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How to prevent second wave of coronavirus cases for New York

The Hill logo The Hill 4/6/2020 Sandra Gelbard, opinion contributor
How to prevent second wave of coronavirus cases for New York © Getty How to prevent second wave of coronavirus cases for New York

Following nearly 12 weeks of stay-at-home orders and businesses closures, New York is finally beginning to reopen. While most New Yorkers are eager to resume their lives, New York does not yet have strategic guidelines or a systematic approach for reopening that will help us avoid the feared "second wave" of COVID-19 infections. If we are going to reopen safely and smartly, we must begin by introducing thoughtful guidelines based upon our knowledge of COVID-19 to date in order to prevent a second wave of infections and avoid the need for stay-at-home orders or business closures in the future.

Positively, we know that this coronavirus has not mutated over the past 12 weeks. Thus, the virus' biology, transmissibility, and lethality, are the same as in early March. It is also true that about 13 percent of New Yorkers are now antibody positive, meaning they have overcome the virus and are now presumably immune to reinfection. This also offers limited protection for those who have not been infected, though this alone is certainly insufficient to prevent a second wave.

However, we know that what sets this virus apart from the other two coronaviruses of the last century - MERS and SARs-1, which were both significantly deadlier - is the fact that COVID-19 has seen many asymptomatic carriers, making it an invisible, larger global threat than MERs and SARs-1. So before New York begins its reopening process, it is absolutely critical to identify these asymptomatic carriers so that we can prevent or at least dramatically reduce the spread, and in doing so, prevent a second wave that is more devastating than the first.

Further, given that we know that certain people are more vulnerable to COVID-19 than others, only those individuals under the age of 65 years old with no significant medical issues should be allowed to enter society at this time. These individuals can provide the workforce needed to allow the more vulnerable to stay at home, while still enabling an economic recovery. Those over the age of 65 or those who are younger and have significant medical issues should not enter society if at all possible until there is a vaccine or a reliable treatment that is widely available, neither of which exist yet.

There are misperceptions as to when and how people can safely reenter society without risking exposure to COVID-19, as the public has been told that they can resume most daily activities as long as they take precautions, despite the deadly toll the virus has taken. Ultimately, the way to clear up this widespread confusion is by continuously expanding COVID-19 testing. Unfortunately, though, we have extraordinarily little data due to limited testing to date.

Thus, to move forward safely, individuals who are under the age of 65 with no significant medical issues should be subject to a system of risk stratification, which would be offered to those who reenter society with the goal to help these individuals understand their unique risk factor. To do so, every New Yorker would receive a both COVID-19 test, which determines whether one currently has the virus, as well as an antibody test, which confirms whether one has already had the virus. From this, individuals would be designated "green," meaning safe to reenter, "yellow," meaning moderate risk of reentry, or "red," meaning no entry yet.

People who test negative for the virus and positive for antibodies should be designated as "green" because they can safely reenter society and feel reassured that they are not susceptible to getting reinfected. Further, individuals who test negative for the virus and negative for antibodies should be designated as "yellow" and proceed with caution since they are still susceptible to infection.

Lastly, individuals who test positive for the virus should be designated as "red," should quarantine for two weeks, and not reenter society until they have two consecutive negative COVID-19 tests 24 hours apart. Moreover, this testing needs to be done at a minimum of once a month, ideally once a week, to determine whether an individual has contracted the virus or has the antibodies to protect them from reinfection.

We cannot prevent a second wave until we identify asymptomatic carriers who might unknowingly spread the disease, while also identifying all those who can enter society with the lowest level of risk, or those who are virus negative and antibody positive. To avoid a second wave that could overwhelm our healthcare system, increase the death toll, and create further economic devastation, we must impose guidelines that protect the most vulnerable among us, while also relying heavily on testing to determine each individual's infection risk level.

Sandra Gelbard is a board certified internal medicine doctor and clinical instructor at Langone Medical Center and Lenox Hill Hospital in New York City. She is a member of the American Medical Association and American College of Physicians and has been featured in numerous news programs.

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