number of cases is going to rise exponentially in the days and weeks ahead,” Jha said. “One of the major reasons that we have fallen so far behind on this is a two-month lag in preparation and a two-month delay in getting our testing infrastructure up and running.”
The discussion largely focused on challenges facing the nation, but many of the issues are also playing out locally. Rhode Island for weeks has struggled to expand daily testing in part because of fierce competition to purchase a limited amount of testing materials and other medical supplies from the private sector.
Gov. Gina Raimondo on Wednesday said Rhode Island will have the capacity to test 1,000 people per day beginning Thursday, but she expressed frustration with the challenge of sourcing material.
“Even when you think you’re in good shape, you have to order more,” Raimondo said.
Without enough testing, the state hasn’t been able to accurately pinpoint where the disease is most acute. Without pinpoint data, it’s tough to know who represents a health risk to others — which is especially problematic considering Dr. Robert Redfield, director of the U.S. Centers for Disease Control and Prevention, said up to one in every four people infected with COVID-19 remain asymptomatic.
Without knowing who represents a health risk – absent a vaccination, which today doesn’t exist – state leaders are wary of scaling back the social-distancing mandates that have brought the economy to a screeching halt and thrown more than 80,000 Rhode Islanders into unemployment.
Jha and Kim agreed the solutions both now and in the future are obtainable, but require more aggressive and coordinated testing, isolation and contact-tracing measures that have proven successful in tamping down the virus in other countries, including China and South Korea.
“Let me put it this way: there is no way for us to stop the social distancing rules until we have the ability to do the kind of testing and contact tracing that will give us the confidence to loosen up some of those rules,” Kim said.
Learning from others
China and South Korea reached similar outcomes but with slightly different approaches.
In China, the government first ordered people to stop going out into public, but found cases continued to climb because the disease spread among family members. People with symptoms were then forced into quarantine and isolation centers apart from their families.
The more aggressive approach raised concerns among some global human rights advocates, but helped the country reduce its reproductive number – a measurement of how many other people on average are infected from one person with the disease – to 0.32 on Feb. 11 compared to 3.9 a month earlier. (A disease is still spreading if the reproductive number is greater than one, Kim explained.)
“Korea did the same thing but made it not mandatory,” Kim said.
Like China, South Korea tested anyone with symptoms and separated them from their families, offered access to services and aggressively tracked down contacts. Unlike China, however, South Korea was successful in spurring a voluntary response through galvanizing its citizens around the idea that COVID-19 represented a clear and present threat to their families, Kim explained.
The former World Bank leader acknowledged that such measures may sound challenging to Americans, but he said such efforts must be replicated in some way if leaders want to reopen the economy – as has started happening in China and South Korea.
“You hear a lot about flattening the curve,” Kim said. “Well, you can flatten the curve, but that means it will just go for very long time until you take this other approach.”
In China, he added, it took about two months after more aggressive measures were implemented before the economy started reopening.
Rhode Island could be moving toward something similar to what happened in South Korea on a smaller scale, although state leaders have been hazy about specifics. When asked Tuesday whether the state has plans to implement digital tracing using mobile phones, Raimondo said the state is developing an app that could track symptoms and quarantine efforts.
“There will be use of a mobile phone, definitely,” Raimondo said. “We will have mobile apps for people to frankly do everything. We’re trying to get everybody to stay at home, so we’re trying to move everything we can to mobile phones.”
The governor said it’s premature to roll out more specific details, but said she expects to announce more next week.
Tracking an illness through phones
Tracking people using mobile phones helped China, a communist country, and South Korea, a democratic country, not only respond to COVID-19 surges, but also monitor for flareups afterward.
A Target 12 review of mobile devices belonging to multiple Chinese residents showed the government continues to trace people using the popular payment app Alipay. (The app is similar to Venmo in the United States, but it can be used for business-to-customer purchases in addition to person-to-person transactions.)
The app collects location data through purchase history and GPS, which can be matched against others to trace contacts among users. Each person also has a unique QR code, which changes colors based on what kind of health risk they theoretically pose.
Red is dangerous and the person could be put into quarantine or isolation. Green is safe, meaning the user can go about life and work normally. If the color changes orange, it means a contact is showing symptoms, meaning testing, quarantine or isolation of the user might be necessary.
In South Korea, authorities have likewise retraced people’s steps using purchases and security-camera footage to track travel patterns, according to a New York Times report. If a person tests positive in a certain region, other people’s cellphones in the area will vibrate with emergency alerts. Those in quarantine must download a new app that alerts authorities if the quarantine is broken.
Whether Americans could stomach similar tracking strategies in the United States hasn’t been tested yet locally, but there’s historically been less of an appetite for domestic surveillance of citizens.
Raimondo was sharply criticized and received pushback from multiple quarters – including New York Gov. Andrew Cuomo – after ordering the R.I. National Guard to track down New Yorkers who had traveled into Rhode Island.
But Kim said he thinks citizens might look at what’s happened in other countries and see that more aggressive measures are necessary to solving the problem locally, adding that it may require a successful regional response to prove the approach nationally.
“The great hope is that the governors – or some consortium of governors – can take the lead,” Kim said.
Jha echoed the sentiment, saying it isn’t a time to cast aside challenging ideas just because they sound too difficult to implement. And taking bold measures, he added, could help expediate the effort to reopen different parts of society, including classes at Brown.
“A lot of this is going to be driven by the facts on the ground at that time, but I think that there is good reason to believe that we can get this disease under control,” Jha said. “If we can have the kind of trace, isolation, contract tracing stuff that Jim has laid out – and if we’re doing it across not just across New England states but across the country – there’s no reason to think that we can’t open up classes.”