Conference Presentation, Interview
Phasing in the Reopening of the Economy
Goldman SachsSharmin Mossavar-Rahmani, Dr. Luciana Borio, Dr. Florian Krammer, Sharmeen Mosavaramani
- New York City's reopening is projected to be slower than less dense areas due to population density and mass transit constraints, necessitating additional phases or modified progression to avoid significant spikes in reproduction rates.
- Lifting restrictions in states like Texas and Georgia is expected to drive increases in case rates and strain hospital capacity, with re-imposition of measures likely required if rates remain uncontrolled.
- Specific reopening strategies for Texas include doubling population-level testing capacity over the next two weeks and relying on targeted protections to mitigate surges, while social distancing is anticipated to slow the pandemic but not stop case growth without herd immunity.
- Herd immunity is estimated to require 65% to 75% population immunity given an R0 of 2 to 3, a threshold far from met even in high-prevalence areas like New York.
- School reopenings are expected to begin with preschool, child care, and elementary programs due to smaller class sizes, whereas higher education will likely start with labs and limited on-campus activities, including virtual lectures and separation of older faculty.
- The outlook for future waves involves several peaks and troughs in localities until herd immunity is achieved, with expected severity levels comparable to a severe flu season if effective treatments are utilized, rather than a repeat of the initial spring peak.
- Remdesivir is predicted to become the standard of care for advanced COVID-19 patients based on expected NIH study results, while Leronlimab faces skepticism regarding toxicity and requires randomized controlled studies.
- Use of chloroquine and hydroxychloroquine is not recommended outside of randomized controlled studies due to narrow therapeutic indices and toxicities, whereas Regeneron's Kevzara may continue study in critically ill patient subsets.
- Monoclonal antibody products from Regeneron and Vir are expected to enter clinical trials by June, and vaccine studies are anticipated to clarify antibody titers required for protection, with the BCG vaccine study expected to yield more data by year-end.
- SARS-CoV-2 antibodies are expected to provide protection against reinfection for one to three years based on common cold coronavirus data, though hard data for the specific virus is still needed.
- Reliable vaccines are considered essential to end the pandemic, with public health measures including testing, contact tracing, and social distancing required to maintain control until their arrival.
- Testing capacity is expected to improve through better allocation of materials, with Texas aiming to double population testing capacity in the near term, while the Mount Sinai ELISA test is expected to become widely available soon.
- Contact tracing efforts involving voluntary tools, Bluetooth technology, and the Google/Apple coalition are expected to ramp up, though current capabilities are described as insufficient for effective containment.
- Future economic impacts from case peaks and troughs are expected to be minimized through enhanced contact tracing awareness, which can lower the height of the waves compared to previous containment strategies.