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May 5, 2020

The move to reopen states could come with a harrowing toll, models project

Daily Briefing

    Many states have begun relaxing social distancing measures without first meeting metrics proposed by the White House to help protect Americans' safety—and CDC and public health experts are now projecting the country will see drastically more cases of Covid-19 and deaths tied to the new coronavirus than they had been a few weeks ago.

    Covid-19 weekly webinar: What health care leaders need to know

    US Covid-19 cases surpass 1.1M, death toll tops 68K

    U.S. officials as of Tuesday morning had reported 1,186,900 cases of Covid-19, the disease caused by the new coronavirus, in the country—up from 1,165,300 cases as of Monday morning.

    As of Tuesday morning, officials also had reported a total of 68,843 U.S. deaths linked to the new coronavirus—up from 67,785 deaths reported as of Monday morning.

    CDC, public health experts project rising rates of Covid-19 cases, deaths

    While the numbers of Covid-19 cases and deaths continue to increase across the country, many states are moving forward with plans to reopen nonessential businesses and relax social distancing measures they had put in place to help curb the country's Covid-19 epidemic—even though several of those states have not met certain metrics laid out in guidance the White House released earlier this month to help states reopen safely. The guidance suggests that state officials consider reopening nonessential businesses and 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 cases of Covid-19 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.

    As of Monday, 27 states had eased social distancing measures and reopened nonessential businesses to some degree, while several other states announced plans to do so in coming weeks, according to a new analysis by the Kaiser Family Foundation (KFF). However, KFF found that many of those states haven't met the caseload or testing criteria outlined in the White House's guidelines. For example, in states such as Colorado, Florida, Indiana, and Texas, the numbers of residents who have tested positive for Covid-19 has been increasing, yet officials have moved forward with easing social distancing measures and reopening nonessential businesses, the Washington Post reports.

    Public health officials and experts have warned that scaling back efforts intended to mitigate the new coronavirus' spread too soon could lead to additional spikes in the country's numbers of Covid-19 cases and deaths—and models from CDC and other public health experts are now predicting those concerns could come to fruition.

    CDC in an internal draft report obtained by the New York Times and the Washington Post projects the rate of newly reported Covid-19 cases in the United States will reach 200,000 per day by June 1—up from a current rate of about 30,000 newly reported cases each day, the Times reports. In addition, CDC in the draft document projects that the rate of newly reported Covid-19 deaths in the United States will reach about 3,000 per day on June 1—up from the current rate of about 1,700 newly reported deaths per day, according to the Times. CDC in the draft document predicts the rates of newly reported Covid-19 cases and deaths will begin to increase beginning around May 14.

    The projections are based on data from CDC and other agencies, the Times reports. According to the Post, it's unclear whether CDC's projections account for states' reopening plans, efforts to scale up testing for the new coronavirus, or a combination of such factors.

    Both CDC and the White House have dismissed the draft report, the Post reports. A CDC spokesperson said the agency did not release the draft document, and the White House in a statement issued Monday said, "This is not a White House document, nor has it been presented to the [White House's] Coronavirus Task Force or gone through interagency vetting." The statement continued, "This data is not reflective of any of the modeling done by the task force, or data that the task force has analyzed."

    But separately, the University of Washington's Institute for Health Metrics and Evaluation (IHME)—a predictive model that the White House has used for its Covid-19 case and death count projections—on Monday revised its projections, estimating that Covid-19 cases and deaths would rise significantly over the next few months as states loosen social distancing policies and reopen nonessential businesses. The IHME model now projects the United States will see about 134,000 deaths tied to the new coronavirus by Aug. 1—up from its projection last week that the country would see 70,000 deaths linked to the virus by August.

    Christopher Murray, the model's creator, said IHME's higher estimates "reflect the effect of premature relaxation of restrictions. In this era where those mandates are being relaxed, people should be aware the risk of infection is still there."

    FDA strengthens rules on coronavirus antibody tests amid accuracy issues

    Meanwhile, FDA on Monday announced the implementation of new, stricter requirements for tests designed to indicate whether a person has developed antibodies to the new coronavirus.

    Policymakers and U.S. health officials have viewed the antibody tests as a way to provide key data that could allow them to reopen businesses and ease social distancing measures. However, public health experts have warned that it's still unclear whether having coronavirus antibodies means a person has developed any immunity to the virus. Further, they've cautioned that many of the tests are unregulated and often produce unreliable results.

    In light of growing concerns about the antibody tests' accuracy, FDA under the new requirements announced Monday will require companies selling the tests to submit data demonstrating the tests' accuracy within 10 days of the tests being sold on the U.S. market. FDA said manufacturers will need to show the tests meet minimum quality standards and submit a request for an emergency use authorization (EUA) from FDA. If manufacturers don't meet those requirements, FDA will remove their antibody tests from the market, the agency said.

    But Hahn cautioned against using results from the tests as the sole indicator for whether it's safe to ease social distancing measures and allow people to return to work.

    "Whether this is the ticket for someone to go back to work [based solely on an antibody test result], my opinion on that would be no," he said (Stolberg/Sullivan, New York Times, 5/4; Cook et al., Politico, 5/4; Olorunnipa, Washington Post, 5/4; Owens, "Vitals," Axios, 5/5; Wan et al., Washington Post, 5/4; Ollstein/Oprysko, Politico, 5/4; Wise, NPR, 5/4; Wayne, Bloomberg, 5/4; Kaplan, New York Times, 5/4; Harris, "Shots," NPR, 5/4; Associated Press/NBC News, 5/4; New York Times, 5/5).

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