When can we open up America again?

This is a legitimate question that many are asking. Some are asking it from a macro-economic perspective because they are investors who want to get the bull running again. Others are asking from a much more personal perspective because they lost their jobs, they are watching their retirement plan drop in value, or they need to feed their kids or get them in a safe environment such as school. No matter what, there will be massive economic impact globally and personally from this pandemic. A better question could be - "When will we know how many people are sick in the United States?" It implies more compassion for the sick, the families of the deceased, the workers on the front lines. This question might be better as the answer is necessary before "when can we open up America again?". Unfortunately, we can't answer this due to our inadequate response to this pandemic. We are woefully behind on testing by losing almost the whole month of February and barely starting to get it together by the end of March with a patchwork of local self-organization. This is all well-documented in How the Coronavirus became an American Catastrophe. 

On March 20th, a friend who is a nurse shared the mixed messaging that was coming from Iowa health officials on testing when Iowans were being denied testing with the messaging of "not everyone needs to be tested" which I believe is disingenuous as it is hiding the broader truth and obscuring the real problem. A better message could have been - "...we only have Y tests available per day and we have to prioritize. Given your current symptoms, you do not meet the cutoff for our prioritization. We hope to remediate this problem soon by X date but unfortunately this is what we have to do until we get more..." A message like that may create more empathy for the situation and highlights the root challenge of us not being able to effectively ramp testing services and kits. Note that as of this morning, only 4,673 tests have been performed in Iowa with 298 positives and 3 deaths. Since we are restricting testing so much, we can only see a tiny surface area of risk (in this case, 4,673/3,150,000 = 0.1%). 

When you look at the broader United States, you have only 801,416 tests given (or 0.2% visibility, self-selected to the most sick) and a positive finding in 122,166 people which creates a 15.3% positive rate. Since we are only testing the most sick, let's make an assumption that the actual positive rate if we did random sampling would be 25% of that which would lead to a 3.8% positive rate. This would lead to a rough estimate of 12 million affected in the US. If you use existing death rate percentages you get a range of 219,000 using the current US death rate to 1,250,000 assuming system-collapse death rate of 10%. If you use the global death rate of 4.65%, the estimate would be 581,724. This range is a terrible range and is increasing over the last week. The range is also tightening as US death rates are increasing.  

Testing rates are ramping up. California was woefully behind last week and has now ramped up significantly but still way behind. Faster test kits, more test kits, and more coordination in the distribution of test kits seem to be one of the most important things we can do to make good decisions about opening up America again. I don't agree with politicians who pick a date out of thin air (e.g. "Easter") since the data is dynamically changing and must be analyzed on at least a daily basis.
on by X date but unfortunately this is what we have to do until we get more