Shut down, start over, do it right
An open letter to America’s decision makers, on behalf of health professionals across the country.

Dear decision makers,

Hit the reset button.

Of all the nations in the world, we’ve had the most deaths from COVID-19. At the same time, we’re in the midst of “reopening our economy,” exposing more and more people to coronavirus and watching numbers of cases -- and deaths -- skyrocket.

In March, people went home and stayed there for weeks, to keep themselves and their neighbors safe. You didn’t use the time to set us up to defeat the virus. And then you started to reopen anyway, and too quickly.

Right now we are on a path to lose more than 200,000 American lives by November 1st. Yet, in many states people can drink in bars, get a haircut, eat inside a restaurant, get a tattoo, get a massage, and do myriad other normal, pleasant, but non-essential activities.

Get our priorities straight.

More than 117,000 Americans had died of COVID-19 by mid-June. If our response had been as effective as Germany’s, estimates show that we would have had only 36,000 COVID-19 deaths in that period in the United States. If our response had been as effective as South Korea, Australia, or Singapore’s, fewer than 2,000 Americans would have died. We could have prevented 99% of those COVID-19 deaths. But we didn’t.

The best thing for the nation is not to reopen as quickly as possible, it’s to save as many lives as possible. And reopening before suppressing the virus isn’t going to help the economy. Economists have gone on record saying that the only way to “restore the economy is to address the pandemic itself,” pointing out that until we find a way to boost testing and develop and distribute a vaccine, open or not, people will not be in the mood to participate.

Listen to the experts.

Public health professionals have made clear that even after we’ve contained the virus by staying at home, in order to reopen American cities and towns safely, we will need:

-- Enough daily testing capacity to test everyone with flu-like symptoms plus anyone they have been in close contact with over the last 2 weeks (at least 10 additional tests per symptomatic person). We currently have only 35% of the testing capacity we need to meet that threshold. The more people get sick, the more testing is required.

-- A workforce of contact tracers large enough to trace all current cases. That’s 210,000 more contact tracers than we had in April, but the number keeps going up as infections rise. Most states are far short of the number of contact tracers they need.

In addition, we need more personal protective equipment (PPE) to keep essential workers like health professionals, emergency responders, and grocery store clerks safe.

Shut down now, and start over.

Non-essential businesses should be closed. Restaurant service should be limited to take-out. People should stay home, going out only to get food and medicine or to exercise and get fresh air. Masks should be mandatory in all situations, indoors and outdoors, where we interact with others.

We need that protocol in place until case numbers recede to a level at which we have the capacity to effectively test and trace. Then, and only then, we can try a little more opening, one small step at a time.

You should bar non-essential interstate travel. When people travel freely between states, the good numbers in one state can go bad quickly.

If you don’t take these actions, the consequences will be measured in widespread suffering and death.

We need you to lead.

Tell the American people the truth about the virus, even when it’s hard. Take bold action to save lives -- even when it means shutting down again.

Unleash the resources needed to contain the virus: massively ramping up testing, building the necessary infrastructure for effective contact tracing, and providing a safety net for those who need it.

Many of the actions of our government thus far have fallen short of what the moment demands. Mr. Trump, federal administration, honorable governors: we remind you that history has its eyes on you.

Sincerely,

Matthew Wellington
Public Health Campaigns Director, U.S. PIRG

Ezekiel J. Emanuel, M.D., Ph.D.
Vice Provost of Global Initiatives
Chair, Department of Medical Ethics and Health Policy
Levy University Professor
Co-Director, Healthcare Transformation Institute
Perelman School of Medicine and The Wharton School
University of Pennsylvania

David Sherman, PhD
University of Washington

William Hanage, PhD
Harvard T. H. Chan School of Public Health

Richard H. Ebright, Ph.D.
Rutgers University

Karen Walter
University of Washington

Karen Thickman, PhD
University of Washington, Department of Microbiology

Seth Trueger, MD, MPH
Northwestern University

Sanjat Kanjilal MD, MPH
Harvard Medical School, Brigham & Women's Hospital

Valerie Bengal, MD, FAAFP former UCSF Associate Clinical Professor
UC Santa Cruz and Capacitar International

Mariposa Mccall, MD

Reshma Ramachandran, MD, MPP
National Clinician Scholars Program, Yale School of Medicine

Janet Perlman, MD, MPH
UCSF

David Rosen, MD, PhD
Washington University School of Medicine

Farheen Qurashi, MD, FACS

Jamie Burke
Colorado State University

Anthony Orvedahl, MD, PhD

Drew Schwartz, MD, PhD
Washington University School of Medicine

Howard Forman, MD, MBA
Yale University

Krysia Lindan, MD, MS
University of California, San Francisco

Margaret Handley, PhD, MPH
University of California San Francisco, Department of Epidemiology and Medicine

Thomas Lietman, MD
UCSF

Travis Porco, PhD, MPH
University of California, San Francisco

Veronica Miller, PhD
UC Berkeley School of Public Health

Kenneth Rosenberg, MD, MPH
PHSU-PSU School of Public Health

Jason Newland, MD
Washington University

Cathie Currie, PhD

Elizabeth Jacobs, PhD
Department of Epidemiology and Biostatistics, University of Arizona

Saskia Popescu, PhD, MPH, MA, CIC
University of Arizona

Pamela Koehler, JD, MPH

Fern P. Nelson, M.D.
Veterans Administration Hospital

James Gaudino, MD, MS, MPH, FACPM
OHSU-PSU School of Public Health & Gaudino Consulting

Joan Casey, PhD
Columbia University Mailman School of Public Health

Daisy Sherry, PhD, ACNP-BC

Joyce Garrison, PhD

Bruce Agins, MD, MPH
UCSF

Kay Mattson MSW, MPH
Independent international Public Health Consultant

Susan Walker, MS

Patricia Harper, MA
San Bernardino Balley College

Bonnica Zuckerman, MPH
UVM


Paul Song, MD
PNHP

Katherine Villers, MUA
Community Catalyst

Angela Rasmussen, PhD
Columbia Mailman School of Public Health

Megan Ranney, MD, MPH
Brown University & GetUsPPE


Jeffrey Cohn, MD, MHCM



Bethany Letiecq, PhD

George Mason University


Jared Rubenstein, MD


Vineet Arora, MD, MAPP

University of Chicago and IMPACT4HC


Marian Betz, MD, MPH


Ann Batista, MD


Pete DeBalli, MD

UCF School of Medicine


Morgan Eutermoser, MD


Carrie Beckman, PharmD

UC Health


Marc Futernick, MD


Linda Girgis, MD


Megan Whitman, MD


Iris Riggs, PhD


Krys Johnson, PhD, MPH
Temple University


Catherine Cowley-Cooper, RN

Michael Core, MD

Theo Allen, BS

Ryan Marino, MD
Case Western Reserve University

Eric Goralnick, MD, MS
Brigham and Women’s Hospital/Harvard Medical School

Jason Ayres, MD

Michael Kelly, PhD, MSW
Loyola University Chicago School of Social Work

Craig Norquist, MD

Wade Berrettini, MD, PhD
University of Pennsylvania Perelman School of Medicine

Aalim Weljie, Ph.D.
University of Pennsylvania

Kevin Foskett, PhD
University of Pennsylvania

John Hansen-Flaschen, MD
University of Pennsylvania

Garret FitzGerald, MD
University of Pennsylvania

Vasilis Pozios MD

Amy Humrichouser, MD
University of Michigan

Aurora Horstkamp, MD
Washington State University

Timothy Ellender, MD
Indiana University

Michael Becker, DO, MS

Alan Peterson, MD

Christine Brewer, MSW, MSN, RN
Villanova University

Kay Vandenberg, MD, FACOG

Melissa Freeman, MD

Pamela Norton, PhD
Drexel University College of Medicine

Diane McKay, Psy.D.
LECOM

Dominique Ruggieri, PhD
School of Medicine and Center for Public Health Initiatives, University of Pennsylvania

Eve Bloomgarden, MD
Northwestern University and IMPACT4HC

Nicole Theodoropoulos, MD
UMass Memorial Medical Center

Robin Aronow, MA

Catherine Marsh, B.A.
EndCoronavirus.org


Jessica Garfield-Blake, MEd
Knox Trail Middle School Teacher

Jerry Soucy, RN, CHPN
Death Nurse, LLC

Syra Madad, DHSc, MSc, MCP

Jonathan Moreno, PhD
University of Pennsylvania

Reid Masters, MD

Keelin Garvey, MD

Laurence Carroll, MD

Lana Fishkin, MD
Thomas Jefferson University

Jack Colford, MD, MPH, PhD
UC Berkeley

Lynne Agar, APRN, MPH

Margarita Fallena, MD

Shelley Ross, Ph.D.

Rohini Haar, MD, MPH
UC Berkeley School of Public Health

Maimuna Majumder, PhD, MPH
Boston Children's Hospital & Harvard Medical School

Sangeeta Ahluwalia, PhD
RAND Corporation/UCLA

Laura Whiteley, MD
Brown University

Patience Afulani, PhD
UCSF

Vernon Chinchilli, PhD
Penn State College of Medicine

Pamina Gorbach, DrPH
Fielding School of Public Health, UCLA

Judith Hahn, PhD
University of California, San Francisco

Steven Pergam, MD, MPH

Benjamin Lerman, MD
Alta Bates Summit Medical Center

William Davidson, M.D.
PNHP

Constance Regan, Ed.D.

Cynthia Baum-Baicker, Ph.D.

E John Wherry, PhD
University of Pennsylvania
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