Although the outbreak Covid-19 has shown us on a global scale that there is no certainty of the future, experts – epidemiologists, scientists – imagine a progressive lifting of restriction measures and lockdown for after the virus. They are doing so in moderation, though, in the face of evidence of the behavior of the pandemic. One thing is clear to them: the lifting of restrictions and the return to daily activities outside will be progressive, and should be done in phases. In the United States, currently the epicenter of the pandemic, experts don’t foresee fixed dates for their activation.
Ed Yong, a journalist with The Atlantic, recalls this fact: in the U.S. an average of 30,000 new cases are being reported every day.
So there will be different speeds for the return to activities.
The Road Map to Reopening study, prepared by former FDA officials and public health and epidemiology experts from John Hopkins University, talks about four phases — the United States, as most of countries, is still in phase one–:
Phase One. Slowing down the spread. This is the phase at which national, regional and local governments, as appropriate, ordered the closure of schools, bars, restaurants and other spaces where large groups of people tend to congregate and restricted movement and decreed general lockdown with exceptions for essential activities. “These measures will need to be in place in each state until transmission has measurably slowed down and health infrastructure can be scaled up to safely manage the outbreak and care for the sick,” the document recommends.
Phase Two. Reopening by zones. Experts believe that in the U.S., states can move forward individually to lift restrictions, “when they are able to safely diagnose, treat, and isolate COVID-19 cases and their contacts.” At this stage, diagnostic tests should be widespread. The authors see the reopening of schools and businesses as feasible, but with measures of physical distancing and limitations on meetings, the use of masks, strict hygiene in public places and continuous disinfection of shared spaces. Limitations should be extreme for people over 60 years of age and for those with pre-existing diseases. Those who are passing through Covid-19 should maintain their isolation at home.
Phase 3. Establishing immune protection. The physical distance is lifted. This can be done, the study argues, with therapeutic treatments for the patients who are most at risk, an effective vaccine (scientists from several countries around the world are working to create one, but it could take more than a year to be ready), and extensive surveillance and monitoring.
Phase 4. Be prepared for the next pandemic. “After we successfully defeat COVID-19, we must ensure that America is never again unprepared to face a new infectious disease threat,” the study authors state. To this end, they recommend increased investment in research and development initiatives; the expansion of health infrastructure, including public health; and clear governance structures to implement clear preparedness plans.
The Roadmap for Reopening recommends states to only move from phase one, the current phase, to phase two when they are able to prove a sustained reduction in cases for at least 14 continuous days, which is the incubation period of the virus; and also when they have the capability to test “all persons” with symptoms of Covid-19 and monitor all confirmed cases and their contacts; and when local hospitals are confident that they can treat all patients requiring hospitalization without having to apply crisis care standards.
One of the authors of this study, Mark McClellan, told PBS that the length of time these plans will be in place in the United States will depend on how affected each area is and how quickly they are able to move forward between phases.
“Many areas of the country have been lucky. They haven’t had very many cases. So, for them, it will be relatively easy to put in place testing and tracking. It is not going to take as many people, not going to take as much resources,” McClellan said. “So, I think you will see progress within the next month, but it will happen at different paces across the country. And it really depends on getting these key capabilities in place to give people confidence they can go out and get back towards normal without risk of contracting the virus,” he summarized.
Ed Yong, on the other hand, reported in The Atlantic’s piece that a group of health experts led by Ezekiel Emanuel, a former adviser to the Obama administration, believes that general orders to stay at home in the U.S. should continue “at least until May 20th”.
Michael Orterholm, an infectious disease epidemiologist at the University of Minneota, went further in his statement to Yong: ““I think people haven’t understood that this isn’t about the next couple of weeks. This is about the next two years.”
Diagnostic tests for the virus are key to effectively control of the virus.
BBC News journalist Katty Key reported that 100,000 tests are currently being done in the United States every day, but, she reported, the Harvard University Safra Center believes the number of daily tests should rise to between 5 million and 20 million for control to occur. According to Nobel Prize economist Paul Romer, a New York University professor quoted by Key, the number of tests performed each day should be 22 million.
Key interviewed Peggy Hamburg, who was in charge of the Food and Drug Administration with Barack Obama. In Hamburg’s opinion, ideally, antibody tests (immunity) could also be done and then people could return to economic activity. But, she warns, “we’re not there yet to do that with confidence.” There is no solid scientific data on how long it takes to immunize the virus after a contagion has been overcome.
California Governor Gavin Newson and public health officials presented a plan this week for the progressive reopening of activities in that state, reported The New York Times’ Jill Cowan and John Ismay. The timing of activation will depend, they said, on sufficient and rapid evidence to monitor any outbreaks; on officials being able to prevent infections in vulnerable groups such as the elderly and the homeless; on hospitals being sufficiently equipped with beds, ventilators and protective equipment for their workers; on advances in therapies that could help patients recover more quickly; on the adaptation of public places so that physical distance can be maintained; and on the ability at the state and local levels to reinstate containment measures quickly if necessary.
Los Angeles Mayor Eric Garcetti announced that mass gatherings at sporting events or concerts may not resume in that city before 2021.
Other visions suggest a faster speed to reopen economic activity. The BBC News reporter spoke to Tim Bossert, former security adviser to Donald Trump, who says the United States will have to reopen activities without the amount of data that scientists would want, because the economic cost of maintaining a very long shutdown is too high. He suggests, therefore, using the tests that already exist and applying them to people without symptoms, so that asymptomatic people can comply with isolation.