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The Administration recently issued “Guidelines: Opening Up America Again.” What do you make of them?

Question: The Administration recently issued “Guidelines: Opening Up America Again.” What do you make of them?

Answer: Thanks for asking this question as it forced me to read the new guidelines rather than the newspaper reports and twitter occasional snark I had been consuming! Since I imagine that most of you also haven’t read the guidelines, l’ve written up a synthesis (see bullets and Table 1 below). So quickly, what do I think? Well, I’m happy to see something rather than nothing! And it’s good to see that the plan is tied to metrics rather than random dates (Easter!). But, what’s fascinating and (in my opinion) depressing here is that NOTHING is the responsibility of the federal government in what is a national emergency. As someone who has grown up believing in the federal system, this abdication of responsibility is shocking. As you’ll see in the Guidelines, it’s each State’s responsibility to set up testing, contact tracing, and to assure that hospitals have necessary PPE. I’m not arguing that States shouldn’t have responsibility too, but where it the national partnership? What is the federal responsibility?

Next issue in these guidelines is that the testing strategy is still focused on symptomatic testing. We now know that transmission during the asymptomatic period is a huge issue (see Q&A of yesterday). So why are we still focusing testing on symptomatic individuals. We need more testing!! Third, and this has been talked about a lot in the last few days, these guidelines are not comprehensive. For example, what do Governors do if they are in Phase 1 and see a re-emergence? Do we move back to extreme social distancing? They are also lacking specifics. For example, what are schools and daycare centers supposed to do with kids with sniffles (as they always have)? Do they get sent home? Similarly, what degree of employer-based contact tracing is required? Finally, an ongoing issue, as our colleague Caitlin pointed out — how can we continue to expect people to stay home when sick or when possibly exposed when most folks in our country don’t even have sick leave?

Okay, I could say more, but I’ll stop there. If you want to see a set of guidelines that have more meat, check out Johns Hopkins Center for Health Security’s “Public Health Principles for aPhased Reopening During COVID-19:Guidance for Governors” that was just released.

Synthesis

  • Reopening will be based on Governor’s decision, ideally in regional collaboration, and will be done in phases.
  • Before considering reopening, Governors must see these criteria met:
  1. A sustained downward trend in flu-like illnesses and covid-like cases over 14 days;
  2. A sustained downward trajectory in covid-cases OR proportion of positive tests over 14 days;
  3. Ability of hospitals to treat patients without crisis care; and
  4. Robust testing program in place for at-risk healthcare workers, including emerging antibody testing.
  • Before considering reopening, States must have in place:
  1. Testing and Contact Tracing: Ability to quickly set up testing sites for symptomatic people and test such people; Ability to trace contacts of those who test positive; Use of sentinel surveillance sites to screen for asymptomatic infection and conduct contact tracing
  2. Healthcare System Capacity: Ability to quickly and independently provide necessary PPE and medical equipment; Ability to surge ICU capacity
  3. Have in place plans: to protect health and safety of workers in critical industries, of those living and working in high-risk facilities, of mass transit workers and users; to advise citizens of social distancing and face covering protocols; and to monitor conditions and take steps to limit and mitigate any rebound
  • In all phases, individuals must: practice good hygiene and stay home if sick.
  • In all phases, employers must: develop and implement appropriate policies (travel, social distancing, PPE, etc.); monitor workforce for symptoms and not allow symptomatic folks to come to work; develop and implement procedures for workforce contact tracing following positive test result of an employee.

Table 1. Reopening by Phase

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