Dr. Mark McClellan MD, PhD and the director of the Duke Margolis Center for Health Policy co-authored with several other experts, a roadmap to re-open the US economy a few weeks ago. It is predicated on looking at evidence, and checking capabilities for testing, surveillance and public health. It had four basic stages:
- Control the Spread (we are here right now)
- Limited re-opening with massive surveillance
- Deployment of therapeutics and vaccines to return to normal-ish
- Prepare for the next pandemic
The writing team laid out a fairly clear set of criteria for a region to move from Phase 1 to Phase 2:
Trigger for Moving to Phase II
A state can safely proceed to Phase II when it has achieved all the following:
• A 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 standards of care,
• The state is able to test all people with COVID-19 symptoms, and
• The state is able to conduct active monitoring of confirmed cases and their contacts.
That means a state has a clear peak and a very steady decline. States may go with a smoothing function for a decline as there seems to be strong day of the week seasonality on reporting (Saturday-Monday is light, Wednesday is a local peak of reported cases) or they can require fourteen continual days of decline where each day has a lower case count than the previous day. It means the healthcare system is near normal with nurses, doctors, aides, and cleaning staff all having appropriate protective gear. It means there is a robust testing regime in place that can quickly smother any local flare-ups by rapidly identifying and isolating anyone who was in contact with an infectious individual. It means a lot is in place with a lot of planning and preparation having occurred and then a competently executed public health campaign. If there are failure points in testing, tracing and isolation, the state or a region can flip back to Phase 1 of shutting down to stomp down on the reproductive rate again.
Now the relevant question is: Has Georgia, South Carolina, Florida, Tennessee met any of these criteria?