The U.S. will begin following a phased-in approach to begin reopening the economy in the wake of the COVID-19 crisis, the White House Coroanavirus Task Force announced on Thursday evening.
Deborah Birx, M.D., the response coordinator for the task force, detailed the criteria states and cities should use to determine when and how they should begin opening different segments of their respective economies.
For starters, Birx said, they must see data that shows a sustained decline in influenza-like illness, as well as positive COVID-19 cases with persistent testing, for a minimum of 14-days.
"For the hospitals, it's to ensure we can treat all patients without resorting to any crisis care and ensuring there is a robust testing program in place for at risk healthcare workers including frontline responders with the emerging antibody tests," Birx said.
She said they are setting up "sentinel surveillance sites" to detect asymptomatic individuals in the community. "We want to be able to find them in communities of particular vulnerability so we'll be doing sentinel surveillance throughout nursing homes, throughout inner-city federal clinics, and throughout indigenous populations to really be able to find early alerts of asymptomatic individuals in the community." That would be followed up by contact tracing, she said.
Birx said the plan lays out expectations for planning to ensure healthcare facilities have adequate access to PPE to handle surges and that ICUs can handle increase capacity.
"We want every state to have a plan for the health and safety of its workers in critical industries and to protect the health and safety of those living in high-risk facilities including senior care facilities." Nursing homes will be a particular focus moving forward, she said.
All plans include ongoing efforts by individuals to contain the spread of the virus including social distancing efforts, persistent handwashing, disinfecting surfaces, using face masks in public areas and staying home when ill, Birx said.
The guidance released on Thursday approach also calls for:
In those states that have gone through the criteria, such as 14-days of a decline in evidence of illness despite adequate testing, can move into phase one.
In phase one, vulnerable individuals should continue to shelter in place while those individuals that do begin going out in public continue practicing social distancing such as avoiding large gatherings and non-essential travel. Visits to senior living facilities and hospitals should continue to be prohibited. Gyms can open if they can adhere to strict physical distancing. Elective surgeries can resume on an outpatient basis.
Employers should make special accommodations for vulnerable individuals and continue encouraging telework options. Employers should begin returning employees back to work in phases. Schools should remain closed. Large venues including sit-down dining can only be operated under strict physical distancing protocols and maintaining that six feet.
Health groups urge caution
Health experts urged caution about "prematurely easing social distancing measures" before adequate testing is available.
The Infectious Diseases Society of America and its HIV Medicine Association released recommendations calling for a rolling and incremental approach to lifting these restrictions. That approach must reflect state and regional capacities for diagnosing, isolating and treating people with the virus, tracing their contacts, protecting health care workers, and addressing the needs of populations disproportionately affected by COVID-19, they said.
"Changes to current physical distancing policies should only begin when widespread testing allows accurate surveillance of the coronavirus spread," the organizations said in a statement. "A significant expansion of tests, testing, personal protective equipment (PPE) and other medical supplies, and public health workers is still needed to reach the level of testing and surveillance necessary to safely reopen the country."