Executive Summary
America is confronting two crises: an economic crisis laying waste to our livelihoods and a healthcrisis threatening our lives. The twin crises are deeply intertwined: our economy cannot be reopened without credibly addressing fears of infection and resurgence. The immediate reaction, anational lockdown, was successful in slowing the virus. We must now shift to a plan that balances the need to protect our health and reopen our economy by locking down only those who are
infectious. This paper presents a simple, scalable, and credible solution: introduce a comprehensive“test and isolate” policy, making it safe for Americans to return to work and keeping the infection
rate below 5% of the population.
Until a vaccine is developed and deployed, the simplest and safest path to this outcome is a national testing strategy that marshals our existing resources to test everyone in the U.S. once every
two weeks and isolates all those who test positive. It does not rely on any new technologies, is far
less disruptive and costly than our current policy, and will work even in a worst-case scenario. Below is a roadmap to a future in which the American people are confident that their health and our
economy’s future are protected against this virus.
The roadmap is comprised of the following steps:
1) Expand the pool of testing capacity by working with federal and state governments to:i) Remove regulatory barriers; and,ii) Establish a testing network of national and university laboratories.
2) Identify a revenue stream that the public sector can use to pay for the tests we must give
people to find those who are spreading the disease, especially those who show no symptoms.
Because this revenue must pay for tests of people who seem healthy, we need to provide afinancial incentive to laboratories to do this work.
3) Start testing the essential workers who are already on the job:i) Begin with healthcare and other frontline workers who are most likely to be
infected, so we keep one infected worker from spreading the virus to colleagues.
ii) As our capacity for running tests expands, start testing other essential workers
such as grocery clerks.
iii) Isolate anyone who tests positive; test their family members and close col				leagues.
4) Extend the tests to those who we want to urgently return to work, teachers for example.
5) Offer tests to everyone—students in the classroom or customers in the grocery store—andgive them permission not to wear a mask in public if they have a recent, negative test for thevirus.
“Test and isolate” is the response that we can commit to now, with full confidence that it will protect us from this virus and from the next. It is the fastest path to a revived economy because itis the simplest and safest path. A strong commitment from Congress to provide states with theresources they need to ramp up a comprehensive testing plan will set us on the path to defeating
the virus and responsibly reopening the economy.

1Introduction
The citizens of the United States face a health crisis caused by an aggressive and dangerous viralpathogen. The health crisis caused an economic crisis because people do not consume, work, orinvest when they are afraid.
In response to the mounting health crisis, U.S. policymakers made the right decision. They stopped
the spread of the virus by locking down all nonessential workers. The priority now is to switch toan equally effective and far less disruptive strategy: lock down only those who are infectious.
Because we had no way to tell who was infectious, we had to start by locking down everyone
who was not an essential worker. We must now make preparations to shift to “test and isolate,” atargeted version of lockdown aimed at limiting the spread of the virus to no more than 5% of the
population, saving hundreds of thousands of lives. The simplest way to find and isolate is to test
everyone regularly and to isolate the small fraction of the population who test positive.
To restore the confidence required to revive the economy, we need a credible plan for keeping thetotal number infected below 5%. Lifting the lockdown without a plan, surrendering to the virus,
and letting it return to its path of exponential growth would be devastating in both economic andhuman costs. It won’t matter if everyone is free to do anything they want. Fear and uncertainty
spawned by surrender will paralyze us all.

The simplest way to find those who are infectious is to test everyone
regularly. We should make it our highest priority to massively expand
the number of tests we can administer each day and to give those tests topeople who do not show any signs of being sick.
The simplest way to find those who are infectious is to test everyone regularly. We should make it
our highest priority to massively expand the number of tests we can administer each day and to
give those tests to people who do not show any signs of being sick. The simplicity and transparency of this policy is what makes it credible. It won’t be easy, but we have the tools and we know
they work; there is no question whether we can do each of the steps in this roadmap. The only
question is whether Congress will commit to rebuilding confidence in the health of our people andeconomy so we can get started on the path towards recovery.
To be sure, we can augment tests with supporting measures and explore other ways to prioritize
who gets tested next, but it would be a catastrophic mistake to delay the switch to “test and isolate” until we resolve all disagreements about how to implement supplementary measures such as
contact tracing, including serious concerns about requiring everyone to carry a smartphone with atracking app.
There is a simple roadmap for shifting from locking down all nonessential workers to locking down
the very few who are infectious:
1) Expand the pool of testing capacity by working with federal and state governments to:i) Remove regulatory barriers; and,ii) Establish a testing network of national and university laboratories.
2) Identify a revenue stream that the public sector can use to pay for the tests we must give
people to find those who are spreading the disease, especially those who show no symptoms.
Because this revenue must pay for tests of people who seem healthy, we need to provide afinancial incentive to laboratories to do this work.

23) Start testing the essential workers who are already on the job:i) Begin with healthcare and other frontline workers who are most likely to be
infected, so we keep one infected worker from spreading the virus to colleagues.
ii) As our capacity for running tests expands, start testing other essential workers
such as grocery clerks.
iii) Isolate anyone who tests positive; test their family members and close colleagues.
4) Extend the tests to those who we want to urgently return to work, teachers for example.
5) Offer tests to everyone—students in the classroom or customers in the grocery store—andgive them permission not to wear a mask in public if they have a recent, negative test for thevirus.
There is no question whether we can do each of these steps. The only question is whether we will;
and if we will, when we start.

Criteria For A Viable Containment Strategy
The virus can only do one of two things: exponentially grow, or exponentially decline. Even if thenumber of infections drops very low (or hits zero), easing containment policies without a viable
alternative like “test and isolate” in place would resume exponential growth of the virus, likely
bringing us back to our current situation. Our strategy, once implemented, must not only be able
to continue for the next 12-18 months (or more) until a vaccine is widely available, but it also must
be able to adapt to the unforeseeable challenges that will arise between now and then.
To stop the spread of Covid-19 and protect our nation from future resurgence, our containment
strategy must:•

Instill confidence in the American people: Fear is driving part of the current economic downturn—fear for our own health and fear of additional lockdowns. Our policy must be simple andfeasible enough to instill confidence in the American people that the health crisis is being effectively managed; that federal, state and local governments, along with the business and healthcommunities, are working closely together on this policy; and that its implementation will prevent additional economic losses.

•

Use resources that are available now: A national policy that calms fears and moves quickly,
two essential features of success against the virus, cannot require yet-undiscovered breakthroughs and additional uncertainty. We do not have time to wait for new developments, nor
do we need to. This plan does not require new scientific breakthroughs—we must use what wehave now with intention and purpose.

•

Have the resources to continue for an extended period of time: Our policy needs to be sustainable so that it can provide continuous support until we have a vaccine. This requires thatthe policy’s benefits always outweigh its economic and health costs, and that the resources
needed to execute the policy have the full backing of the federal government.

•

Offer a comprehensive solution across different scenarios: The policy must eventually beavailable to all Americans across the country. A partial solution that is only available in a handful of states or for a short period of time is destined to fail over the long-term, as our nation
will only be as resilient as the state with the most infections. Even if our best guesses about the
future turn out to be wrong, we must be able to deploy a strategy that adequately meets themost severe scenarios of the virus’ spread.

3

Widespread testing is the most viable option that’s optimal for both the economy and our publichealth.

“Test and Isolate”: The Most Viable Option
A return to normalcy isn’t possible without a vaccine. But we can get close with a national “testand isolate” strategy. The fundamental approach is simple:
1) Test everyone to find out who is infectious.
2) Isolate them.
3) Continue testing, and continue isolating.
“Test and isolate” builds on the same logic that goes into the lockdown approach: mass lockdown
works because it isolates people who are infected. But instead of isolating everyone, we must
transition to an “identify and isolate” strategy, finding those who are infected, including
asymptomatic carriers, and selectively isolating them.
We have the testing technology, and we know it works. We simply need to scale up ourcapacity. The simplicity and certainty that testing conveys, no matter the scale of the pandemic,
instills confidence in the policy.

The Case For Testing Everyone
To control this pandemic, and any future pandemic, the U.S. should make the investment necessary
to test people every two weeks, which would mean 25 million tests per day on an ongoing basis. It
should also have a surge capacity of twice this amount, which would allow us to test every American every week if needed. At the moment, the U.S. is testing around 150,000 people daily, and to
make matters worse, we are testing the wrong people. Instead of testing those with symptoms, oururgent priority should be to test people who might be asymptomatic spreaders of the virus.
Achieving this level of testing is difficult, but entirely feasible. The sooner we focus our efforts
towards the necessary steps to making testing ubiquitous, the sooner we can reopen the economy
and restore people’s confidence in the future. It is the only path to certainty that makes it safe toreturn to work, safe to visit your grandparents, safe to put your child back in school, and a myriad
other things that have become dilemmas during the pandemic.
By shifting the focus toward testing the people most likely to spread Covid-19, we are
significantly refining our isolation policy and creating the necessary confidence for all others to
begin safely returning to work. All who test positive must isolate themselves. While voluntary contact tracing is not the solution on its own, it can be implemented in situations like these to amplify
the reach of every individual test result, pinpointing those who are likely spreaders and isolatingthem from the rest of the workforce. Screening and targeted isolation will need to continue until
we have a vaccine.
For this plan to work, we must:
1) Expand the pool of testing capacity by working with federal and state governments to:i) Remove regulatory barriers; and,ii) Establish a testing network of national and university laboratories.
2) Identify a revenue stream that the public sector can use to pay for the tests we must give4

people to find those who are spreading the disease, especially those who show no symptoms.
Because this revenue must pay for tests of people who seem healthy, we need to provide afinancial incentive to laboratories to do this work.
3) Start testing the essential workers who are already on the job:i) Begin with healthcare and other frontline workers who are most likely to be
infected, so we keep one infected worker from spreading the virus to colleagues.
ii) As our capacity for running tests expands, start testing other essential workers
such as grocery clerks.
iii) Isolate anyone who tests positive; test their family members and close colleagues.
4) Extend the tests to those who we want to urgently return to work, teachers for example.
5) Offer tests to everyone—students in the classroom or customers in the grocery store—andgive them permission not to wear a mask in public if they have a recent, negative test for thevirus.
We will almost surely discover additional policies that improve and refine our testing strategy as
it is put into action. At this moment, we need to move quickly and decisively towards national
testing, and be open to adopting any refinements if they turn out to be as effective as advocatespromise. Reaching consensus on the need to test everyone is the first step, and we are well on
our way to agreement here. Now, we must start taking action to reopen America responsibly.

The Roadmap To Testing Everyone
1) Expand the pool of testing capacity.
First, we need to widen the pool of talent for running tests and remove the regulatory hurdles.
Many of the current shortages can be attributed to artificial bottlenecks created by regulatory requirements. Researchers in university labs have already solved all of the constraints that have been
holding back labs operating under the restrictive regulation of clinical diagnostic tests managed by
the FDA.
We should not only allow these workarounds to alleviate supply chain pressure, we should also
fast-track trusted university labs and marshal national laboratories to increase processing capacity.
This would introduce competition to the testing market, lowering the price of tests without
jeopardizing trust in the testing process. There are 20 laboratories in the U.S. that offer Pacific
Biosciences next-generation sequencing equipment and 16 laboratories with comparable equipment made by ThermoFisher (see Appendices A & B). Recent research papers suggest that any
one of these has the potential to scale up to millions of tests per day.

The bottom line is resources, not scientific breakthroughs, areneeded to expand our capacity for testing. If we commit to this type of
expansion, technological innovation will lower the cost andincrease the speed of the existing tests.
The bottom line is resources, not scientific breakthroughs, are needed to expand our capacity fortesting. If we commit to this type of expansion, technological innovations will lower the cost andincrease the speed of the existing tests. We are already seeing promising results from different
ways of testing that conserve supplies, including genetic lab-developed methods that rely on automation and allow the pooling of tests to run multiple at once. Once regulatory permissions arecleared and capacity is scaled up to the necessary level, new technologies can be implemented asthey are proven ready to refine and streamline the testing process.

52) Identify a revenue stream.
Clearing the roadblocks is a first step, but the market will not solve the issue alone as testing
evolves into a public good. Building this capacity will take an investment from the federal
government to ensure labs can count on a funding stream.
At scale, a reasonable estimate would be a $10 cost per test for labs. 20 million tests per day
translates into about $73 billion per year. Along with other costs for infrastructure, training, andproduction of supplies, I estimate the government will need to allocate $100 billion to thedevelopment of a testing strategy. I urge Congress to include the $100 billion in the Phase 4coronavirus stimulus bill to generate a revenue stream for labs as soon as possible. The market
cannot independently solve this problem. The need for a new revenue stream that creates necessary incentives for labs to innovate at the scale possible is inescapable.
For each month of lockdown, the U.S. economy suffers a loss of $500 billion from lost output
that month and lost capacity to produce in the future. Lifting the lockdown without a clear
containment strategy will have relatively little financial impact due to continued fear anduncertainty (we may cut the loss to $400 billion a month) and will undoubtedly carryextraordinary human cost. A temporary relaxation of lockdown will offer little economic benefit
because it won’t give consumers or firms the necessary confidence to plan and invest.
The economic argument for investing in an approach we know will provide certainty andsafety is undeniable. A $100 billion annual investment in testing until all Americans have been
vaccinated would pay for itself many times over, and it would provide the necessary revenue
stream for labs to rapidly expand testing capacity.

Allocation of the $100 billion via block grants to the states is thefastest and most precise path to ubiquitous testing, though any program will
require extensive federal guidance and regulatory agency participation.
It is critical that this revenue stream is separate from the public and private systems that pay forpeople’s healthcare. These tests will need to become more of a public good than a medical procedure, and we will need to test everyone regardless of symptoms. Knowing the status of everyone—even asymptomatic spreaders—is crucial to making people feel safe and confident to return
to work.
There is broad consensus that testing is the only way to reopen America safely, and I havedemonstrated why mass testing is the most viable option to address the economic and healthcrises we are currently facing. Speed of response is now a critical factor. Allocation of the$100 billion via block grants to the states is the fastest and most precise path to ubiquitous testing, though any program will require extensive federal guidance and regulatory agency participation. Programs such as the Emergency Network for Covid-19 Testing proposed by the Rockefeller
Foundation, which uses federal and state agencies to negotiate with testing facilities, may be thefastest route to creating sustainable, universal testing operations across the country. Regardless,the need for bold, decisive investment at the national level, to signal the adoption and pursuit of acontainment strategy based on testing, is vital.
3) Start testing the essential workers who are already on the job.
Right now, we are focused on testing the wrong people. Those who are already symptomatic
should self-isolate, and doctors should proceed with treating severe, hospitalized cases as presumed positives. Until we have a vaccine or therapy to treat Covid-19, testing already ill people
is not a practical use of testing resources, nor does it harm those patients to move the target of
testing elsewhere.

6Instead, we need to focus on healthcare workers and other first responders such as police officers
and emergency technicians. These frontline workers are most likely to be infected, so we must
keep these infected workers from spreading the virus to their essential colleagues and the general
population with whom they interact daily. As our capacity for running tests expands, we can start
testing other essential workers such as grocery clerks, sanitation workers, and transportation personnel.
Throughout this process, we must isolate anyone who tests positive and move to immediately test
their family members and close colleagues.
4) Extend the tests to those who we want to urgently return to work.
Moving down a hierarchy of essential workers, we can begin to safely reactivate parts of our economy such as schools, restaurants, retail businesses, manufacturers, and other urgently needed services that may not be considered “essential” during lockdown. As testing capacity increases andprocesses are refined, these categories can expand, following the same protocol as healthcare andfrontline workers. We can potentially start moving the contacts of anyone who tests positive to thefront of the line for testing, while continuing to test the family members and close colleagues ofanyone who tests positive.
5) Offer tests to everyone.
Lastly, the rest of the workforce can safely resume activity knowing that those who are infected,
even though they may not show symptoms, are isolating at home. Those who test positive and isolate themselves may need financial support, which will cost significantly less than financially
supporting the entire population in a mass lockdown scenario like the one we are in now.
With a national commitment to widespread testing and necessary funding in place, states canfocus on implementation and enforcement on a broader scale. Armed with the data to precisely
target containment efforts, we can move priorities from a rapid scale-up of testing to focusing on
areas that are most in-need and refining testing technologies. A central data-sharing platform will
likely be necessary to facilitate resource allocation and identify supply needs. Complementarystrategies, including contact tracing and antibody testing, can help maximize efficient use of testing resources if their benefits come to fruition, but they cannot serve as the sole solution now.

Other Containment Policy Options
Experts from across industries have put forth other strategies to contain the virus, all in pursuit of
the universal goal of restarting the economy while curbing Covid-19. While these other policies cancertainly help contribute to recovery, none constitute a successful containment strategy alone.
Lockdown: The most immediate option is a continued lockdown. This is not a viable option. It does
not inspire confidence in the American people (it looks more like surrendering to the virus thandefeating it), it is not sustainable, it is not comprehensive, and it does not limit economic damage.
Economically, it is too costly to pursue for even the next month, much less the next 12–18 months
before a vaccine (if not longer). And with businesses and government eager to reopen states
and the national economy, if our collective will to protect the public good and sustain lockdowns
flounders without a viable alternative in place, we face a vicious cycle involving periodic returns tolockdown, arresting both our lives and economic productivity.
Contact Tracing: As calls for contact tracing increase, we must remember that while it may be
a suitable complement to proven containment policies like “test and isolate,” it is not yet viable
enough to be counted on independently. It is unreliable (it requires inherently unreliable data,
whether collected manually or digitally), it does not inspire confidence (it is not definitive on who

7

is infected), it is not comprehensive (it does not address asymptomatic spreaders of the virus), it
is not robust (the technological capabilities and human capital needed to rapidly scale when an
infection spikes are immense), and it is not feasible (it is not available today and it is unlikely tosecure buy-in from key decision-makers due to civil liberties concerns). As such, contact tracing
cannot be considered a viable option for widespread containment response, but it remains a helpful tool for epidemiological disease surveillance.
Antibody Testing: Antibody testing seems like a promising solution at face value, and it certainly
should not be ignored while assessing the immunity of an individual or of larger communities. Yet
it is not robust enough on its own to generate any substantial benefits, and the medical community has not reached a consensus around whether or not contracting the virus guarantees immunity.
Antibody testing might develop to the point where it plays an important role in keeping infections
to less than 5% of our total population, but as of now it is best deployed for disease surveillance,
not for ensuring the safe return of Americans to the workplace.
Other policies may prove complementary to a broader strategy, but none of these strategies are
sufficient on their own to address the twin health and economic crises.

Conclusion
For my whole career I’ve been focused on a single idea: just because something is unfamiliar
doesn’t mean it’s impossible. We are at a point now where we must choose between fighting
this virus with all of America’s resources, intellect, and will, or surrendering because an answer
we can have confidence in feels too hard to execute. Yes, the numbers are large, but the casefor mass testing is strong from economic, ethical, and public health standpoints. It is without adoubt the best option right now with the resources we have and the challenges we are facing.
By expanding the pool of testing capacity, providing government funding to states to execute,
implementing a wide-scale testing program starting with healthcare workers, and supporting
those in isolation as the rest of the workforce resumes activity, we can truly and finally start torecover from this pandemic.
Of course, we need more than private- and public-sector discussions on a plan to address thehealth and economic crises from which we suffer. We need courage, creativity, and boldleadership from our elected leaders and we need it now. Congress must provide states theresources they need to set up a comprehensive national testing plan so we can reopen our
economy confidently and responsibly.
With hope and confidence,

Paul Romer
University Professor, NYU
2018 Nobel Laureate in Economics
www.paulromer.net@paulmromer
Contact Information
Press Inquiries: Hamilton Place Strategies: paulromer@hamiltonps.com
Office of Paul Romer: Daniel Teweles, Chief of Staff: daniel@paulromer.net

8Appendix A: Labs In The United States That Offer Pacific Biosciences Next Generation Sequencing
Equipment•

Brigham Young University, DNA Sequencing Center, Department of Biology•

City of Hope Integrated Genomics Core•

Cold Spring Harbor Laboratory Next Generation Genomics Core•

Corteva Agriscience•

GENEWIZ•

Histogenetics•

HudsonAlpha Genome Sequencing Center•

Icahn Institute for Genomics and Multiscale Biology at Mount Sinai•

Maryland Genomics Institute of Genome Sciences•

McDonnell Genome Institute at Washington University School of Medicine•

McGill University and Génome Québec Innovation Centre•

MOgene LC•

RTLGenomics•

Rutgers University, Waksman Genomics Facility•

University of Delaware—DNA Sequencing & Genotyping Center Delaware Biotechnology Institute•

University of Georgia Athens (UGA)—Georgia Genomics and Bioinformatics Core (GGBC)•

University of Minnesota Genomics Center•

University of Washington, DNA Sequencing Center•

University of Wisconsin Biotechnology Center•

Washington State University, Molecular Biology and Genomics Core

9

Appendix B: Labs In The United States That Offer ThermoFisher Next Generation Sequencing
Equipment•

Boston University•

Cedars Sinai•

Children’s Hospital Los Angeles•

Claritas Genomics•

The Hospital for Sick Kids•

Kashi Laboratories•

Memorial Sloan-Kettering Cancer Center•

The Molecular Resource Center•

Ohio State University•

PrimBio Research Institute•

Roswell Park Cancer Institute•

RUCDR Infinite Biologics•

University of Arizona•

University of British Columbia•

University of New Mexico•

WuXi AppTec10