Public Health Intervention Framework for Reviving Economy Amid the COVID-19 Pandemic (1): A Concept

INTRODUCTION At the time of writing this article, there are 1,464,852 confirmed cases, with 85,397 deaths in nearly 199 countries [1]. In the U.S., 417,206 infection cases with 14,183 deaths were reported in 54 states [2]. China used extraordinary measures to contain the outbreak at extreme cost to its economy. Many nations used similar approach in an attempt to contain local outbreaks. The Wall Street firm lowered its first-quarter gross domestic product forecast to -3.4% from -2.4% and its second-quarter GDP forecast to -38% from -30%. On an annual average basis, Morgan Stanley expects real GDP contracting 5.5% in 2020, the steepest annual drop in growth since 1946. The Congressional Budget Office said on Thursday that the economy will contract by at least 28% in the second quarter [3]. Labor Department reported 701,000 jobs were lost in March. As economy struggles to recover from the initial recession, if the disease’s impact dissipates, the U.S. economy may pick up to 3 percent or more by 2023 [4]. This optimistic projection is based on an assumption that no more pandemic strikes. There is no predictable treatment for the disease in medicine at this time. The hope is finding effective drugs and vaccines, but it may take at least 12 month to 18 months for vaccine to reach the public [5]. There are many viruses that could strike humans at any time. Two other coronaviruses, OC43 and 229E, were discovered in the 1960s but had circulated in cows and bats, respectively, for centuries; and other two, HKU1 and NL63, were discovered after the SARS outbreak, also after circulating in animals [6]. Many of RNA viruses mutate rapidly [7] to generate new strains to defeat existing vaccines and drugs. Breaking the chain of infection by identifying and controlling infected persons is impossible. Any diagnostic method produces a certain percent of false negative results, thus identifying all infected persons is impossible. Moreover, preliminary research from China suggests that the most common type of COVID-19 test, known as a reverse transcriptase polymerase chain reaction (RT-PCR) test, may give false-negative results about 30% of the time [8]. More than 43,000 people in China had tested positive without immediate symptoms by the end of February [9]. Those people may transmit the virus without even knowing it. Recently, the virus was transmitted in nursing home in Maryland. One local outbreak was reportedly caused by a health care worker who did not have a fever and was not screened out [10]. CDC recently stated that 25% infected persons have no symptoms. It is obvious to see that the world cannot place its hope in medicine to contain the pandemic. Sound economic policies cannot be based on the strike of luck. The rapid increase in new cases in the U.S. and the world prompts us to examine existing measures that have been used in the fight against the pandemic and explore better intervention measures. DEVELOP A PUBLIC HEALTH INTERVENTION FRAMEWORK A. Examine Death Risks for Different People in the Population We first note that medicine has complicated the disease by attempt to simplify it. Based on death data from China and the first 100 deaths in the U.S., it is clear that death risks