Criteria For Loosening Restrictions

Last week, President Donald Trump decided that the country must open back up. He issued a slide package about requirements for opening things back up. The next day, he issued three “LIBERATE” tweets, naming specific states. The purpose of those tweets seems to have been to encourage demonstrations against distancing provisions issued by those governors.

The demonstrations themselves seem to be centrally directed rather than spontaneous, and financially supported by the right-wing money machine.

The White House requirements lay responsibility on the states only. The federal government has abdicated its role in making sure that citizens are safe. They are also almost entirely devoid of measurable criteria. The one exception is the “gating criteria.”

  • Downward trajectory of influenza-like illnesses (ILI) AND “covid-like syndromic cases” reported within a 14-day period
  • Likewise for “documented cases” OR “positive tests as a percent of total tests”

Exactly how these “gating criteria” are supposed to work, or who is to make the judgments and how, or which data are to be reported to make up these “downward trajectories” is not explained. Nor is a “downward trajectory.”

No state, and certainly the United States overall, has seen any such 14-day decrease to justify loosening distance restrictions. A Gallup poll shows that 70% of the nation would prefer to continue as we are.

Governor Larry Hogan of Maryland, a Republican, has said that the state’s daily death toll, hospitalizations, and ICU bed use must all decline every day over a 14-day period before he will consider loosening restrictions. His full plan is to be released this week.

The White House requirements make the states responsible for testing. This, along with the states’ having to procure personal protective equipment (PPE) and ventilators on their own, has resulted in a scramble and presumably a bonanza for middlemen. Apparently various components of the tests are in shortage, which accounts for the current decrease in testing. The federal government could identify these shortages and require production of the missing components under the Defense Procurement Act.

Testing is essential to bringing and keeping the progress of disease under control. It looks like people who are incubating COVID-19 but have not yet shown symptoms can spread the virus. It’s also possible that some people may carry the virus and never get sick. Those people cannot be identified without widespread testing. Harvard experts argue that we need at least three times the level of testing we have now.

As more people become sick and recover, it will also be important to test for immunity, about which we know little. We do not know whether having had COVID-19 confers a robust immunity, how long that immunity lasts, or whether it could, as has recently been found for dengue fever, make a subsequent infection worse. It would be valuable for individuals to know if they are immune. The numbers of immune people are important for gauging how and when to begin opening the economy back up. Antibody tests are coming onto the market now, but they are uncertified by the FDA and variable in reliability.

Plans must also be in place to return to stringent distancing if lessening those requirements leads to a flare-up. The parameter for the disease’s spreading, R, seems to be approaching 1 with stringent distancing. But herd immunity, the fraction of people who are recovered and presumably immune, which must be 70% or higher to be effective, is under 10% and probably less than 5%. Criteria should be set ahead of time and made public so that there are no surprises.

Further complicating the situation is that federal officers have been interdicting supply shipments to the states. On top of the forced competition among the states, the seizures make access to PPE and other necessities uncertain. Numerous seizures have been reported; the Chief Physician Executive of Baystate Health in Springfield, Massachusetts, published his experience in the New England Journal of Medicine. No explanation has been given for these seizures. The federal government is actively undermining the ability of the states to deal with the pandemic.

There is no reason to believe that it is safe to back off from distancing now. The numbers of cases and deaths in the United States are still going up. We must have a period of decrease in those numbers before we even consider it.

Cross-posted to Balloon Juice