What happens after shelter in place?
Knowledge about the COVD-19 pandemic continues to evolve almost daily. According to the CDC, the United States has been currently in the acceleration of the pandemic wave, or the upward curve as the new virus infects susceptible people.
Since there is no vaccine or drug to prevent the virus, the focus has been on community actions including social distancing and home isolation to mitigate the spread of coronavirus and the subsequent disease COVID-19.
Across the country, schools, movie theaters, restaurants, and sporting arenas have been closed to discourage social gatherings and non-essential work staff have been encouraged to work from home.
What is the next step?
These community actions, while designed to save lives and flatten the curve, have caused social and economic hardships experienced on a global level. Therefore, there has been a great focus and debate on the next steps in response to this pandemic.
According to the Centers for Disease Control and Prevention (CDC), these next steps can only happen when a deceleration of the pandemic wave has been determined. Because COVID-19 has impacted regions of the US with different levels of intensity, states have the responsibility to determine and implement recovery plans. The United States Federal Government has proposed the following state and/or regional criteria that must be satisfied before a phased reopening can begin.
What is a phased reopening?
Once certain criteria has been met, the state or region could advance to:
- Phase 1: Vulnerable individuals would continue to shelter in place and schools would stay closed. Workers would be urged to telework and non-essential travel would be discouraged. Businesses, such as restaurants, could reopen with strict social distancing protocols.
- Phase 2: Schools and daycares could reopen and some people could return to their workplaces. Non-essential travel could resume. Gatherings of more than 50 people would be avoided. Vulnerable individuals would continue to shelter in place. Nursing home visits would still be prohibited.
Phase 3: There would be no workplace restrictions. Businesses like restaurants would operate under very few restrictions. Vulnerable individuals could go out in public but would be encouraged to practice social distancing.
What criteria must be met before phase 1 can begin?
The following criteria in symptoms, cases and hospitalizations must be met:
- SYMPTOMS: Downward trajectory of both influenza-like illnesses AND COVID-19 type cases reported within a 14-day period.
- CASES: Downward trajectory of documented COVID-19 cases within a 14-day period or a downward trajectory of positive tests as a percent of total tests within a 14-day period.
- HOSPITALS: Ability to treat all patients without COVID-19 crisis care AND robust testing program in place for at-risk healthcare workers, including emerging antibody testing.
What is robust testing?
According to these guidelines, these criteria can only be met when there are systems in place to accurately identify and isolate new exposures to coronavirus. This includes the ability to:
- Quickly set up safe and efficient screening and testing sites for symptomatic individuals and trace contacts of those with positive COVID-19 test results.
- Test indicated persons with influenza-like illnesses for COVID-19 and trace the contacts of those with COVID-19 positive test results.
Ensure surveillance sites are screening for asymptomatic cases and individuals withCOVID-19 results are traced; as well as identifying all persons who may have come into contact with an infected person.
What testing is now available?
In order to successfully screen as the above criteria demands, there will need to be a fast and reliable way to screen large numbers of people. Currently, there are several different ways to test for coronavirus. Two main types of tests for coronavirus are available: molecular and serological. Molecular tests use swabs to detect the presence of viral genetic material in the nose and/or throat. This is the way that COVID-19 is diagnosed. Serological tests are blood tests that can identify those that have recovered from the COVID-19 infection.
The U.S. Food and Drug Administration (FDA) recently approved the first at-home collection molecular test. The test kits contain supplies to collect samples, including a nasal swab which you send back to the lab for testing. There is also a new point-of-care test, that just received emergency-use authorization by the FDA, that may deliver results in as little as five minutes. For more information about available testing for coronavirus please read this article
When will Phase 3 occur?
Even when wide-spread point of care testing is available and accessible to all, life may not return to pre-coronavirus standards anytime soon. There are still no FDA-approved medications to treat COVID-19. An available vaccine may not be available for several years. It is easy to feel overwhelmed and powerless in a period of uncertainty like this one. The important thing to know is that small steps taken by individuals and communities have a large impact to slow the spread of COVID-19. Continue to check in with the CDC for the most up to date information on how to stay safe.