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How Is The Federal Government Doing At Guiding A Smart Reopening?


Like it or not, the U.S. economy is shaking out of its many weeks on pause. Several states have lifted stay-at-home orders. Factories are reopening from Michigan to Washington state. Cellphone data show people moving about a little more often. So how is the federal government managing a smart reopening? Two weeks ago on this program, we questioned Andy Slavitt and Dr. Scott Gottlieb, one Democrat, one Republican, both veteran former health officials. They'd been advising current officials and offered some principles to reopen a couple of weeks ago. So now we brought them back. Gentlemen, good morning.

SCOTT GOTTLIEB: Good morning.


INSKEEP: Andy Slavitt, I want to start with you. You'd been saying the Trump administration did adopt a sensible reopening plan several weeks ago. What's happened since?

SLAVITT: Well, like countries around the world, you know, there is a way to try to manage and contain this virus and slowly step up economic activity. We've seen it in Europe. We've seen it in Asia. We've seen it in Australia and New Zealand. And the U.S. put out a plan which I think was very sensible. I think it had some input from Scott in it, had a little bit of input from me. And it essentially focused on conditions on the ground. It wasn't state specific. It essentially said, let's make sure we have a controllable number of cases in our community. Let's make sure we have testing in case there is a small outbreak. Let's make sure we have contact tracing so that we can limit the spread if it happens.

And that will make people feel safer. That, in turn, can help stimulate economic activity. And we can live in a state like that a little longer while the scientists get to work. The Trump administration has really not been following - and governors around the country generally - have not been following their own plan. And that's been a little bit concerning because I think it's a plan that requires a little bit of patience, a little bit of work. But we know from past outbreaks that it's the way to both minimize the death toll and bring the economy back faster.

INSKEEP: Well, Scott Gottlieb, has the administration simply grown impatient with its own approach?

GOTTLIEB: Well, I think the reality is that we all - when we outlined the Stop the Spread measures in April, we all had an expectation that at this point, we'd be seeing sustained declines in new cases if we put those measures into place. And we haven't seen that. And so the reality is we're opening against a backdrop of much more spread than what we anticipated. I think many of us probably felt - and I did - that it would be hard to keep the economy shut through May, just given all the hardship of the economic shutdown and the public health implications of doing that.

But all of us at least - at least I felt - that we'd be at a point right now where it'd be safe to reopen because we'd get the number of new cases down sufficiently. We haven't done that. We're reopening against that backdrop anyway. And I think it just increases the importance of what we call the case-based interventions, trying to put in place measures to track down individual cases, do contact tracing, do case isolation of people who are infected. If we don't lean heavily on those interventions against a backdrop of a lot of spread right now and we reopen the economy in that environment, we're likely to see renewed outbreaks.

INSKEEP: Do you see serious efforts even to try to get where you think you need to be in terms of testing, in terms of contact tracing, in terms of these interventions you just described?

GOTTLIEB: I'm more confident about the testing. I think that we're ramping testing aggressively, in part because new technology's coming into the market. We're doing about 2 million tests a week right now. We just saw the approval of the first antigen-based test that's going to bring about 1.5 million tests per week capacity as a marker within the next several weeks. More innovations are going to be coming onto the market through May. So I think testing's going to be available. Now, whether or not there are sites that are conducting the testing and make it accessible to patients is another question. I think when it comes to case-based interventions, that isn't as readily available because there's a lot of political debate around, you know, the utility of that. You see a lot of governors going forward. But at a national level, we really haven't embraced those in a robust way that I would like to see.

INSKEEP: I'm glad you both mentioned governors because, of course, they are players here, whether they are Republican or Democrat. I even noticed that Gretchen Whitmer, Democratic governor of Michigan, who's done a pretty hardcore lockdown up to now, approved reopening of auto plants. So there's a clear bipartisan desire to get moving if possible. Andy Slavitt, isn't there a case to be made for a kind of creative reopening whenever a company can figure out how to avoid employees in a crowd, which is what the auto plants are trying to do?

SLAVITT: I think so. Look, I think everybody is in what must feel to them like a no-win situation. And so I think we all should acknowledge that our governors are doing the best that they possibly can in a trade-off that's really difficult to make. I think the ones that are feeling the most political pressure and are, you know, reacting in a way to try to bring some things back - and indeed, you know, there may, in fact, have been areas in places where we did close too quickly. There are rural communities around the country that have had close to no outbreaks and that have been fairly safe. And they have seen all of their economic activity muzzled.

I don't think it makes any sense for that to happen. There's a lot of things people could do safely outdoors that I think would relieve some of the cabin fever and some of the pressure, not necessarily economic pressure. Those things can be implemented again. So we should be patient with our governors adjusting, tinkering, doing a little bit of trial and error. But boy, it sure would be nice if when they were doing that, they could instantly test because the difference between learning after two days that you got it wrong and 10 days that you got it wrong is fairly dramatic.

INSKEEP: Well, let's talk about that. The New York Times consulted a number of health experts who tried to look ahead at the next year or even two years before there's a vaccine widely in place. And that would be a steep - short time frame for a vaccine, really. And they lay out scenarios in which we might lift social distancing, wait as cases begin to increase. And then when they get to a certain level, you clamp back down again. Is that a realistic way to get through the next year or two?

GOTTLIEB: I think, unfortunately, it might be what we're facing. We don't know what the fall's going to look like. We think that there's going to be a seasonal effect. So as we get into the depths of the summer, there's going to be some downward pressure on new cases. And I'm talking more about July and August. We have a long way to go before we get to the months where you start to see, perhaps, some seasonal pressure.

But when we come back in the fall, we face the risk that this could reignite again, and we're facing outbreaks and, you know, the risk of another epidemic. And I think it's going to require cities, when they do have large outbreaks, to try to take local measures to contain those outbreaks. And I think that there's going to be a new normal. There's going to be certain things that just don't come back in the same way and a lot of things that we do differently to try to contain the spread of this until we can get to a vaccine.

INSKEEP: Andy Slavitt, you get the last word about the next year or two. What do you see?

SLAVITT: Well, look, I think there are some promising therapies that are going to be in trials month after month after month. And to leave this on a note of some hope, if we let scientists do their work and this becomes a far less deadly disease and it's something we can diagnose earlier and earlier and earlier, then I think it is safer to get back to life because then you can test people who are asymptomatic or test people as they're just getting symptoms and get them some of these therapies earlier. So, you know, we should have confidence in our scientists. And in the meantime, I think we're all going to figure out how to get by the best we can with a fair amount of patience and some great collective action.

INSKEEP: OK, Andy Slavitt held a top health care position in the Obama administration. Dr. Scott Gottlieb led the Food and Drug Administration under President Trump. They both continue to give advice to current officials. Gentlemen, thanks to you both.

GOTTLIEB: Thanks a lot.

SLAVITT: Thank you, Steve. Transcript provided by NPR, Copyright NPR.