Daily life has changed significantly for most of America during the last few weeks and many questions are being posed in the public square; what’s ahead for fighting COVID-19 and when will we return to normal? Or, more accurately, how will we define a new normal?
Some, like Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), and California Governor Gavin Newsom have commented that life will be different for quite a while, or perhaps forever. For example, Dr. Fauci has somewhat jokingly suggested that we say goodbye to shaking hands in our culture, and Governor Newsom has remarked that, when dining out, waitstaff may wear gloves and masks and provide disposable menus – at least during some portion of the reopening phase.
How will we know when it’s safe to reopen our states? Dr. Fauci cautioned that changes to stay-at-home orders should be made in gradual phases to avoid a surge in cases. States have already begun issuing their own milestones that must be achieved before modifying stay-at-home guidelines, and some states in the West, East and Midwest have formed regional pacts to coordinate with one another on their reopening policies to ensure efficacy and avoid harmful setbacks.
A March 2020 report written by some of America’s top experts in medicine, epidemiology, and public health emergencies offers guidance from experts on how our country should move forward in response to COVID-19. According to the report’s definitions, our nation is currently in Phase I, which is intended to slow the spread of COVID-19. It notes that “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 report recommends the following criteria should be met before proceeding with reopening measures (move to Phase II). These “triggers” for each state include:
- Sustained reduction in cases for at least 14 days,
- Hospitals in the state are safely able to treat all patients requiring hospitalization without resorting to crisis standard of care,
- State is able to test all people with COVID-19 symptoms, and
- State is able to conduct active monitoring of confirmed cases and their contacts.
Phase II will consist of “State-by-State Reopening.” During this phase, schools, universities, and businesses would reopen with physical distancing and increased hygiene and cleaning measures implemented. Additionally, social gatherings would need to be kept to less than 50 people. Individuals within high-risk populations, like adults over 60 years of age or those with underlying health conditions, would still be encouraged to limit time in the community during this phase. In addition, teleworking would still be advised, as well as wearing a mask in public and maintaining the CDC’s recommended hygiene measures.
The report continues to outline how we could move forward in establishing immunity and set ourselves to be prepared for the next pandemic. Read the full report here.
The authors include:
- Scott Gottlieb, MD, resident fellow at the American Enterprise Institute and former commissioner of the Food and Drug Administration
- Caitlin Rivers, PhD, MPH, epidemiologist and assistant professor at Johns Hopkins Center for Health Security
- Mark McClellan, MD, PhD, director of Duke-Margolis Center for Health Policy and former commissioner of the Centers for Medicare and Medicaid (CMS)
- Lauren Silvis, JD, senior vice president at Tempus Inc. and former chief of staff for the Food and Drug Administration
- Crystal Watson, DrPh, MPH, health security expert and assistant professor at Johns Hopkins Center for Health Security
Want to find out where your state stands in achieving some of the measures outlined above? There are many COVID-19 maps:
- Johns Hopkins University COVID-19 Dashboard – map of data on testing, hospitalization rates, cumulative confirmed cases and more.
- Covid Act Now – map showing how COVID-19 is spreading in each area, including hospital overload levels.
- Definitive Healthcare: US Hospital Beds Dashboard – map of data on hospital bed usage, including staffed beds and ICU beds.
Clearly, each state is in a different position regarding current COVID-19 cases, testing, hospitalization rates, and hospital bed capacities, and will create response plans with varying requirements over the coming weeks and months. We encourage you to stay informed on the latest COVID-19 factors at play in your area, as well as state and local orders to know your authorities’ response plan.
Visit our dedicated COVID-19 resource page for more information and downloadable assets to help yourself, and your patients, stay safe and informed.
 Scott Gottlieb, MD, Caitlin Rivers, PhD, MPH, Mark B. McClellan, MD, PhD, Lauren Silvis, JD, Crystal Watson, DrPh, MPH, American Enterprise Institute, “National Coronavirus Response: A Road Map to Reopening,” March 28, 2020, https://www.aei.org/wp-content/uploads/2020/03/National-Coronavirus-Response-a-Road-Map-to-Recovering-2.pdf.
 Scott Gottlieb, MD, Caitlin Rivers, PhD, MPH, Mark B. McClellan, MD, PhD, Lauren Silvis, JD, Crystal Watson, DrPh, MPH, American Enterprise Institute, “National Coronavirus Response: A Road Map to Reopening,” March 28, 2020, https://www.aei.org/wp-content/uploads/2020/03/National-Coronavirus-Response-a-Road-Map-to-Recovering-2.pdf, page 6.
 Scott Gottlieb, MD, Caitlin Rivers, PhD, MPH, Mark B. McClellan, MD, PhD, Lauren Silvis, JD, Crystal Watson, DrPh, MPH, American Enterprise Institute, “National Coronavirus Response: A Road Map to Reopening,” March 28, 2020, https://www.aei.org/wp-content/uploads/2020/03/National-Coronavirus-Response-a-Road-Map-to-Recovering-2.pdf, pages 7-9.