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New Supplemental Report to the Roadmap to Pandemic Resilience

May 12, 2020

Pandemic Resilience: Getting it Done
A New Supplemental Report offers Localized Guidance for Safe  
Economic Re-opening in the Wake of COVID-19 Closures

Bipartisan authors of the “Roadmap to Pandemic Resilience” offer concrete, localized recommendations for testing, tracing and supported isolation, based on differing levels of disease prevalence, so that communities across the US can re-open and stay open.

As a follow-up to the “Roadmap to Pandemic Resilience,” which calls for massively scaled up programs of testing, tracing and supported isolation (TTSI) as a means to safely re-open the U.S. economy after COVID-19 closures, today Harvard University’s Edmond J. Safra Center for Ethics, with support from The Rockefeller Foundation, released a new supplemental report, “Pandemic Resilience: Getting it Done.” This supplement includes detailed guidance on the levels of testing and tracing needed to reopen different communities across the US, based on disease levels in distinct locales.

“TTSI efforts are not one size fits all. Different metro areas and communities have different levels of COVID prevalence and thus different testing and tracing needs,” said Danielle Allen, Director of Harvard University’s Edmond J. Safra Center for Ethics. “Local and state authorities from Manhattan to Montana, Detroit to Arizona, will find detailed guidance for their communities in ‘Pandemic Resilience: Getting it Done.’”

“As mayor of an urban city within a rural county that’s part of a mid-sized metro area in a state where the prevalence of COVID-19 varies dramatically from place to place, I’m building a TTSI program for a unique place, not New York City or the Alaskan wilderness,” said Christopher Cabaldon, Mayor of West Sacramento. “This roadmap doesn’t just show the TTSI highway, it zooms in on the on-ramps and surface streets that different localities can take to get on track. And it provides the clear directions to help us get there…and get it done.”

The report offers different TTSI program recommendations for locales that have low prevalence (Green Zones), moderate prevalence (Yellow Zones), or high prevalence (Red Zones). Green Zone communities have few active infections (a current infection prevalence of less than roughly one per 36,000).  Yellow Zone communities have known active infections at a small scale (less than 1% prevalence of active virus in the population). Red Zone communities have an outbreak which public health authorities have not been able to suppress (1% or higher prevalence of virus in the population). Differences in prevalence around the country help explain the range of political response to stay-at-home orders and advisories. We demonstrate how further prioritization for resource allocation would be made possible taking into account vulnerability using the COVID-19 Community Vulnerability Index.

An illustrative list of where each U.S. metropolitan statistical area fell as of May 8 is available in the supplemental report. Two weeks ago, the country still had Green Zones, but now none remain. An interactive map with data about where each area falls is available online at pandemictesting.org.

“The devastating economic impact of COVID-19 cannot be overstated,” said Anne-Marie Slaughter, CEO of New America and a co-author on the Supplement. “We understand the urgency to move past the mass isolation of stay-at-home orders and slowly re-open our state and local economies. We are focused on ways to re-open and stay open safely, so we can save lives and livelihoods simultaneously.”

The report supplement comes after new CDC guidance that supports broader use of testing not only for therapeutic purposes, but also for disease control and suppression. The revised guidance now includes testing for asymptomatic individuals, as directed by state and local plans. The supplemental report provides guidance for shaping those plans.

To implement disaggregated testing and tracing programs across the country that would be similar in impact to the strategy employed in South Korea, the report sets targets that aim at achieving breadth and inclusivity in access to testing, and a 4% positivity rate. (The positivity rate is the percentage of tests administered each day that return a positive result.)

At the level of individual locales, this strategy yields the following rules of thumb for calculating testing and tracing needs:

  • GREEN ZONES: one test per day for every 10,000 people; one five-person contact tracing team for every 100,000 people.
  • YELLOW ZONES: 60 teams of five tracers for every death/day in the locale; testing capacity at the level of 2500 tests x (#deaths/day).
  • RED ZONES: 60 teams of five tracers for every death/day in the locale; testing capacity at the level of 2500 tests x (#deaths/day).

Achieving these targets in aggregate across the whole country requires 5 million tests per day for a surge period this summer. Given testing scarcity, the report provides prioritization guidance, while also advocating continued ramp up of testing capacity.

The report also includes recommendations for infrastructure investment in TTSI programs in five categories: personnel; isolation supports; sample collection infrastructure; sample processing infrastructure; and IT infrastructure for data management. 

Even as states, tribal, and local governments take on most of the burden for developing TTSI programs, the report recognizes the continued and necessary role for the federal government, including both the executive and legislative branches, to support state efforts with strategic public investment, knowledge coordination, and flexible financing.

The report recommends the following levels of TTSI infrastructure investment from the federal government:

  • $5.5 billion in local public health offices including IT infrastructure for digital records management systems ($1 billion one-time and $4.5 billion annual);
  • $9 billion for contact tracing personnel over the coming twelve months ($5.4 billion for surge and $3.6 billion for maintenance);
  • $4.5 billion for voluntary self-isolation facilities such as hotels, for infected individuals who cannot safely self-isolate at home;
  • $30 billion over 18 months in income support for individuals maintaining 14-days of voluntary self-isolation;
  • $24 billion for investment in test kits, test and processing capacity;
  • $500 million investment in mega-labs.

With this investment, the country can put the virus on a steady path to deceleration, reopen the economy fully and safely, and keep it open. The resulting infrastructure will build resilience against this pandemic and others to come.

The full supplemental report, as well as the “Roadmap for Pandemic Resilience" and additional in-depth white papers are available at pandemictesting.org and https://ethics.harvard.edu/covid-19-response.