Though the US could pass the peak of its coronavirus outbreak in the next week, it won't be the end of the battle.

In a livestreamed interview on Wednesday, Dr. Anthony Fauci said he and the rest of the White House coronavirus task force were still trying to figure out what to do after April 30, when federal stay-at-home guidelines are set to expire.

Fauci, the director of the National Institute of Allergy and Infectious Diseases, spoke with Howard Bauchner, the editor of the Journal of the American Medical Association. He said he had been in the West Wing "until the wee hours" the night before as the coronavirus task force discussed a major question: "What are the kind of things you have to have in place to safely and carefully march towards some sort of normality?"

That normality will be hard to come by without risking more death and overwhelmed hospitals, since experts warn that new infections could surge after lockdowns lift. There's also a chance the virus could make a resurgence in fall weather.

In the interview, Fauci laid out a playbook to prepare for new waves of COVID-19.

'The things that were not in place in January'

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Healthcare workers at a COVID-19 drive-thru testing site at Henry Ford West Bloomfield Hospital on March 25.
Carlos Osorio/AP

For the next few months and into the fall, Fauci wants the US to get more prepared than it was when the new coronavirus arrived.

"The keys are to make sure that we have in place the things that were not in place in January, that we have the capability of mobilizing identification — testing — identification, isolation, contact tracing," Fauci said. "There will be cases. We've got to be able to act on them in a very deliberate way that doesn't allow us to get into the situation we find ourselves right now."

That's the tack South Korea took at the beginning of its outbreak. Health officials quickly started testing tens of thousands of people a day and opened COVID-19 drive-thru testing facilities. The government also implemented a robust — though privacy-invasive — contact-tracing program: After tests there reveal a positive case, officials use interviews, GPS phone tracking, credit-card records, and video surveillance to trace that person's travel history, according to The Washington Post.

In the US, on the other hand, government agencies have been criticized for rolling out testing and isolation policies too slowly. Errors and delays in producing the US Centers for Disease Control and Prevention's coronavirus test led to dangerous shortages, and decisions about lockdowns have been left to states in piecemeal fashion.

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A man crossing a nearly empty 5th Avenue in midtown Manhattan in New York City on March 25.
REUTERS/Mike Segar

Many experts have said the slow response contributed to the virus' rapid spread.

"This is such a rapidly moving infection that losing a few days is bad, and losing a couple of weeks is terrible," Ashish Jha, the director of the Harvard Global Health Institute, told Bloomberg. "Losing two months is close to disastrous, and that's what we did."

Testing in the US is now ramping up, but it's too late to contain the outbreak by testing and contact tracing alone. More than 14,700 people have died nationwide.

"Ultimately the answer is going to be a vaccine," Fauci said.

It could take at least 18 months, however, to develop, test, and distribute a vaccine. That means other interventions are needed during that time.

Antibody testing

This photo taken on March 11, 2020 shows a lab techician working on a neutralising antibody test on MERS
A lab technician working on a neutralizing antibody test on the MERS coronavirus at a laboratory at the International Vaccine Institute in Seoul, South Korea — part of an attempt to learn more about the coronavirus on March 11.
Ed Jones/AFP via Getty Images

People who have been infected develop antibodies that can probably fight off the virus if it they encounter it again. This would most likely make them immune, though it's unclear how long that protection lasts.

"Clearly one of the things is to get a feel for what the penetrance of infection was and who out there has been infected, recovered, and is now not vulnerable," Fauci said.

Fauci said immunity should last at least through September for people who were infected in February. People who are immune, then, could go back to work earlier than others.

"Those are the people, when you put them back to particularly critical infrastructure jobs, that you worry less about them driving an outbreak," Fauci said.

To identify those people, a handful of companies are developing blood tests that detect COVID-19 antibodies — though Fauci said the US needed to validate any such tests.

"There has been some unfortunate international experience," he said.

He was most likely referring to the UK, where the government ordered millions of antibody test kits only to find out that none of them worked.

'Don't ever let it get out of hand again'

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A healthcare worker wheeling a patient into the Wyckoff Heights Medical Center in Brooklyn, New York, on Monday.
REUTERS/Brendan Mcdermid

"If we get back to some form of normality, we've got to be careful we don't ever let it get out of hand again," Fauci said during the Wednesday interview. "Do not send a sick child to school. Do not send a sick worker into the workplace. Don't anybody ever shake hands again. I mean it sounds crazy, but that's the way it's really got to be, until we get to a point where we know that the population is protected."

Even after a vaccine is widely available, Fauci said, the pandemic should prompt the country to rethink its local public-health systems and better prepare for the next infectious disease outbreak.

"We have a habit of when we get over a challenge, we say let's move on to the current problem," Fauci said. "We should never be in a position of getting hit like this and have to scramble to respond again."

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