• The COVID-19 pandemic has rampaged throughout the planet, but a few encouraging signs are giving some citizens the impetus to emerge from their homes. Although the number of cases and deaths continue to rise, several countries have flattened or are clearly on the far end of the bell curve.

    Testing in the U.S. has surpassed 10 million and the percentage of severe cases requiring ventilator support are dropping somewhat compared to total cases.

    Although some pandemic supplies are still generally unavailable to the average citizen, hospital staffs (in our area, at least) seem to be getting more personal protection equipment than before. While still accepting donations, Cleveland Clinic Florida states on its website: “…through months of planning for the pandemic it had “adequate supplies and medical equipment…”

    As time goes on, personal protection gear will become more available

    Aside: This may not be the case everywhere. If you have a lot of extra personal protection equipment, consider donating some to your local hospital in case of a second wave of COVID-19 cases.

    While we are beginning to get more optimistic with regards to public health, the financial news is terrible. 36.5 million unemployment claims have been filed. Businesses are reaching the point of no return; some brick-and-mortar enterprises may not survive if they don’t reopen soon.

    And the customers? Just because the businesses are reopening doesn’t mean the patrons will come flowing back. Many people have been traumatized and are scared to venture out into the New Normal. Some have been able to work from home, cook dinner instead of eating out, and otherwise fend for themselves. They won’t be seeking these services outside the home so much anymore, even if money isn’t an issue.

    Cooking at home

    The Centers for Disease Control and Prevention (CDC) recently released a detailed 17-page document of its recommendations for reopening. Some believe the criteria may be too strict. The battle between public health and public policy continues.

    What are the criteria that must be met before reopening occurs in the U.S.? The federal government is giving leeway to state governments, but there are 50 states, and almost as many different plans of action.

    FEDERAL PLANS

    The federal government (and most states) want a phased approach to return to normal (or at least the New Normal). Optimally, certain milestones should be reached before beginning phases:

    SYMPTOMS: The federal government recommends that the reopening should begin when there is a downward trajectory on the graph of cases of influenza-like illnesses (ILI) within a 14-day period as well as a similar trajectory specific to COVID-19 signs and symptoms.

    CASES: The federal government wants to see a downward trajectory of documented COVID-19 cases within a 14-day period, or at least a downward trajectory of positive tests as a percentage of total tests conducted with a 14-day period. This assumes at least a similar (or larger) quantity of tests performed during the same time period.

    HOSPITALS: The goal is to have a robust testing program in place for at-risk healthcare workers with a particular interest in checking for antibodies against COVID-19. Also, hospitals would need to have no or few patients requiring “crisis care”.

    PHASE 1

    INDIVIDUALS SHOULD:

    Continue to shelter in place and, if not social-distancing, isolate anyone considered vulnerable to COVID-19.

    Maximize physical distance from others when out in public.

    Avoid gatherings of more than 10 people.

    Minimize non-essential travel and isolate after you travel (self-quarantine).

    EMPLOYERS SHOULD:

    Continue to have employees work from home whenever possible. Workers should return to the workplace in phases.

    Keep break rooms and other common areas closed.

    Try to minimize non-essential work travel and follow CDC guidelines on isolation when they get back.

    Consider special protections for employees that fall into the vulnerable population group (65 and older, underlying health conditions).

    SPECIAL CASES:

    Schools, day cares, and camps should remain closed.

    Visiting senior living facilities and hospitals will still be prohibited.

    Large venues (restaurants, theaters, sports arenas, places of worship, gyms) can operate under strict physical distancing and sanitation protocols. Bars should remain closed.

    Outpatient elective surgeries can resume.

    PHASE 2

    If a state or region has not seen a rebound in cases as a result of the above measures and fulfills the initial requirements for starting Phase 1 a second time, they can implement Phase 2.

    INDIVIDUALS SHOULD:

    Continue to shelter in place if vulnerable. Take precautions to isolate those living with you who are considered vulnerable, especially if not social-distancing.

    Maximize physical distance from others when out in public.

    Avoid gatherings where there is more than 50 people.

    Non-essential travel can resume.

    EMPLOYERS SHOULD:

    Maintain Phase 1 guidelines except that work travel, when necessary, can resume.

    Continue to have employees work from home whenever possible. That could include returning workers in phases.

    Continue to keep common areas in the workplace closed.

    Consider special accommodations for vulnerable employees.

    SPECIAL CASES

    Schools, day cares, camps and other youth activities can reopen.

    Visitors are still prohibited at senior care facilities.

    Bars may reopen with reduced numbers allowed in a standing-room area.

    PHASE 3

    If a state or region is still not seeing a rebound in COVID-19 cases and fulfills the requirements for starting the phases for a third time, they can begin Phase 3.

    INDIVIDUALS SHOULD:

    Begin to interact with the public again while limiting large group gatherings and continuing social distancing.

    Minimize time spent in crowded areas even if low-risk.

    EMPLOYERS:

    There is no longer restrictions for staffing or worksites.

    SPECIAL CASES:

    Visitors are allowed at a senior care facility or hospital.

    Large venues can operate with only limited physical distancing.

    Gyms can operate normally (with standard sanitation policies).

    Bars can allow more people in standing room areas.

    STATE PLANS

    The federal government gives a great deal of leeway to state and local officials in tailoring criteria to meet circumstances in certain areas. Rules may differ in a large metropolitan area in a state as compared to more rural zones.

    The goals for a particular state should at least:

    • Protect the health and safety of essential workers.
    • Protect the healthy and safety of those living and working in high-risk facilities, such as nursing homes.
    • Protect employees and users of mass transit.
    • Disseminate information widely to inform citizens about social distancing, face coverings, and other preventative strategies
    • Have the ability to closely monitor and rapidly take steps to limit or mitigate first or second wave outbreaks by returning to more restrictive measures.

    STATE-BY-STATE

    Some governors are forming pacts with neighboring states while others go their own way. Some are extending stay-at-home orders while others are formulating specific plans of action for reopening some businesses immediately.  The plans for each state are public information, which can be found at:

    NORTHEAST: https://www.npr.org/847331283

    MIDWEST: https://www.npr.org/847413697

    SOUTH: https://www.npr.org/847415273

    WEST: https://www.npr.org/847416108

    WHAT SHOULD YOU DO?

    The average citizen can move the process of reopening along by cooperating with advice to decrease new cases of COVID-19. By now, people should know to:

    •             Continue to frequently wash hands with soap and water or hand sanitizer, especially after touching communal or otherwise frequently touched items or surfaces.

    •             Avoid touching their faces, especially nose, mouth, and eyes.

    •             Sneeze or cough into a tissue or, at least, the inside of an elbow or upper arm.

    •             Disinfect frequently used items and surfaces often.

    •             Use a face covering while in public, especially in areas where people congregate.

    Reopening will be difficult even in the most favorable circumstances. We’ll need to help each other get through it as intact as possible. If we don’t, we may be undone in the same way the Martians were in Orson Welles’ “War of the Worlds”: by a microbe.

    Joe Alton MD

    Dr. Alton

    Fill those holes in your medical storage with medical kits and supplies from Nurse Amy’s entire line at store.doomandbloom.net.

    Just some of the medical kits from Doom and Bloom/Grab n Go

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