Opening the U.S. Economy . . . Gradually

Last Thursday, President Trump unveiled the federal government’s guidelines for re-opening the U.S. economy. The plan features three stages for getting businesses and industries started up again after the nationwide lockdown because of COVID-19. Largely at the discretion of governors and other state officials, implementation of each phase of the plan would be subject to successfully meeting certain criteria for control of the spread and effects of coronavirus on the population.

Phase One would continue to require persons in the most vulnerable populations—elderly and those with underlying health conditions—to shelter in place. Social distancing would continue, and gatherings of more than ten persons would be discouraged. Use of personal protective equipment (PPE) such as masks and gloves would be recommended. Employers would continue to allow or encourage teleworking, but stores and shops could reopen gradually as long as employers were able to enforce social distancing (such as closing common areas that would encourage mingling and taking measures to ensure that customers and employees maintain adequate separation). Non-essential business travel would be minimized, and CDC guidelines for quarantine following travel would be adhered to. Schools and daycare facilities would remain closed, and visiting senior or other assisted living facilities would be prohibited except under strict guidelines. Movie theaters, dine-in restaurants, gyms, and places of worship could operate as long as they adhere to strict social distancing practices. Medical establishments could resume providing elective procedures. Bars would remain closed.

Phase Two, which applies to states and communities in Phase One with no evidence of a rise in COVID-19 or increased positive tests for coronavirus infection, allows for public gatherings of 50 people or less, but still encourages social distancing where possible and practical. Vulnerable populations would continue to shelter in place, but nonessential travel would be permitted. Employers would continue to follow the guidelines in Phase One, but schools and daycares could reopen. Movie theaters, restaurants, gyms, and places of worship would maintain social distancing protocols, but on a “moderate” basis. Bars could re-open with diminished standing-room capacity.

Phase Three permits vulnerable populations to resume normal public activities as long as they practice social distancing. Employers could resume unrestricted staffing and activities, and visits to senior and other assisted living facilities could resume, with standard hygiene practices in place. Restaurants and movie theaters could operate with limited social distancing protocols. Gyms could operate normally, as long as they follow standard hygienic requirements. Bars could operate with increased standing room occupancy.

For any state or other entity to enter Phase One or continue to subsequent phases, the following requirements should be met:

• Downward trajectory of flulike illnesses and COVID-19-like cases within a two-week period;
• Downward trajectory of documented coronavirus cases or positive test results within a two-week period;
• Ability of hospitals to treat all patients without crisis care, combined with robust testing and protection of healthcare workers.

Next, states and other entities must demonstrate:

• Ability to provide safe and efficient testing for symptomatic persons, combined with contact tracing;
• Testing for persons with COVID-19 or cold/flulike symptoms;
• Screening for asymptomatic carriers of coronavirus, especially at or near locations serving vulnerable individuals and low-income or racial minority populations.

Additionally, healthcare systems must demonstrate ability to provide sufficient PPE and other medical equipment to handle a surge in cases, and ICU capacity must be capable of absorbing a rapid increase in patients. State and local authorities should be capable of monitoring and responding quickly to rebounds or outbreaks of infection and also of providing safe mass transit and protection for essential workers in critical industries.

Governors of several states, including California, Texas, Ohio, and Florida, have already announced plans for phased reopening of their respective economies. To varying degrees, all have mentioned the need for care and a gradual approach that avoids jeopardizing public health.

Of course, even if a given state is able to reach Phase Three, we still need widely available testing—including screening for coronavirus antibodies that indicate immunity—to be assured that transmission of the disease is under control. No doubt, many individuals, especially those in vulnerable populations, will still choose to exercise extra care and restraint as they resume going out in public.

As always, stay safe and remain healthy! And,

Buen Camino!