COVID-19: Governors Begin Reopening After White House Issues Guidelines

President Donald Trump issued broad guidelines for a re-opening of the US economy this week, outlining the COVID-19 regulations that should be in place while leaving final decisions to the nation’s governors.

The 18-page document, titled “Opening Up American Again,” could put pressure on some states to send people back to work but acknowledges that conditions vary across the country. Governors are not legally required to follow the guidelines, and both health and business leaders have acknowledged that the ability to test for COVID-19 will be essential.

On Friday, a number of governors announced that they were loosening social distancing in their states.

• Texas Gov. Greg Abbott announced plans for a staged reopening. State parks are opening on Monday and next Friday, Abbott says retail outlets will be allowed to serve customers who ordered ahead. On April 27 - a week from this coming Monday - Abbot said it may be possible for restaurants and movie theaters to open if they can operate while sticking to social distancing rules.
• Vermont Gov. Phil Scott also announced that starting next week that two people could work in the offices of realtors, attorneys, appraisers, and other “low contact” professional services. The governor also said garden and construction supply stores will be allowed to open next week but only with phone and online ordering.
• Minnesota Gov. Tim Walz announced the opening of venues and businesses related to outdoor recreation, including golf courses, driving ranges, shooting ranges, and bait shops, although the openings were made contingent on social distancing guidelines.
• New York Gov. Andrew Cuomo said it that the timing of reopenings may vary. “I think it is logical to think that the timing of reopenings would take into consideration the differences in infection rates and hospitalization rates,” he said at his daily press briefing on Friday. “If you have less of a problem, you can reopen up faster.” In his state, Cuomo said it may be appropriate to think about a staged opening of regions rather a county-by-county approach.

Meanwhile, also on Friday, the American Hospital Association, the American College of Surgeons, the American Society of Anesthesiologists, and the Association of perioperative Registered Nurses issued a joint statement about resuming elective surgery. The eight-point “roadmap” says there should be a sustained reduction in the rate of new COVID-19 cases in the “relevant geographic area” and an adequate supply of PPE, beds, ICU beds, and ventilators. Hospitals are experiencing financial stress because of the sharp fall off of elective surgery and most other elective procedures.

“We must have a working economy,” Trump said on Thursday. “And we want to get it back. Very, very quickly. And that’s what’s going to happen. ” The same day Labor Department figures showed that 22 million Americans have filed for unemployment since Trump declared a national emergency March 13.

The “gating criteria” in the report cover:
• Symptoms. There should be a downward trajectory of “influenza-like illnesses” in the previous 14 days, and a downward trajectory of COVID-like symptoms in cases reported over the same period
• Cases. A downward trajectory of total diagnosed cases or a downward trajectory of positive tests, compared with total tests given over the previous 14 days.
• Hospitals. Should be able to treat all patients without crisis care and have testing in place for at-risk healthcare workers, including antibody testing.

Much of the responsibility for managing re-entry would fall to the states, which would be responsible for developing robust testing programs to ensure safety of healthcare workers and citizens alike. The report calls on states to have a testing system in place that can trace contacts of people who test positive for COVID-19 and quickly produce results. Sentinel screening would be used for some high-risk asymptomatic groups, such as older adults (especially those in congregate care settings), the poor, racial minorities, and Native Americans.

Healthcare systems must be able to “quickly and independently” make sure staff have adequate personal protective equipment (PPE) and enough medical equipment, such as ventilators, in case renewed surges occur.

The plan outlines 3 distinct phases of re-opening for individuals and for employers, including instructions for personal hygiene and re-engagement steps for specific types of employers. In the phase 1, for example, visits to senior living facilities and hospitals would still be prohibited, and strict hygiene protocols would be followed for all who interact with patients. Elective surgeries could resume in phase 1, on an outpatient basis, “at facilities that adhere to CMS guidelines.”

If a state or region clears the gating criteria after a second 14-day period, the area could reach phase 2. Additional “opening” would be permitted for individuals and in workplaces, with elective surgeries permitted on both an inpatient and outpatient basis. However, visits to senior care centers and hospitals would still be prohibited.

Employers are coached to encourage telework during phases 1 and 2.

Once a state or region cleared the 14-day period a third time with no signs of COVID-19 rebound, the area would begin phase 3. This phase would bring unrestricted staffing at worksites. Visits to senior care facilities and hospital would resume.

During this phase, vulnerable populations should still adopt physical distancing. This would include the elderly and those with certain chronic conditions such as diabetes, obesity, or asthma, or those undergoing chemotherapy. Even low-risk individuals are encouraged to avoid large crowds.