Reopening the Country

Just 6 weeks ago, the US had 100 confirmed cases of COVID-19 and 6 deaths – all in Washington state. Today, the country is a vastly different place. There are 560,433+ confirmed cases in all 50 states and in all US-held territories, and 22,115+ COVID-19 related deaths and the US leads the global case count. Most states are entering their fourth week of mandated shelter-in-place orders, and only essential businesses remain fully operational.

As US federal, state, and local lawmakers grapple with critical decisions as to when – and how – businesses can reopen and we can leave our homes again, two of Europe’s worst-affected countries, Italy and Spain, have relaxed some restrictions amidst the World Health Organization cautioning that lifting quarantine orders too soon could create a second “deadly” wave of infections. Italy plans to reopen some retail stores, and residents will be allowed to go outside, although the nation-wide lock-down will remain in place until May 3. Spain has allowed construction and factory employees – two vital industries in the nation’s economy – to return to work in some parts of the country. The ease of certain restrictions did not come without criticism, as leading public health leaders in Spain fear that the decision is an “unnecessary risk” and could cause an onslaught of new infections and “collapse” regional and local healthcare systems.

Reopening too early is a concern echoed by the United States leading infectious disease expert – Dr. Fauci. Dr. Fauci stated on Saturday that for the US, “there will be a rolling re-entry … it is not a one-size-fits-all.” Although he lamented that pullbacks could begin in May, he cautioned that “if you do [reopen] in an all-or-none way, there is an extraordinary risk of there being a rebound.”

Restarts will be Gradual & State-By-State

Human trials for a vaccine have started, but it will be 18 months at the very earliest that we could see a vetted and approved vaccine or an effective treatment solution for COVID-19. Until then, we will always have some risk of transmission and community spread. Despite the risk, it is expected that states will gradually begin to reopen in phases over the next few months as some states, like New York and New Jersey, are reporting a slight “plateau” and even a decline in cases.

In the northeast, the Governors from New York, New Jersey, Delaware, Pennsylvania, Rhode Island, and Connecticut announced today a coordinated plan for reopening that region, and that the plan will be released in a few weeks. Their teams, and public health officials and lawmakers around the country will use the following criteria and other key factors executed through a multi-faceted system of barometers when deciding how and when to reopen.

Evaluating Healthcare Systems

The most important factor to reopen will be the condition of local and regional healthcare systems, and the predictive number of near-future cases. Hospitals and medical facilities will need to be able to treat all patients, and expected patients, without resorting to crisis mode, as New York City is still currently experiencing. Available resources, medical supplies, and the health and safety of medical staff will be among the key drivers in determining how an area can handle more cases if quarantine restrictions are lifted.

The Flattening of the Curve

Lawmakers will review if protective measures like social distancing and confinement were effective in reducing community transmission. If local and regional cases drop significantly within a 14-day period, the duration that symptoms typically present in an infected person, it is assumed that suppression of the virus is occurring. These measures will vary state to state, and will depend on the local population, the number of cases, and other factors.

Antibody Testing

States and health leaders are pushing for widespread antibody testing for their communities which would give critical insights as to who has been exposed to the virus, recovered, and therefore has immunity to future infections, and could safely return to work. Antibody testing is important as it not only shows who is immune, but also shows how widespread and deadly the disease really is. Dr. Sood, Vice Dean of Research at University of Southern California Sol Price School of Public Policy, is working with Los Angeles Public Health Department to determine just how deadly this disease is. Sood: “There have been 223 deaths in LA county. If 2,500 people were infected, then this is a very deadly disease. If antibody testing reveals that 2.2 million people had been infected, then it would not be as dangerous.” And the country could reopen. Dr. Fauci stated that antibody tests would be available to public state labs in a matter of days or weeks.


States are moving forward to coordinate reopening efforts, and while pre-COVID-19 normalcy is months if not years away, progress is being made.