When Can We Get Back to Normal?

People are experiencing quarantine fatigue, that’s for sure. But we need to continue holding the line and following social distancing guidelines right now. Different segments of society are calling for lifting restrictions immediately, and yet others are calling to wait for a vaccine. Neither of these is reasonable right now.

First, we don’t want to undo the progress we have made with social distancing and make the mistake of opening too soon (or rather, too soon and without important safeguards in place) like we are seeing in Hokkaido, Japan:

  • “Experts say restrictions were lifted too quickly and too soon because of pressure from local businesses, coupled with a false sense of security in its declining infection rate.”
  • ““Hokkaido shows, for example, that what’s happening in the U.S. with individual governors opening up is very dangerous; of course you can’t close interstate traffic but you need to put controls in place,” says Kazuto Suzuki, Vice Dean of International Politics at Hokkaido University. “That’s what we now know: Even if you control the first wave, you can’t relax.””

Second, we know there are conversations happening on when it’s appropriate to re-open and how. It is not and cannot be a unilateral discussion or decision—there are so many intertwined factors to consider. I, for one, am happy to leave that to the experts. I also do not envy our leadership right now; they are kind of in a damned if you and damned if you don’t situation. Regardless, it would behoove us all to acknowledge that this is a NEW virus never before seen in the world’s population. Even the experts from all sectors of society are scrambling to figure out not only the science of the virus and its medical effects, but also how to manage public health, the economy, and society overall.

The White House recently released the guidelines for Opening Up America Again (download the website as a document here; accessed April 27, 2020). These guidelines are state- or region-based with three phases to opening and a path to “normal.” However, before a state or region can begin Phase One, it must meet data-driven “gating” criteria and have core preparations in place.

Are states or regions ready? The gating criteria are:

  • Downward trajectory of flu-like illnesses reported in a 14-day period –AND– downward trajectory of COVID-like syndromic cases reported in a 14-day period
  • Downward trajectory of documented COVID cases within a 14-day period –AND– downward trajectory of percentage of COVID-positive tests within a 14-day period
  • Hospitals are able to treat all patients without crisis care –AND– have a robust testing program in place for at-risk healthcare workers including emerging antibody testing

Are states or regions ready? Core preparations which should be worked on right now, during this restriction phase, include:

  • Testing and contact tracing
  • Healthcare system capacity
  • Plans to protect workers in high-risk settings, mass transit, protocols for social distancing and mask use, and surveillance and plans for mitigation should new outbreaks occur

When the states/regions have met these criteria, that is when the reopening phases can occur. “In the first phase, people are encouraged to continue practicing social distancing while vulnerable populations remain at home and employees are allowed to continue teleworking. If there’s no indication of a coronavirus rebound, a state can move to phase two, which allows schools to open, nonessential travel to resume and large venues to begin to ease physical distancing. Phase three lifts most remaining restrictions, although it still advises large venues continue “limited” social distancing.” (White House is reviewing expanded guidance on reopening society, Washington Post, April 27, 2020)

The important thing to remember: the stay-at-home/shelter-in-place restrictions were placed to BUY TIME for us to prepare. To reopen, we need to have in place:

  • Testing – who is infected, who has antibodies (at this point in time – antibody testing will give us better answers on how much it has spread in the population; we cannot as of now say they confer immunity)
  • Fortified healthcare system including protection for our healthcare workers
  • Strengthened public health system with surveillance, contact tracing, isolation/quarantine protocols

This draft document from Resolve to Save Lives (downloaded April 19, 2020) is a nice overview of its recommendations on when and how to reopen.

Our way of life will be different at least for a while, likely including continued social distancing measures, wearing masks, and other recommendations (e.g., hand sanitizers at every entrance to buildings, temperature checks). Even following these guidelines, there will be mistakes. There will be second waves. There will be more COVID-19 deaths. This virus is likely not going away. But, better treatments will be discovered. A vaccine, if and when it is available, will not be a panacea, but will be extremely beneficial.

We can learn to live with it, there is hope.

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