The Centers for Disease Control and Prevention (CDC) recently released their most detailed guidelines for reopening weeks after the White House reportedly repressed them.
The new guidance of 60 pages is not as detailed as a version that leaked on May 13, as first reported by the Associated Pressbut has a structure and completeness not seen before in federal reopening documents.
Not only does it cover non-essential companies, but it also offers suggestions for tracking contacts and best practices for schools, places of worship and public transport. The document, although not required, is useful because it offers a step-by-step plan; unfortunately – despite the assurances of CDC director Robert Redfield – few states actually meet the proposed criteria for phase 1 reopening, a fact that has not prevented about 30 states from starting it.
States and jurisdictions should see at least one of the following during a two-week period before the reopening process begins: a decrease in the number of confirmed cases, a decrease in the number of cases requiring intensive care, a decrease in the number of people present in emergency rooms with flu-like symptoms, a downward trajectory in positive tests as a percentage of the total tests, producing faster test results and showing the ability to treat all cases without crisis care.
The gating criteria are similar to those in the White House Guidelines for Reopening America the beginning of May. The document notes that some areas cannot progress through the phases in sequence, as viral transmissions rise and fall. “Given the potential for a recovery in the number of cases or the level of community transfer, a low threshold for restoring stricter mitigation standards is essential,” the guideline says.
The document also provides detailed guides for individual jurisdictions and public areas such as shops, bars and schools during the reopening process.
“This guidance provides a menu of security measures, from which institutions can choose the ones that make sense for them in the context of their activities and local community,” it reads.
The document is because many schools are planning how and if to reopen personal learning. The guideline recommends that schools remain closed in phase 1 of reopening.
Schools can safely reopen in phase 2, but the CDC recommends taking some important health measures first, such as daily temperature checks for staff and students, and having students have lunch in their own classrooms. It also strongly encourages face cloths for staff and older students, especially when social distance is not possible.
Hygiene supplies, such as soap and hand sanitizer, should also be readily available to students, and classroom and bus surfaces must be disinfected daily. Windows and doors should be open as much as possible to increase airflow; however, this is probably not possible for districts in cooler, northern areas.
The guidance also offers ideas for keeping students physically separated as safely as possible. While some school districts try to limit the number of days students are physically present at school, the CDC recommends keeping the same group of students and staff together as often as possible. This could be more easily achieved with elementary students, but high and high school students, who typically share a classroom with a new group of students and staff for each class period, could see major changes in the way their classes are planned.
However, some of these important criteria are hampered by regional differences in testing capacity and reporting. To add to the confusion, Redfield said on Tuesday it was safe for states to reopen now, contrary to the guidelines of his own agency.
“I want to make it clear that the community broadcast, the community broadcast that overwhelmed public health departments in late February, March, April, is really coming down,” said Redfield in an interview with Hill.
Most states are now taking definitive steps toward reopening – though it happens that only 13 states had actually met CDC guidelines on May 17.
The guidelines are unclear at what stage certain communities should be
The White House guidelines were in effect in late April, when Georgia, Tennessee and South Carolina started the reopening process. Georgia in particular took aggressive steps toward reopening, allowing bowling lanes, gyms, tattoo parlors, barbershops, nail technicians, beauticians and massage therapists to open their doors on April 24, and restaurants and cinemas to maintain strict social distance guidelines. April 27th.
Due to the delay between infection and a positive test, it is too early to make definitive statements about Covid-19 in a place like Georgia. But after an initial decline in positive tests just after reopening (from infections that had occurred two weeks earlier), Georgia is again seeing the infection rate start to rise again.
According to the 60-page document, Georgia may need to start considering relocating a housing order or other, more stringent social distance measures. However, states are not required to follow the guidelines and moreover there is plenty of room for interpretation within the guidance that Governor Brian Kemp could circumvent.
The confusion lies in part of the soft language used throughout the document. Despite the use of strict gate criteria, some recommendations in the document are prescribed for areas with “low levels” of Covid-19 distribution and areas “with confidence that the incidence of infection is really low”.
Adding to the difficulty of managing a convincing reopening process are regional differences in infection rates within states themselves. For example, in Virginia, many rural areas of the state have low infection rates to begin with, and some meet some of the gate criteria for Stage 2 or 3. But in the northern part of the state, in the suburbs of Washington, DC, for example, still community spread at a fairly high levelwhich, according to the guidance, would mean waiting for reopening or going through the stages.
This puts Virginia governor, Ralph Northam, in a difficult position in making statewide decisions. In response, Northam has lifted many of the statewide restrictions and allowed some counties, as in northern Virginiato open again later. It is a pattern now seen across the country. Progress is being made in controlling the outbreak in one part of a state, while the situation in another city or province is deteriorating. Reopening done well in the US is likely to cause many seizures until an effective treatment or vaccine is widely available.