Ten days ago, the @RockefellerFdn released a white paper on how we could reopen all US schools over the next new months with aggressive government investment in frequent proactive COVID testing and more.

I think it's an important report. Some highlights:

https://www.rockefellerfoundation.org/wp-content/uploads/2020/12/Taking-Back-Control-a-Resetting-of-Americas-Response-to-Covid-19.pdf

A central aspect of the proposal is that we take advantage of testing options in the pipeline, aggressively scaling up capacity and using this to test students and teachers alike.

The aim is to test students at least weekly. Teachers, twice weekly.

The first step in the plan is to reopen all elementary schools by February 1. These are a logical place to start. The need for in-person schooling is arguably greatest, the susceptibility of children <10 is likely lowest, and class structure limits within-school outbreak sizes.

By March 1, the aim is to have all schools at all levels open, with 300 million tests per month going toward this effort.

The idea would be to use pooled testing to stretch capacity and keep costs down. We've not made enough progress on this in the US. I was tweeting about it back on March 2 yet EUAs remain limited. https://twitter.com/CT_Bergstrom/status/1234663431313088512

An alternative approach is that with a CLIA waiver, one can deploy pooled surveillance testing and then come back to re-test individuals using EUA-approved diagnostic tests.

https://www.cdc.gov/coronavirus/2019-ncov/lab/pooling-procedures.html

What's the difference? A quick refresher on pooled testing from a talk I gave last summer.

Without pooling, it takes 25 tests to check 25 people.

The two-stage pooled testing approach works like this. You test batches (here, batches of 5 for illustrative purposes, but a batch could be e.g. a classroom in a school setting).

If a batch tests positive, you retest everyone in that batch.

This is slightly inefficient. One-stage approaches break up the groups in multiple ways so that you don't have to re-test to uniquely identify the positive individuals. Here's an overly-simplified illustration. But II don't think you can do this under a CLIA waiver?

Back to the Rockefeller report. Here are some numbers on the cost to implement a two-stage pooled testing nationwide. Estimate: $8.5 billion a month. It may like a big number but don't let it scare you. Think of it in the context of multi-trillion dollar stimulus packages.

Where does the capacity come from?

It's not all about testing of course.

Buildings need to be upgraded for ventilation etc.

And one estimate suggests we'd need "$116.5 billion pay for extra staff, PPE, enhanced cleaning, and other safety measures."

But the Rockefeller report argues this would provide huge ROI.

One thing I appreciate about the report is that it explains clearly what actions an incoming administration can take to make all of this happen.

Centralized payment and procurement.

Invoking the defense production act.

Streamlined, nationally regularized procedures for testing approval, HIPAA logistics, etc. are essential.

The Rockefeller advocates liability protections as well. I am not qualified to comment on this as I do not understand the issues at stake.

Direct payment systems are essential. The CARES act does not requirer insurers to pay for proactive testing of asymptomatic people.

But getting tested when asymptomatic is almost a pure public good with relatively low private value. We need the government to cover this.

We will need to create the aforementioned regional testing facilities.

The report rightly notes that tests with >48 hour turnaround are not useful. I'm unsure about whether denying payment for such is the right management option.

Finally, another dashboard.

I don't know if we need another dashboard, per se, but smart agile distribution of testing supply to ensure rapid turnaround is essential, and information system that facilitate this will be vital.

All of this will take a lot of staffing. Where does that come from?

We have a uniformed service that does exactly this: US Public Health Service Commissioned Corps.

(In fact US Surgeon General Jerome Adams is a Vice Admiral in the UHPHS.)

Bring them in to help with logistics.

Draw upon other public staffing sources, and provide states with the necessary funding.

Ok, so "Covid Ambassadors" sounds a bit like the cringy "Safety Superheroes" program they had in my elementary school in the 1970s, but the point is spot on. Community trust is essential, and that comes from leadership within in the community, not from outside.

This one is huge: we need to VACCINATE TEACHERS as soon as possible.

I'll be releasing my own modeling work on this shortly.

And then there is public communications.

The first recommendation is almost straight out of the CDC's Field Epidemiology Manual. It's essential, and—compared to what we've seen for the past ten months—radical.

"Offer a daily briefing on the pandemic with the President’s Covid-19 taskforce...The day’s message should be delivered by experienced healthcare professionals and reflect the consensus of scientific opinion [and] address changes in response efforts as the pandemic evolves..."

The other key component of public communications is the recognition that social media are the major, though not exclusive, vehicles of spread for misinformation and disinformation about the pandemic—and that this has cost numerous lives.

That's just the executive summary. I find it a compelling eight-page read, and agree with a large fraction of it.

https://www.rockefellerfoundation.org/report/a-resetting-of-americas-response-to-covid-19/

I'll also pick a few observations from the more detailed plan that the report provides.

It's useful to have some hard numbers on the scope of testing needed.

Coupled with estimates of testing capacity.

Testing is not a panacea of course. Masks are essential. Social distancing, hygiene, etc. will be crucial.

This is essential: we have to make it possible for people to comply with quarantine. That means payment for people staying home, and job protection.

More on staffing and the USPHS Commissioned Corps.

With respect to needs beyond testing:

Finally, none of this will happen without support and cooperation and buy-in from the teachers' unions. They have to be engaged as allies, not adversaries.

You can follow many of the contributors to this report on twitter. A few that tweet regularly about related issues:

@MaraAspinall
@MichaelPellini
@jonoquick
@rajshah
@christinasilcox
@echarlu

and of course the @RockefellerFdn.