This is the first in what will be a weekly snapshot of what we’ve learned this week related to the Capital Region’s inclusive recovery and growth.
What a terrible, extraordinary week to launch our FFAST Forward update! Case counts are rising exponentially in parts of the country– eight days after 100,000 US cases were found in one day for the first time; the number topped 150,000 on Thursday. The Capital Region isn’t spared. While most extreme case growth is outside the immediate region around the Capital — in southwestern Virginia and western Maryland — hospitalizations and bed capacity taken by COVID-19 patients are rising everywhere. The drivers for this rise are diverse; the pandemic has found every corner of the country, folks are letting their guard down in small congregate settings, and, sadly, public health has been politicized, accelerating spread. This is the leading indicator of concern for public health officials. National estimates suggest that we could see up to 2,000 deaths per day between now and the end of January. The impact is particularly devastating to small business owners and entrepreneurs, who are often from the hardest-hit under-represented among us.
However, there appears to be light at the end of the tunnel. Pfizer’s vaccine trials’ 90% efficacy report is extraordinary; typically, cautious scientists like Eric Topol and Anthony Fauci have been effusive. The time to a possible vaccine, and its effectiveness is unparalleled. The two lead vaccine candidates use mRNA, which can scale fast but has never successfully developed a vaccine before. A Maryland company, Novavax, is in the top tier of vaccine competitors and recently received FDA fast-track authorization as it expands its Phase III trials.
So: while we pull back to greater social distance and closures to spare as many as possible until broad vaccine immunization, we should also celebrate the pace at which science will likely bring us back.
What is that pace, and what do we do in the interim?
The National Academies formalized their four-phase vaccine distribution framework last week, and the CDC has adopted the framework, too… The first phase has two steps, 1a) covering first responders and front-line health care workers, and 1b) covering congregate care residents and vulnerable populations with serious multiple co-morbidities. The Academies estimate that those two groups comprise about 15% of the total U.S. population or about 50 million people.
Which would require 100 million doses of the two-dose Pfizer vaccine.
Pfizer anticipates delivering up to 50 million doses by year-end worldwide, of which 25 million will be available in the U.S.
All this math matters because some health officials, including HHS Secretary Azar, suggest that “by spring, everyone who needs it will be vaccinated.” My best guess is that we will not have enough vaccine to immunize all of Phase II — 50% of the U.S. population, including teachers and staff in schools — before Autumn 2021.
Which brings us to FFAST.
A clear consensus is emerging that Fast (turn-around time), frequent, asymptomatic testing is a necessary slice of the swiss cheese required to reopen safely. The National Academies concurred with this assessment this week.
FFAST is already happening.
100 colleges and universities in the northeast working with the Broad Institute; the University of Illinois; Stanford; and Johns Hopkins University, among others, have all moved to frequent (at least twice a week) broad population surveillance testing to ensure they’re catching outbreaks quickly. Consultants working with us have developed a model showing that the ROI for investing in FFAST is positive for any enterprise that wants to reopen more broadly. Nobel Laureate in economics Paul Romer estimates that the return on investment from sufficient testing is between 10x and 100x.
The cost to conduct FFAST is declining rapidly. Surveillance testing with antigen tests with positive results verified by traditional PCR works.
And back-stopping positive results with traditional PCR works. The Broad Institute produces more than 75,000 tests per day currently and quotes pricing at less than $25 per test. They’ve now started working with public schools in the Boston area. The University of Illinois, using a saliva protocol (PCR as well — which Johns Hopkins will use to reopen this spring), is quoting pricing as low as $10 per test. Colorado is scaling FFAST for public schools using the Yale saliva protocol at about $16 per test.
We — the Greater Washington Partnership — are supporting the Rockefeller Foundation’s programs across the region to reopen our schools more quickly and safely which will allow us to reopen more businesses more quickly.
Why FFAST when we can just wait and feast on a vaccine in April?
That’s back to why the math matters.
Unless more vaccines are rapidly approved and can scale production parallel to Pfizer (watch for Moderna soon), school kids and their families likely won’t be immunized before late 2021. Right now, many schools are planning to stay remote until all students, faculty, staff, and families are vaccinated. That could be January 2022.
The consensus among professionals is that the cost to kids of another year of remote-only learning is egregious. We know that many private schools aren’t waiting, so the differential inequitable impact on public school kids is even greater. The chorus is growing to prioritize reopening our public schools.
The region has led the way in collaborating across jurisdictions to address the problem; Governor Hogan, as head of the National Governors Association, has led a 10-state effort to purchase fast antigen tests; the metro Washington region announced an effort this week to coordinate their contact tracing back-end systems.
One lesson of exponential pandemic growth is that it’s always worse to wait. It’s time to put in place plans for sufficient FFAST to reopen our schools broadly and rapidly, and early in 2021. The Partnership is working hard to do all it can — including contacts with the incoming Administration to help accelerate efforts together — to make that possible for the Capital region. Together, let’s move forward, ffaster.
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