Simply put, we are not ready. Let’s start with a math problem.

Kathy, Bobby, and Ellen all have marbles. Kathy has 4 marbles, while Bobby only has 3. How many marbles does Ellen have?

Got the answer? Of course not. I haven’t given you enough information to arrive at a credible answer. You need to have more data to be able to figure out how many marbles Ellen has. Otherwise, you would have to make some wild guess with little to no chance that you would be right. That’s what the US is about to do. We are embarking on a major societal change based on a small amount of flawed data. There is so much we don’t know. As if that were not bad enough, we are beginning to remove the non-pharmaceutical interventions that have corralled this virus without putting in-place the critical safeguards of testing, tracing, and isolating. People are going to die unnecessarily.

We all want to get back to what we had. Let us out of the house. Let us go to lunch, the beach, ballgames, and our friends and families. That’s not too much to ask. We’ve done this long enough and, besides, we’ve “flattened the curve”. We done good. We want to go back to work.

All of that is true. It sure seems like a long time that we’ve been mired in this. Unfortunately, we don’t set the timeline. COVID is the decider now. This virus sets the clock. To help put things in perspective: we are all excited to see New York on the downside of the first curve. Success! However, New York is still hospitalizing over 1200 people every day with COVID diagnoses. Who would have imagined in mid-March that 1200 daily COVID hospitalizations would be a sign of success? Those numbers still do not represent a victory. We have more work do.

How many people in the US have been infected? Where are the hot spots in the West right now? What is the US capacity for diagnostic COVID testing? How many people have died from COVID in the US? What is the proportion of COVID infections in the US who are asymptomatic? What is the prevalence of COVID in the US right now? Can COVID reappear in people who have seemingly recovered from the disease? Does COVID infection result in immunity from the disease? If so, for how long? Are there any effective treatments for the more severe cases of COVID? What will be our testing capacity per week in one month? for diagnostic tests? for serologic tests? Is the US health care infrastructure sufficient to survive another wave of COVID should we re-open our society without adequate safeguards? Is this country’s public health infrastructure ready to tackle the test-trace-isolate paradigm that must be in-place to protect us all?

There are even more questions for which we don’t have answers. I just grew tired of typing. So, how many marbles does Ellen have? We don’t know. There’s so much we don’t know.

Knowledgeable public health people hoped that the social distancing and sequestering interventions would prevent the virus from wantonly spreading and, in fact, they were wildly successful. Those interventions bought us time and we squandered that time. While we were scrambling to obtain ventilators, masks, hospital beds, and PPE, someone in the Federal government should have been ramping up diagnostic and antibody testing and, most importantly, working with the State and local health departments to prepare for the awesome burden of administering and analyzing those tests, notification and interviewing of people with positive tests, confirming the isolation of those people, contact tracing, and sequestering of contacts. These are laborious, onerous tasks for which no current health department has the personnel or financial resources. I personally did many of these tasks for STD patients early in my CDC career. More than most epidemiologists, I know what this effort requires and we have not even begun to address any of these capacity needs.

The Federal government still has no overarching plan for COVID even after knowing about this threat for almost 4 full months. There was no cogent plan for distributing material to the states as they were slammed by the virus. There was no plan (is no plan) for diagnostic testing, nor is there a plan for ramping up sufficient antibody testing. Every single knowledgeable epidemiologist states unequivocally that this country is nowhere near the necessary numbers of diagnostic tests needed for reopening our schools and workplaces. However, the guy pictured above says that we “have plenty of tests. . . and they’re beautiful tests. . . some people say that they are the best tests ever. . . Obama had terrible tests, the worst . .” Christ, why is he in the White House for these difficult days?

I am afraid we are going to open our society without the ability to identify and respond to the inevitable small outbreaks that will occur as people begin to interact once again. Those small clusters will grow to be the second wave of the pandemic in the US unless we are extremely lucky. I am worried that US citizens might not be as willing to voluntarily quarantine for the second wave and then, with no vaccine, we will lose our ability to limit the impact of this deadly virus on our vulnerable populations and our health care system.

How about these ideas: ramp up testing to sufficient national levels; provide guidance to the State and local health departments in setting up the necessary systems for rapid testing and contact tracing; provide funding necessary for health departments to hire sufficient number of people to conduct the interviewing and contact tracing; provide guidance and regulations to large and small employers to PROTECT THEIR EMPLOYEES (totally  lost in the discussions about restarting the economy); also, please use those ridiculous nightly briefings to succinctly provide factual data to the American people along with moral support – in other words, eliminate Trump’s role in the briefings, FDR is rolling in his tomb.

We don’t know what we are doing, but we are going to do it anyway. What a plan.

Full math problem: Kathy, Bobby, and Ellen have 15 marbles. Kathy has 4 marbles while Bobby only has 3. How many marbles does Ellen have? Now you have sufficient information to answer the question.

For Trumpers: the answer is – Ellen has 8 marbles.

For millennials and younger: ask your parents what a marble is.