As the COVID-19 pandemic has caused state, federal, and international governments to impose various degrees of "safer at home" orders to flatten the curve, at some point we will have to begin to discuss whether the cure (economic Armageddon) is as bad as, if not worse than the disease.

While I won't question the medical rationale for making such recommendations, the question for Americans that must be addressed is, when and how will we exit the coronavirus turnpike? 

The economic impact of the national shutdown is estimated to displace upwards of 53 million American workers.  What will be the impact on American lives as a result of the economic shutdown instituted by the governments' response to the coronavirus?.

Economists at the Federal Reserve Bank of St. Louis are warning that if the current rate of U.S. job losses continues, the country's unemployment rate could reach a staggering 32.1% by the end of June as the coronavirus pandemic–induced downturn sparks mass layoffs across the nation. 

We as a society, and particularly as a free society, need to begin to have the discussion of how and when we will begin to take the off-ramp from the coronavirus shutdown.  Lives will be lost as a result of impending financial ruin.

One idea (presented below) is to move away from the strict "one size fits all" model currently in place and toward a coronavirus risk model based in part on the testing that is coming online.  While not comprehensive, the following model could provide a method for returning to some semblance of societal and economic normalcy.

As our testing ability improves, we will be able to use results as a mechanism to help businesses open and safely allow customers to return.  We now have the ability to conduct antibody tests that are quick and inexpensive.  These tests will identify patients who have immunity (IgG antibodies) versus current infection (IgM antibodies).  An immune person can likely safely return to work and be out in public, as would also be the case with an immune customer.  A five-minute test prior to entering a store or restaurant would allow both a worker and a customer to safely return.  A person who has neither antibodies (not yet exposed) would be stratified into a risk category to determine activity.  

Confirmed Infected (IgM antibodies or virus detection)

Confirmed infected are defined as those who have tested "positive" for the COVID-19 virus or the acute IgM antibody.  These people need to follow medical guidance, which is either in-hospital treatment or at-home self-quarantine.  They would be retested until immunity is confirmed and the acute infection is resolved. 

High Risk (with no antibody protection)

Taking guidance from the CDC, those who are at the highest risk are defined as older Americans, 60 and above, and those who are immuno-compromised.

As Dr. Deborah Birx has also recently stated, people who live in COVID "hot zones" are at higher risk of contracting the virus than other parts of the country.  If you live in New York City, you are at higher risk of contracting coronavirus than if you live in other parts of the country.

Here are the confirmed cases by state.

Older Americans, people with compromised immune systems, and those who live in COVID "hot zones" should severely curtail their social interactions, very similar to many of the "safer at home" policies currently instituted by many states and municipalities. 

Medium Risk

If you are experiencing flu-like symptoms, you should self-quarantine and be tested and retested to confirm COVID-19 or to rule it out.

If you live in an urban population center in New York, New Jersey, Michigan, Louisiana, or California, you are at higher risk of contracting the coronavirus and should take precautions to protect yourself and your neighbors.

If you are healthy but live with someone in a high-risk category, you should take precautions to protect your loved ones and consider testing to know the status of immunity.

Low Risk or confirmed antibody protection

If you are young and healthy and live in a more suburban or rural setting, your risk of contracting COVID is low.  While you should continue to practice "social distancing" measures and wash your hands regularly, you should be permitted to go back to work and begin to socialize in small group settings.

Jeffrey Barke, M.D. is a primary care physician in private practice in Southern California.