Opening Up America Again: The Dilemma

By Dr. Alesia Greene

 

As America welcomes the month of May, the President’s “30 days to Slow the Spread” guidelines have expired. Nationwide it is now up to the states, counties, and cities to set the public health policies for their local areas. 

 

However, the President’s Coronavirus Task Force did provide a recommended strategy for states to help minimize our risk of a large second wave of COVID-19 infections, medical resource strain, and deaths. The tough part for most of us is that local policies are coming from all levels and many do not align with the Task Force’s recommendations.

 

The Opening Up America Again guideline reveals a three-phase approach on when it would be safest to lift stay at home orders for each state or community. Each phase is 14 days long and monitors three basic data points:

 

Satisfy Before proceeding to phased comeback

 

Communities should be monitoring the number of people with symptoms consistent with COVID-19, people with confirmed COVID-19, and hospital resource capacity to include adequate protection and monitoring for health care workers.

 

As of May 1, twenty-one states have advanced to Opening Up Phase 1 despite a lack of evidence that COVID-19 cases or positive tests are on a downward trajectory. Further, in those states that have leaned forward and opened up public spaces, people have often disregarded the basic social distancing guidance. 

 

Alternatively, our leaders are faced with tough decisions as so many businesses and families are on the edge of financial survival and pushing ahead to open up as soon as possible is the lifeline they need.

 

The dilemma of when and how fast to open up and, most importantly, our SUCCESS in opening up without another significant peak of COVID-19 infections will ultimately rely on each of us as citizens. Can we stay disciplined with social distancing and hand hygiene? Can we be honest when we are sick and stay home from a job or school for 14 days? Can we avoid making exceptions for large group socializing because it’s a special occasion or “just this once?” 

 

Opening up will continue to require all of us to wash our hands frequently with soap, avoid touching our face, disinfecting surfaces frequently, and wearing a face covering while in public, particularly when using mass transit or in places where you cannot maintain 6-feet of distance from other people.

 

In addition to good hygiene practices, the President’s Task Force has some other important limits for individuals in the opening up phases.

 

Advancing forward and backward through these phases based on COVID-19 cases and positive tests is to be expected. As we come back into our public spaces it is expected that outbreaks will occur which may require temporary stay at home restrictions. However, if individuals adhere to these guidelines, suppression of person-to-person spread will persist.

 

Finally, a few thoughts surrounding herd immunity: The end of the COVID-19 pandemic will rely on the majority of the world population achieving sustained immunity to the virus. There are many unknowns right now about population immunity. 

 

At this point some early sampling in Miami as well as Los Angeles, and Santa Clara County in California suggests that the US current immunity rate is between 4-5%. A sampling in New York City showed it could be as high as 12-17%, but there are some concerns regarding that study. For the spread of COVID-19 to stop, it is estimated that approximately 70% of individuals would need to be immune.

 

Further caution is also needed as there are so many unknowns about the COVID-19 immunity. How long does it last? How high do the levels have to be to protect a person from becoming re-infected? Polio, as an example, requires five vaccine boosters before humans develop significant lifelong immunity. Measles requires only two, but is so infectious that it requires 94-95% of the population to be immune before it stops spreading.

 

Our dilemma as we open up is: are we going to achieve “herd immunity” the hard way or bide our time with a phased approach to achieve it through vaccination (a tool that is probably 12 months away)?

 

“Therefore if you have any encouragement from being united with Christ, if any comfort from his love, if any common sharing in the Spirit, if any tenderness and compassion, then make my joy complete by being like-minded, having the same love, being one in spirit and of one mind. Do nothing out of selfish ambition or vain conceit. Rather, in humility value others above yourselves, not looking to your own interests but each of you to the interests of the others.”  Philippians 2:1-4