Illustration: Sarah Grillo/Axios

Americans are looking for an exit ramp away from the extreme social distancing brought on by the coronavirus, but that will require steps we're not yet prepared for.

The big picture: Responsibly easing off of social distancing will only be possible as the number of new cases levels off, and will depend on extensive testing to avoid another surge in infections.

"The problem is that the next phase of containment is contingent on resources we don't have,” said Jennifer Nuzzo, senior scholar at the Johns Hopkins Center for Health Security.

Where it stands: If we're going to back off of aggressive measures like school and business closures, the next phase of the response would involve doing a lot of the things we should have done from the beginning.

  • That includes quickly identifying and isolating newly infected patients, and identifying others they may have infected.
  • Places that house vulnerable people, like nursing homes, would still need strong oversight.
  • “You need to bring down the overall burden and then you can get to the point where you can target the individual cases,” former Food and Drug Administration Commissioner Scott Gottlieb sad.

Yes, but: All of that requires fast, widespread testing, which the U.S. still can't do.

  • We’re still facing shortages of some supplies needed to make and conduct tests, and it still takes several days to receive test results.
  • “If we let up, we’ll be back to where we were before social distancing,” said Ali Khan of the University of Nebraska Medical Center.

What's next: Syndromic surveillance — testing a random portion of the community — might help the U.S. get a better handle on the true prevalence of COVID-19.

  • Seattle has launched an effort to do just that, adapting an existing program that checks for influenza prevalence.
  • And the FDA recently signed off on a test that can deliver results within 45 minutes, though it's only available to help diagnose very sick patients, not to catch cases before they become severe.

Life won’t go back to normal for a long time. Normalcy will return in doses, and at different paces in different parts of the country.

  • “It’s not like a switch that’s going to be flipped. It’s going to be much more gradual. And people that are high risk are probably going to be the last ones” to see relaxed restrictions, John Hopkins’ Joshua Sharfstein said.

The bottom line: “The worst-possible outcome would be a second epidemic, a second wave…we can’t afford to have this happen again,” Gottlieb said.

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