Lifting lockdowns safely relies on effective testing. Germany is surging ahead, but US states are flying blind

As governments around the world begin to ease their lockdowns – and as new infections are inevitable – they will have another chance to get their answers right.

Without a vaccine in view, what governments need to do to lift lockdowns tests, tracks and quarantines, according to WHO spokeswoman Dr. Margaret Harris.

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"We need to know where the virus is, and then to separate the sick from the healthy – that's why you need testing. You have to check that people who have symptoms actually have the virus, and then find people they have been in contact with and isolate them," she told CNN.

"If you can't do that, go back to square one."

In two proposed plans to reopen the US economy, public health experts and economists said the country had to perform millions of tests every week before the restrictions could be safely lifted.
People are waiting outside a nail salon in Atlanta, Georgia, on Friday.
The United States has conducted a total of 4.69 million tests, according to data from COVID tracking project via Johns Hopkins University (JHU). It's far from over Rockefeller Foundation & # 39; s recommendation, which suggests having a capacity of 3 million a week over the next two months. In its plan, which prominent experts contributed, the foundation says the country should expand its capacity to 30 million a week over the next six months.
Another plan, published by Harvard University's Edmond J. Safra Center for Ethics, is published on Monday, suggests that the country must deliver at least 5 million tests a day in early June to begin reopening, and as many as 20 million a day to fully mobilize the economy, ideally by the end of July.

US misses benchmark testing (but also UK)

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The way some leaders talk about the level of testing can be confusing. President Trump had claimed that the United States had conducted most of the tests in the world, and while it may vote, per capita, it is not leading.

Trump disagrees with Fauci about US testing capacity

While it is useful to look at how far a country tests per capita, WHO says it is a better measure to measure whether a country is testing adequately. Dr. Mike Ryan, executive director of WHO health care programs, said recently that a good goal is to have at least 10 negative cases for every positive case confirmed. This means that if a state or country performs testing and returns with positive cases of around 9% or less, it is likely to test well.

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The US has a positive result rate of 18.8%, according to COVID Tracking Project figures cited by JHU.

So high prices suggest that a country only tests the worst cases, usually people who are seriously ill and in hospitals, Harris said.

It's the same picture in some US states. Georgia has conducted around 101,000 tests, with a positive result rate of 21.6%, even further from WHO's scale.

Elsewhere, several European countries also lag far behind when testing and will need to catch up to safely restore their communities.

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The UK stands out, with just over 610,000 tests done and a positive case rate of 23.4%, worse than Georgia.

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The difference is that the British government has expanded its social restrictions. But it looks at when and how to lift the lock.

The British government has set a target of conducting 100,000 tests a day by the end of the month, and although they insist it is on the field, it only managed to complete around 28,500 on Thursday, raise speculation that it will not reach its goal.

France and Sweden also perform tests under WHO's scale.

Germany lifts the lock with caution

Germany makes a good case for comparison with the US. It too has begun to ease the lockdown, and it also leaves much of the decision to the individual states. Still, the approach is far stricter than what we see in Georgia, and the states of Germany show a uniform sense of caution.

Merkel warns Germany is on the & # 39; thinnest ice & # 39; as Europe realizes social distance is here to stay
Germany has a huge test capacity. At its peak about two weeks ago, it conducted about 400,000 tests a week, according to the Robert Koch Institute (RKI), the national public health agency. It now has the capacity to conduct 730,000 tests weekly, and plans to increase the number of tests as it gets easier.

At the end of last week, RKI reported that Germany had tested more than 2 million people and has a positive result rate of 7.5%, well above the WHO scale.

Last week, German Chancellor Angela Merkel released a list of steps the country would take to begin lifting the lock, and on Monday, stores up to 800 square feet began to reopen as long as they have hygiene and social distance measures in place.

Bookstores, car dealers and bike shops can now also open again no matter the size. Restaurants, bars and gyms will remain closed.

Merkel also announced that the country would increase its tracking efforts and deploy a team of five officers for every 20,000 people in the population to track people who may have come into contact with the recently confirmed case.

As governments groped about their coronavirus response, these four got it right. Here's how to do it.

But Merkel has repeatedly warned that the situation could quickly turn around if people do not adhere to social distance measures, which are still in place.

On Thursday, Chancellor warned Germany was on "the thinnest ice" after many people flocked to shopping areas and pedestrian areas this week, prompting German virologists to warn of complacency. While Merkel supports the reopening decisions made by the federal government and the states, "their implementation worries me … they appear to be very bold, perhaps too bold," she said.

Germany considered only reopening because the reproduction rate – the average number of people infected by each person – had fallen below 1 to 0.7. According to WHO, keeping this frequency below 1 means the virus can subside and eventually die out. On Friday, however, German authorities reported that the rate had gone up to 0.9.

Trump is at odds with the White House

The message in the US has been less coordinated and clear.

In theory, the White House supports the idea of ​​extensive testing, contact tracking and quarantine. It just requires it in its own right "Guidelines for opening up America again."
But Trump, in the face of one staggering rise in unemployment related to the shutdowns, at the same time, several governors have been aggressively pushing to reopen their finances, some of them before May 1st. a recent model by the Institute for Health Metrics and Evaluation, at the University of Washington, which shows that no state should open before that date, suggesting about half the states in the country should remain closed until May 25 or later. Georgia opens about eight weeks early, according to the model.

Trump has also supported protesters who rally against home-home measures that they say violate their rights.

Kemp, a Republican governor and faithful ally Trump, seemed to have the president's support in his plan. But on Wednesday, Trump changed the tune, and said he "strongly" disagreed with Kemp's approach and that "it's just too soon" to open stores like hair and salons and tattoo parlors.
Kemp defended his plan on Thursday, and said on Twitter that his decision was computer-driven, although he did not provide any data to support the statement.

"Our next measured step is data driven and led by state public health officials. We will continue with this approach to protect lives – and livelihoods – for all Georgians," he wrote.

In separate posts, he also said that the state dramatically increased test capacity.

Task Force members sent Birx to convince Trump to condemn Kemp's Georgia reopening decision, source said

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Thursday that if he advised Kemp, he would tell him "not just turn the switch and go."

"Because there is a danger of a setback. And I know there is a desire to move forward quickly. It is a natural human desire. But to go ahead and jump in phases where you should not be, I would recommend him as a health professional and as a doctor for not doing it, "said Fauci, who is part of the White House & # 39; coronavirus task force.

There is plenty of opposition to Kemp's plan in Georgia as well, and many store owners there said they would not open again on Friday.

Atlanta Mayor Keisha Lance Bottoms, a Democrat, told CNN in an interview that she was "confused that we have opened up this way."

"I don't know how to get a haircut and keep a safe distance from someone who cuts your bangs, it just doesn't make sense to me," she said.

And it's not just Georgia. Oklahoma also let "personal care companies" like hairdressing salons open on Friday, in a plan very similar to Georgia's. Montana will lift its stay-at-home order on Sunday, while most businesses where social distancing can be practiced are allowed to open. Florida has already opened some of its beaches, in one controversial decision that drew criticism on social media.

All data in this story was accurate at ET April 24, 2020.

CNN's Nadine Schmidt reported from Berlin. Stephanie Halasz, Arman Azad and Benjamin Berteau contributed to this report.

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