Reopening America: What restructuring communities will look like months ahead

Published 3:28 pm Tuesday, April 14, 2020

By Manoj Jain

Reopening America will be difficult, much like the entry of a space shuttle in the atmosphere or the experiencing of bends by a diver resurfacing from the ocean’s depth.

The reopening has been outlined by Dr. Tony Fauci, the trusted infectious disease doctor and the voice for the scientific community in America, in a podcast for the Wall Street Journal, and former Food and Drug Administration Commissioner Scott Gottlieb, in his report for the American Enterprise Institute.

For any city or community to even begin a conversation about reopening, it will first need to achieve some basic milestones. We must be successfully practicing social distancing, testing for COVID-19-suspect patients, and either averted or have overcome the surge.

The surge is a large influx of patients being admitted to the hospital across cities and communities in America, due to lack of social distancing and contracting the virus 2-4 weeks prior to becoming severely ill.

Gottlieb describes four triggers that can lead to the reopening of our country: the number of cases declining in a sustained manner over two weeks, hospitals coming out of crisis mode, testing being sufficiently available for all symptomatic patients, and successful tracing and monitoring conducted of all cases and their contacts.

After these basics, the nation and individual communities can consider reopening to a new normal. However, each city and community will have a different timeline and phased opening based on their epidemiology, caseload, and resources to monitor and contain a possible resurgence.

Local ingenuity and creativity will be required, and one can possibly envision the following steps. Any opening would require the workers to follow the key rules of handwashing, measuring and reducing proximity encounters, and masking. According to a New York Times article, a study of the SARS epidemic in 2003 showed that washing hands 10 times a day was “55% effective in stopping virus transmission while wearing a mask” was 68% more effective.

A mobile app such as mContain.comcan help workers in small and large business measure and reduce their proximity encounters. A proximity encounter is when one is within 6 feet of another individual for more than 10 minutes.

Once a decision is made of initiating reopening then the question arises as to what work, recreation, and entertainment places should open and when? There is no easy answer to this. However, we can consider opening large corporate workplaces since they can possibly have better enforcement to social distancing measures and may have greater distance among workers.

This can be followed by small businesses, then by shopping malls and small retail shops. Each time making sure that people avoid crowded places and waiting rooms by checking in and then waiting in their cars for their appointment. Next would be a restaurant for limited in-room dining with tables 6 feet apart and servers possibly wearing masks and/or gloves.

The last to open would be large gatherings such as conferences, festivals, concerts, and sports events unless they can assure 6 feet distance among the cluster of fans who may be from a single-family. The National Football League may want to consider this for the fall season. (Obviously, after having each player, staff and coach tested on Thursday for the Sunday’s game.)

While students and faculty are in close quarters and commonly spread respiratory infections, we do not know for the COVID-19 if children are getting infected in large numbers and transmitting the virus asymptomatically. A long summer vacation for children allows a bit of a reprieve in making the decision.

In short, the reopening process will not be easy.  We will need to use innovative approaches to prevent a second wave of infections. Fortunately, America is seeing the first glimmer of light at the end of the tunnel, but we must be deliberate and measured in the speed and trajectory of the reopening.

Otherwise, we may burn or suffer the bends like a spacecraft or a diver during the reentry and resurfacing as we begin to reopen America.

(Dr. Manoj Jain is an infectious disease doctor and faculty member at Rollins School of Public Health at Emory University.)