Governor Wolf Should Improve his Reopening Plan

Governor Wolf has recently issued a plan for reopening the state, improving testing, and performing contact tracing. His plan could use improvement.

Tomas Pueyo published an excellent article on how to do testing and contact tracing. The article is based on international best practices and a scientific understanding of how COVID-19 spreads. A large part of this post is comparing the governor’s reopening plan to the recommendations of this article.

Testing

Governor Wolf’s testing strategy for Pennsylvania is documented here. It has the following issues:

1. It focuses on the wrong metric for testing.  The plan has a goal of testing 2% of Pennsylvania’s population per month, therefore focusing on testing per capita.  However the amount of testing needed depends on the number of infections present, not the size of the population. Therefore the testing goal should focus on the percent of tests that are positive, with a goal of a positive test rate of less than 3%.
2. The plan sets a goal of too few tests. Testing 2% of Pennsylvania’s population per month corresponds to an average of 8,533 tests a day. Pennsylvania averaged 5,963 tests per day in April 2020, and had a positive test rate of 22.9%.  Therefore Pennsylvania needs to increase the number of daily tests by approximately 10 fold, much larger than the plan’s proposal.
3. The plan only discusses testing people with symptoms.  However, as Tomas Pueyo’s article explains, the best available evidence suggests that only 40% of transmissions are from symptomatic people.  The rest are from pre-symptomatic or asymptomatic people. It is essential that people without symptoms are able to be tested if they may have been in contact with an infected person or if they work in a job that brings them in contact with lots of people.  For example, checkout clerks and transit workers should be tested regularly.

Additionally, the economic cost of having people without COVID-19 isolate for 14 days is much larger than the cost of performing a test.

4. There is no discussion of reducing the time for testing to be performed and the test results published and acted upon.  The Allegheny county health department states that case counts less than five  days old are preliminary. The state does not provide information on statewide test timeliness. Five days is too long, the countries with the best practices have managed to make test results available on the same day the sample is collected.

Contact Tracing

Governor Wolf’s contact tracing strategy for Pennsylvania is documented here. It has the following issues:

1. Pennsylvania’s health department is understaffed to perform the necessary contact tracing, and the plan does not address how this will be fixed.  This PennLive article estimates that Pennsylvania needs 2,000 people doing contact tracing, but the health department currently employees fewer than 150. This John Hopkins paper recommends 100,000 contact tracers for the United States as a whole.  Scaling by population, this would correspond to 3,900 for Pennsylvania.

Worryingly, when asked about this yesterday, Pennsylvania secretary of health Dr. Rachel Levine stated, “I don’t have a specific number how we are going to hire but we wanted to have a balance between getting all the people we need but we want to be fiscally conscious as well.”

Hiring more contact tracers is a far more cost effective way to respond to the virus than shutting down Pennsylvania.  To the extent that contact tracers will shorten the shutdown, hiring more may even pay for itself in reducing lost tax revenue. While ideally contact tracing would be funded by the Federal government, the state government needs to make up for the federal failure on this.

2. Pennsylvania has no current plans to test asymptomatic people who have been in contact with people who have tested positive.
3. There is no plan to inform the public where infected people have been so individuals can self-identify for testing.
4. Contacts of infected people are only requested to isolate themselves after they develop symptoms. This isolation is not mandatory and there are no penalties for breaking isolation.  There is no plan for the state to assist people in remaining isolated by, for example, delivering groceries.
5. Unlike countries such as South Korea that have had the most successful contact tracing programs, Pennsylvania does not plan to use GPS data to assist in contact tracing.  Additionally, smart phone tools that they use will only be on an opt-in basis rather than a mandatory or opt-out basis.

A successful contact tracing program will save more lives, cost less, and restrict our freedom less, than the indiscriminate shutdowns in place now. Governor Wolf should work to improve his testing and contact tracing plans.

Reopening Criteria

The criteria for reopening lists having a higher population density as a negative factor. As I’ve written previously, the available data indicates that counties with lower population density may be at greater risk from COVID-19.  Alon Levy reached a similar conclusion evaluating COVID-19 infection rates in Germany, which as more comprehensive testing than the United States and therefore better data. Governor Wolf should either provide justification for this criteria or remove it.

Governor Wolf has stated that testing capacity is a criteria for reopening but has not stated how this is being evaluated. The testing criteria should be based on the percent of tests that are positive and not testing per capita.  Since testing is overly focused on symptomatic people, higher tests per capita is generally a result of there being more infections.

Opening Schools and Daycare

The Economist recently published an opinion piece that schools and daycares should reopen. There is increasing evidence that children are less likely to spread COVID-19 than adults.  Furthermore, the cost to our children and our economy of having schools closed is enormous. I find these articles to be persuasive.

Pennsylvania should allow daycares to reopen immediately state-wide.  It should reopen public schools sometime mid-summer to make up as many of the missed days from this spring as practical.

How Pennsylvania Counties are Performing on Testing

This map shows how Pennsylvania counties are performing based on test performed per capita.

This map shows how Pennsylvania counties are performing based on percent of tests that are positive.

Both these maps are based on the cumulative test results performed as of May 2, 2020. This table documents the data that was used to generate these maps. These maps show that the counties that are first to move from red to yellow are not doing any better on testing than Southwest Pennsylvania.

Allegheny County has fewer tests per thousand residents than the state overall, but a better (lower) positive test rate than the state overall.

County	Test per Thousand Residents	Postive Test Rate
Adams	16.9	8.08%
Allegheny	14.8	7.41%
Armstrong	11.8	6.82%
Beaver	15.7	16.88%
Bedford	5.0	10.08%
Berks	20.4	32.69%
Blair	8.7	2.17%
Bradford	12.2	4.77%
Bucks	19.2	26.38%
Butler	13.2	7.25%
Cambria	10.2	2.40%
Cameron	12.1	1.85%
Carbon	19.9	14.24%
Centre	6.4	9.18%
Chester	13.5	20.75%
Clarion	13.4	4.46%
Clearfield	5.9	3.40%
Clinton	7.4	11.89%
Columbia	14.6	30.62%
Crawford	8.5	2.65%
Cumberland	7.7	18.72%
Dauphin	15.8	14.02%
Delaware	23.6	29.87%
Elk	5.9	2.29%
Erie	7.9	4.24%
Fayette	15.2	4.18%
Forest	5.1	18.92%
Franklin	21.8	9.62%
Fulton	6.5	6.32%
Greene	12.6	5.92%
Huntingdon	7.9	13.52%
Indiana	9.7	7.70%
Jefferson	7.6	1.83%
Juniata	9.9	34.29%
Lackawanna	17.3	26.71%
Lancaster	18.4	18.94%
Lawrence	9.6	7.90%
Lebanon	24.2	20.68%
Lehigh	28.2	27.84%
Luzerne	23.4	29.72%
Lycoming	11.1	6.46%
McKean	4.5	3.31%
Mercer	7.7	7.88%
Mifflin	16.0	5.15%
Monroe	23.4	29.20%
Montgomery	27.0	20.02%
Montour	165.4	1.63%
Northampton	28.6	24.99%
Northumberland	7.8	13.74%
Perry	5.7	12.41%
Philadelphia	26.9	30.42%
Pike	30.2	23.34%
Potter	5.3	4.55%
Schuylkill	17.8	15.24%
Snyder	5.9	13.92%
Somerset	8.8	4.46%
Sullivan	5.8	2.86%
Susquehanna	9.6	21.76%
Tioga	6.7	5.88%
Union	13.5	6.25%
Venango	5.2	2.66%
Warren	4.6	0.55%
Washington	11.2	5.10%
Wayne	12.6	16.05%
Westmoreland	14.7	7.70%
Wyoming	7.5	12.50%
York	17.8	8.31%
	PA Overall	PA Overall
	18.4	20.52%