By Raul Ruiz and Michael R. Reich
Our nation is now entering a new phase in the COVID-19 pandemic, as we seek to reopen the economy while protecting the public’s health. These two objectives are not in conflict. Indeed, we must do both together.
We developed a five-point checklist to guide efforts to open up safely, based on the best available scientific thinking. Our checklist sets standards for evaluating whether the healthcare system, government and community institutions, and the public are ready.
- Is the timing safe to remove precautions?
COVID-19 has delivered a gut-punch to our collective well-being. To start easing restrictions on movement and public gatherings, we need to establish that the transmission rate is slowing significantly and consistently, as recommended by the White House Task Force, and that our hospital system has recovered so that it can handle another surge, especially with adequate ICU beds in local hospitals.
- Are our communities ready to prevent a new flare-up, especially in high-risk situations?
If the economy is going to safely reopen, governments need to assure that effective public health measures are adopted to protect people from infection. These measures should apply to all locations where groups of people gather, especially nursing homes, businesses, schools, churches, transportation systems, and group events.
Our health system needs to have the capacity needed to test, treat, and monitor the cases that are identified. In coordination with local governments, every Governor needs to delineate clear responsibilities for testing and monitoring in their state. Each jurisdiction needs a defined testing strategy (testing everyone, random community testing, high-risk group testing, or another, based on local needs). That strategy should include an explicit methodology, responsible officials, funding, and goals, along with ongoing assessments of need and performance based on science and facts, not wishful thinking.
- Is our health system ready to save lives and contain a flare-up?
Hospitals need adequate supplies of personal protective equipment (PPEs), tests, and ventilators to protect our frontline healthcare workers and to save the lives of patients, so that we can handle a COVID-19 surge for a month.
Each responsible government entity also needs to set up an effective system for contact tracing when cases of COVID-19 are identified. Timely contact tracing of confirmed cases is essential to contain the virus, lower transmission, and prevent a surge of infections.
In addition, newly infected individuals need to be isolated and quarantined so they don’t spread the virus further. People who cannot isolate in their own living space need assistance. Governments and local institutions must employ “support and resource managers” to help place those infected individuals in safe quarantine or isolation locations and help address their nutritional and medical needs.
- Are we ready to establish and enforce requirements, set expectations, and clearly communicate those to the public?
Assuring safe public behavior as the economy reopens will require effective regulations and enforcement mechanisms that demonstrate compliance matters and non-compliance has consequences. Government officials need to communicate regularly with their constituents to explain the reasons for those regulations and the standards for gradual relaxing of social distancing.
- Are there clear guidelines to help government determine when to reinstate stay-at-home precautions?
Finally, governments need to establish and communicate the triggers for restoring stay-at-home measures if the infection rate starts to rise again. The triggers need to be clearly defined, such as a sustained increase in new cases over 14 days.
Creating community support in the coming months requires public trust. Establishing and communicating guidelines will help build that trust, and also reinforce the principle that opening up is conditional on continued progress in controlling transmission.
A downloadable checklist and related key references are available at: www.ruiz.house.gov.
Congressman Raul Ruiz MD, MPH, MPP is trained in humanitarian and disaster aid and is the U.S. Congressman for California’s 36th District, serving since 2013.
Michael R. Reich is Takemi Research Professor of International Health Policy at the Harvard T.H. Chan School of Public Health.
