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April 17, 2020

The White House's plan to reopen America

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    President Trump on Thursday announced guidelines for states to relax so-called "stay-at-home" orders and begin reopening businesses if they meet certain metrics, as U.S. officials reported another spike of more than 2,000 U.S. deaths tied to the new coronavirus in a 24-hour period.

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    US Covid-19 cases surpass 665K, death toll tops 30K

    As of Friday morning, U.S. officials had reported 667,945 cases of Covid-19, the disease caused by the new coronavirus, in the country—up from 636,917 cases as of Thursday morning.

    Officials as of Friday morning also had reported 30,665 U.S. deaths linked to the new coronavirus—up from 28,586 deaths reported as of Thursday morning.

    Trump announces guidelines for states to reopen businesses, ease social distancing measures

    While the number of U.S. patients with Covid-19 continues to grow, the Trump administration and some state officials are taking steps to evaluate whether they can begin easing social distancing measures that have closed many non-essential businesses throughout the country.

    On Thursday, Trump released guidelines for states to follow to begin relaxing stay-at-home orders, reopening businesses, and restarting their local economies.

    The guidelines note that state officials should consider easing social distancing measures only if:

    • Officials have seen a downward trajectory in influenza-like illnesses in their state for 14 days;
    • Officials have seen a downward trajectory in Covid-19 cases in their state for 14 days;
    • Officials have testing programs, including antibody testing, set up for at-risk health care workers; and
    • Providers have the capacity to treat all Covid-19 patients in the state without operating under a crisis care plan.

    Deborah Birx, a physician who is coordinating the White House's coronavirus task force, said under the guidelines, states will be required to set up testing sites; trace the contacts of people who have tested positive for Covid-19; and identify people infected with the new coronavirus who are asymptomatic, as well as their contacts.

    If states meet those metrics, the guidelines suggest they could begin reopening businesses and easing social distancing measures in three phases:

    Phase one

    Under the first phase, states could reopen movie theaters, restaurants, sports venues, places of worship, gyms, and certain other venues as long as they keep strict social distancing measures in place. However, the guidelines advise people to avoid social settings of more than 10 people unless "precautionary measures" are taken, and minimize nonessential travel.

    Schools and daycares, as well as bars, would remain closed under the first phase. In addition, the guidelines recommend that vulnerable populations, including immunocompromised people, remain at home and bans on visits to nursing homes and hospitals remain in place.

    The guidelines state that some people could return to work under the first phase, but they encourage telework if possible. Birx said employers should institute temperature checks, provide disinfectant, and urge employees to avoid non-essential travel. Employees with compromised immune systems and underlying health conditions who are more vulnerable to Covid-19 should receive special accommodations and be encouraged to work from home, according to Birx.

    According to the guidelines, states could consider transition to the second phase if there "is no evidence of a rebound" in Covid-19 cases and they "satisfy the gating criteria" for a second time.

    Phase two

    Under the second phase, residents could resume nonessential travel and bars could reopen with social distancing restrictions in place. States also could reopen schools and allow youth activities. However, the guidelines recommend vulnerable populations remain at home and bans on visits to nursing homes and hospitals remain in place. The guidelines also continue to recommend telework under phase two and urge individuals to continue maximizing the physical distance between themselves and others. Under phase two, the guidelines recommend that people avoid social settings of more than 50 people unless precautionary measures are taken.

    The guidelines state that, after implementing phase two, states that again see no evidence of Covid-19 cases rebounding and that satisfy the gating criteria for a third time can transition to the third phase.

    Phase three

    Under phase three, state officials could lift restrictions on bars, workplaces, and vulnerable populations, but they should continue to implement social distancing guidelines. In addition, states could lift bans on visits to hospitals and nursing homes. The guidelines recommend that individuals under phase three could resume public interactions but should continue to practice physical distancing and avoid social settings where physical distancing might not be possible unless precautionary measures are taken.

    Trump said states could use the guidelines to begin reopening businesses and easing social distancing measures once they feel they meet the criteria. He said some states are in "good shape" to open quickly, perhaps even before CDC's social distancing recommendations expire on May 1. However, Trump also noted that it might take some states longer to reopen.

    Reopening too early could be risky, Fauci says

    Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, warned that states could experience a surge in Covid-19 cases once they start reopening businesses and easing social distancing guidelines. If states do see an uptick in Covid-19 cases, officials would need to restart the stricter measures currently in place.  

    "There may be some setbacks," Fauci said. "I mean, let's face it, this is uncharted water. There may be some setbacks that [mean] we may have to pull back a little. And then go forward."

    According to Axios' "Vitals," experts say it could be risky for any state, including those that currently have relatively low numbers of Covid-19 cases, to open before having a plan in place to address a potential surge in cases, and Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security, said, "I have not yet seen any place amass the plans or the resources to do that."

    Ashish Jha, director of the Harvard Global Health Institute and professor of medicine at Harvard Medical School, explained that states currently experiencing lower caseloads remain vulnerable to spikes in infection rates. Though the new coronavirus has not yet hit rural and suburban areas as severely as cities, "there's nothing that makes those places immune from coronavirus," he said. "It will just take much longer, because the spread is going to be slow" (Owens, "Vitals," Axios, 4/17; Calfas et al., Wall Street Journal, 4/17; Facher, STAT News, 4/16; Dawsey et al., Washington Post, 4/16; Restuccia/Lucey, Wall Street Journal, 4/16; New York Times, 4/17; White House guidelines, accessed 4/17).

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