The Time To Prepare for a Second Covid-19 Wave is Now

We can learn from our earlier mistakes to mitigate the suffering when new outbreaks occur

Photo by Jabin Botsford/The Washington Post via Getty Images

Dr. Fauci testified today before the Senate that it is an absolute certainty there will be new outbreaks of Covid-19 cases. But he expressed concerns that “reopening” could cause even further outbreaks.

On the other hand Rand Paul says there will be no second wave. Who to believe?

The White House forecasts that there will be an additional 10,000 deaths as a result of starting to open the country. But they aren’t doing anything to discourage this.

The idea of a wave makes people think about peaks. People talk about peaks as if they are what allows people to ease their circulation with people. “Don’t worry, we’ve passed the peak.” We create the peaks. We end the peaks. We lower the peaks. And we can make new peaks. Passing peaks only means hospital beds are more empty. It doesn’t mean you need to fill them.

One question is whether there will be a big wave or lots of small waves? In the 1918 flu pandemic, when 650,000 Americans died, different parts of the country had a different patterns based on how they managed social distancing:

How some cities 'flattened the curve' during the 1918 flu pandemic

Even though cases haven’t dropped in many places, and could grow over the Summer. Let’s talk about the Fall when people think about larger peaks. We could have millions of kids returning to colleges and schools, flu season, sports and other things could be starting.

Will a second wave be worse?

• Unmitigated: if we go into the Fall scrambling for PPE, not able to get hands on Remdesivir or therapies, with exhausted nurses and without the ability to test and contain, it could be worse.
• Mitigated: if we stop wishful thinking and plan, we can make it different.

Guidelines are emerging on how to be safer in workplaces, on public transit, and in other parts of public life. These need to be present for all elements of society. The guidelines here are good.

With all that we have to do, why prepare for a second wave now? If we are going to tempt fate and then relax social distancing, we better prepare. Save every life possible.

Relaxing All Social Distancing Behaviors Now Is a Huge Mistake

We don’t want to live through March again. In February after I was sent the projected Italy and South Korea curves, I wrote letters to all the governors urging us to be South Korea and act aggressively to contain. We didn’t. Next time, we should aim to be South Korea.

How should we prepare?

1. Build intelligence and respond fast
2. Generate the best clinical evidence (e.g., when to use vents)
3. Access therapies and supplies in Emergency Use Authorization (avoid Remdesivir problem)
4. Red team scenarios with emergency response
5. Train contact tracing workforce
6. Set up telemedicine to keep care going for patients
7. Flu immunizations
8. Create caches of PPE
9. Have masks for every resident
10. Get nursing homes safe from infections now
11. Call centers and plants implement new OSHA regulations
12. Prepare schools for flexible closings if in session
13. Mail order voting and ballot distribution
14. National Guard readiness

Prepare for Day 1 of a second wave:

1. Deploy testing community wide
2. Isolate those who test positive
3. Contact trace and isolate
4. Have businesses prepare for shut down in 24 hours
5. Close air and rail
6. Prepare flex hospital support
7. Shift resources to hot spot cities
8. Prepare to watch Rand Paul and Chris Christie on cable explain why we shouldn’t do any of those things

It is important for every political leader to think about how to build and maintain the political capital needed to take quick action. Start communicating now about the likely need for action. If you can’t handle the leadership that is required, consider resigning.

If a second major wave never comes some will say all this preparation will be for nothing. But that’s what we do. We prepare to keep our people safe. Like the $600 billion every year on the military. Of course we will need this preparation.

The Coronavirus saga will take twists and turns. Many sadly of our own making. But there’s no excuse now that we’re out of April not to be prepared for future twists and turns.

Don’t count on the Federal government to put sufficient value on your lives and the lives of your family members. If your state doesn’t prepare for a second wave, we should prepare ourselves.

If we create conditions where a second wave is more likely, we damn well better be prepared to cut it off. Leadership is easy in good times. Leadership is important in challenging times.

Getting burned by lack of preparation is something we should never have to go through again.