The reopening of America will need to happen on a state-by state, county-by-county basis. One problem that may hinder the process is that different areas may have many available resources to reopen, but too many COVID-19 cases to safely reopen.
Or other areas may have the pandemic well managed, but few resources to implement a reopening strategy. We have diverse types of localities throughout the country, and the new coronavirus that causes COVID-19 has affected them in different ways.
For instance, Los Angeles and New York City both are heavily populated cities. But New York’s density and reliance on public transit, as opposed to the broad sprawl of Los Angeles connected by multilane freeways, resulted in New York City’s having more cases by itself than any individual state in the country.
The White House clearly recognizes the different situations. It has rolled out a phased approach to reopen the country, giving governors and mayors tremendous leeway in gauging when to begin relaxing mitigation strategies.
States such as New York and its neighbors likely will take much longer to advance through the phases. But some states have fewer than 1,000 confirmed cases of COVID-19 and will be able to reopen sooner.
Included in the White House’s plan is a set of “gating criteria” that should be met before the reopening begins. States or regions should see a 14-day period of downward trends in confirmed or reported cases of COVID-19 in absolute terms or relative to the total number of tests conducted.
As well, the health systems in an area should be able to treat all patients without resorting to crisis care, treating patients with expedient measures such as splitting ventilators or using improvised personal protective equipment. Health systems also will need to have a robust testing program to catch any new resurgence in cases.
In short, these requirements ensure that a state or region not only is managing its COVID-19 caseload, but has the resources to detect and quarantine new cases and withstand a new outbreak. That may present a problem in reopening America.
States and counties differ in their access to levels of public health resources, without which it will be difficult to resume normal activity without great risk to Americans’ health and health care. Even within the state of New York, for example, some counties are reporting case numbers in the double and single digits, as opposed to more than 36,000 cases in Kings County.
Counties with relatively few cases of COVID-19 likely would be able to contain the spread of the coronavirus with broad testing, identification of new cases, and isolating individuals. The problem is that these counties also are much more likely to have under-resourced health departments and may lack adequate supplies or personnel to effect a reopening, which will slow down the overall effort nationally.
The federal government has focused its attention primarily on the hot spots around the country. But as the number of cases begin to trend downward nationally, the government should prepare to assist areas with the fewest cases.
In the early response to the pandemic, the Federal Emergency Management Agency coordinated distribution of large packages that bolstered an area’s health care treatment and testing capacity. Now, FEMA or other agencies should send similar packages, tailored to smaller localities, to areas that need assistance in meeting the gating criteria.
We’ll likely need to assist local testing capacity and capability. Since the beginning of the coronavirus outbreak in America, health officials have developed and employed numerous new tests and types of tests. In addition to the need for test material for high-capacity laboratories, we’ll have greater need for point-of-care tests that can generate individual results within 15 minutes.
These tests would enable more convenient testing sites that allow a person to know almost immediately whether to self-isolate or to carry on cautiously. (So long as there are active cases in a community, everyone will need to exercise caution with regard to transmitting the disease.)
The other potential need in a community is for personal protective equipment, both for health care workers and for those presenting symptoms of illness.
Treating such a contagious disease consumes a large amount of personal protective equipment, especially if there aren’t separate wards dedicated to treating COVID-19 patients.
Ideally, a health care worker discards his set of personal protective equipment after entering and exiting a patient’s room, but when supplies were short, workers had to keep their masks and face shields for several shifts or until they were visibly soiled.
That makes personal protective equipment a good way that the federal government can backstop local efforts to prepare for a resurgence in cases.
Americans want a return to life before the coronavirus. That probably won’t happen, and it certainly won’t happen if we rush the reopening of America and see resurgences of new COVID-19 cases.
The White House’s phased approach relies on states and localities to reopen as fast and as safely as possible. Where the federal government can continue to help is by increasing its focus on areas that are the closest to reopening, and enabling them to do so.