...Viewing Covid-19–related restrictions as more of a public policy issue than a legal one, then, how can a graduated model chart a course that appropriately balances disease control and civil liberties? We believe that decisions to continue, modify, or lift severe restrictions — particularly bans on movement and gathering — should be tailored using credible person-level information. The key source of such information would be a population-wide program of disease testing and surveillance. By identifying people most likely to transmit infection in the near term, individualized risk assessment would respond to Covid-19’s distinctively dangerous risk profile. At the same time, it would avoid sharp trade-offs between discriminatory or unduly broad restrictions and the perils associated with wholesale loosening of restrictions.
To be sure, testing itself is an intrusion. But considering this pandemic’s magnitude, effective testing can reduce or prevent the need for much greater intrusions. Moreover, a degree of voluntariness is maintained by eschewing forced testing and instead conditioning social privileges on cooperation.
Consider, for example, a policy in which people seeking to return to work, school, or social activities are asked to undergo baseline testing for infection and antibodies. Positive tests for infection would trigger self-isolation. Negative tests would certify freedom of movement for a defined period — say, 2 or 3 weeks — after which additional negative tests would renew the certification. If antibodies are determined to provide long-term protection against both reinfection and transmission — which is plausible but not yet established — a positive serologic test would warrant longer-term certification.
Aggregating test results at community and state levels would support a reliable disease-surveillance system. A testing regimen’s stringency could then be dialed up or down, depending on community prevalence of Covid-19. China is following a version of this approach by grading community risk on a four-tier, color-coded scale.
Titrating restrictive measures in this way would require a testing regimen on a scale unparalleled in U.S. history. Federal, state, and local governments would play a role in financing and oversight but would need to rely heavily on hospitals, clinics, nursing homes, retail pharmacies, mobile health services, and private laboratories for implementation. Civil-society organizations (e.g., employers, schools, and retailers) would also have financial and reputational incentives to foster compliance with government directives...
