The AEI’s “road map to reopening” details what’s next for America

Americans are eager to know when we can step outside again. When will it be safe to visit coffee shops, bars, and gyms? Will our kids be able to return to school soon? Will life ever feel normal again? The problem is that reopening dates keep changing. Schools that were initially slated to reopen this week are now expected to stay closed for the rest of the year. The truth is, no one seems to have a clear answer about when—or even if—things will return to normal. This uncertainty stems from the fact that we first need a comprehensive strategy to safely restart the economy. To address this, the American Enterprise Institute (AEI) released a report authored by five leading figures in medicine, public health, and law: Scott Gottlieb, Caitlin Rivers, Mark B. McClellan, Lauren Silvis, and Crystal Watson. Their four-part plan outlines steps the U.S. could take to reopen society while minimizing risks. If followed, it might provide clarity on what needs to happen next. The AEI plan focuses on strategic recovery rather than hasty action. Its authors emphasize caution over speed. Here's how it breaks down: Currently, we're in Phase I of the plan. However, during Phase II, individual states will begin reopening incrementally. A state can transition to Phase II once it demonstrates the ability to effectively diagnose, treat, and isolate COVID-19 cases along with their contacts. In Phase II, daily life will resemble pre-pandemic routines but with significant adjustments. People will likely be encouraged to wear homemade cloth masks in public settings. Public hygiene practices will intensify, including regular disinfection of shared spaces. High-touch surfaces will receive more frequent sanitization, among other measures. Phrases such as "sharply," "isolate," "limit," and "routine" underscore that we'll be living under a 'new normal.' [Insert image description here] Phase III remains somewhat abstract. It involves easing social distancing once reliable tools are available to mitigate COVID-19 risks. Potential tools include widespread testing, therapeutic treatments, and ultimately, a vaccine. Phase IV lies far ahead. Before fully moving past COVID-19, the report recommends ensuring the U.S. is better prepared for future pandemics. This includes creating systems to accelerate vaccine development, modernizing healthcare infrastructure, and establishing what the authors call the 'National Infectious Disease Forecasting Center.' While politicians, leaders, and economists wish they could predict exact timelines for economic recovery, the AEI report avoids offering definitive dates. Instead, it proposes "trigger mechanisms" for transitioning between phases. Meeting the criteria of one phase will initiate a gradual progression to the next, while weakening responses could prompt a return to previous stages. Ideally, this process continues until reaching Phase IV. The initial step toward reopening the economy is exiting Phase I, where we currently stand. Our focus here is primarily crisis management. To advance beyond Phase I, three key conditions must be met: 1. A state must document a consistent decline in COVID-19 cases over at least two weeks, equivalent to one incubation period. 2. Hospitals must be capable of handling all necessary admissions without resorting to crisis standards of care. 3. Testing availability must increase sufficiently to screen symptomatic individuals and monitor them alongside their close contacts. The AEI estimates that achieving approximately 750,000 weekly tests could enable case-specific interventions required for progressing to Phase II. It’s evident that America’s healthcare system struggled to manage the surge in COVID-19 patients. Therefore, the report offers detailed recommendations for hospital readiness, suggesting a minimum of 2.8 ICU beds per 10,000 adults, scalable up to 5-7 beds during emergencies. Ventilator availability should also reach 5-7 per 10,000 adults, excluding emergency-use anesthesia machines. These preparations are essential for leaving Phase I, yet they don’t guarantee a return to pre-pandemic conditions. Additional measures are needed before triggering Phase II: - Increase personal protective equipment (PPE) supplies so all healthcare workers have access to N95 respirators, gloves, and gowns; - Develop robust surveillance systems for diagnosing and tracking suspected cases, identifying their origins, and monitoring transmission; - Scale up contact tracing, isolation, and quarantine efforts, potentially utilizing GPS tracking on mobile devices and monitoring international arrivals; - Offer free voluntary isolation and quarantine programs similar to those implemented in other countries; - Encourage everyone to wear non-medical fabric face coverings. Easier said than done, right? What would the world look like if we adopted the AEI report’s suggestions? By the time we reach Phase II, most businesses, schools, and universities should reopen, provided they adhere to social distancing guidelines. Remote work arrangements should persist wherever feasible, and social events should remain limited. The reopening process will occur gradually and cautiously, with enhanced surveillance accompanying eased restrictions. If businesses or schools reopen and subsequently experience untraceable clusters of infections or sustained increases in new cases for five consecutive days, we'd revert to Phase I and restart the process. Transitioning to Phase III requires either FDA-approved vaccines or other preventive/treatment therapies. Following all AEI recommendations and reaching Phase IV would fundamentally alter American healthcare. It would become cleaner, more hygienic, more surveilled, and more centralized. Whether our leaders heed this advice remains uncertain. Should they choose to act, the path forward will undoubtedly be lengthy but potentially transformative.

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