States focus on reopening. But what about closing again?

After the United States abruptly closed in the spring, states gradually announced their reopening plans. Some have adopted careful phased reopens, where counties or regions must show progress on specific metrics, such as a downward trajectory of COVID-19 cases. Others simply let their stay-at-home orders expire, allowing businesses to reopen with minimal restrictions.

Now, weeks after the first reopens, some rapidly opening states are seeing a sharp rebound from COVID-19. In a note this week, Utah state epidemiologist Angela Dunn detailed an increase in both the cases and the percentage of positive tests since the end of May. She warned that the state may need to go back a phase if the numbers don’t change dramatically soon. Texas has also seen an increase in cases, positive test rates and hospitalizations, prompting state governor Greg Abbott on Thursday to stop the state’s reopening. “The last thing we want to do as a state is go back and close business,” it said in a statement.

But backtracking may be necessary. For the carefully established plans of all states with the reopening, what plans do states have to re-close if necessary, and how will they look compared to the country’s first hastily executed shutdown? In an April report, experts from the University of Minnesota Center for Infectious Disease Research and Policy recommended that “government officials should develop concrete plans, including triggers to reinstate mitigation measures, to treat spikes in disease when They do occur, “and that” government officials should incorporate the concept that this pandemic will not end soon and that people must be prepared for possible periodic resurgences of the disease. ” But after talking to experts and reviewing the reopening documents from various areas, I’ve learned that there seem to be no specific criteria for what could, or should, trigger a selective or massive shutdown. What’s worse, local, regional and state governments do not seem willing to broach the issue with citizens, despite experts’ predictions that the virus will decline and flow in the coming months.

That does not mean that experts are not monitoring him. For example, the Department of Public Health in King County, Washington, where I live, is tracking metrics like reported cases, testing capacity, and hospital occupancy. Those metrics are part of Washington State’s very specific standards: A county requesting to go from Phase 2 to Phase 3, for example, must demonstrate that each hospital in the area has a 20 percent increase capacity and that the The county has 15 trained contact trackers per 100,000 citizens, among other things.

But in the state document outlining the criteria, there is only one short phrase that suggests the potential to reverse phase advancement. When I contacted the department, she reiterated that she could ask counties to go back one phase if there is a significant outbreak, inadequate contact tracking, or poor access to evidence, among other things, but they did not provide further information on whether there are

Reopening plans for many states to the public do not mention the closure again. (I contacted the New York State Department of Health and the Arizona State Department of Health to ask about their plans to stop the reopening or closing again, but neither responded to my requests.) The most detailed treatment of this appears in the Centers for Diseases The May Prevention and Control Report on the reopening, which sets some vague standards that could indicate a “rebound” of the virus: five consecutive days of increased cases or hospital visits , and multi-day increases in the percentage of positive test results, assuming tests remain at the same levels. Many states have already met those metrics. However, the CDC does not provide guidance on what to do in the event of a bounce. It is similar to committing a foul in basketball: it is the first step, but what happens next? COVID-19, of course, is not as simple as basketball, and there are no rules for what follows in the playbook.

The experts I spoke with agreed that it would be nice to have a plan, but it is unclear who might do Such a plan. COVID-19 “calls for a national response,” says Mike Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “We need to do much more to coordinate the national response, so that we can all work on the same page.”

But right now, it’s up to individual states, regions, counties, or cities to decide what’s best for them. And those same experts and government officials live up to their ears just by handling the crisis: There isn’t much time to think about Plan B, because Plan A is trying to keep everything under control. “Everyone has been so busy with the alligators on the south side that no one has thought of draining the swamp at this time,” says Osterholm.

Take, for example, the plan to reopen schools. When I spoke to Michaela Miller, assistant superintendent in the Washington state Office of Superintendent of Public Instruction, she spoke to me about the state plan for schools and the many areas that need to be coordinated: school meals, transportation, and new standards for classrooms such as use of masks and social distancing, among other things. They have 10 weeks to figure this out before the new year begins. I asked if her plans for reopening included contingencies for closure, if there was an outbreak in a particular school or district. She said it is on her mind, but in a general way; In its reopening planning guide, the state advises schools to be prepared for online learning in the event of closure. Miller tells me that districts will be in close contact with county health departments for guidance, and the state hopes to develop consistent policies across counties. But as for the details of when schools might close? Those convos have not yet been held; so much energy is focused on reopening, “says Miller.

It’s certainly possible that behind the scenes, some states, regions, counties, or cities have explicit set criteria that trigger a shutdown, but if that’s the case, there’s the question of why they don’t share this crucial information with the public. . Maciej Boni, a mathematical epidemiologist at Pennsylvania State University, says this is driven, at least in part, by politics and optics. Leaders want to appear optimistic, and there is pressure to “deliver good news when there is no good,” he says, or “to repaint or change the color of the results to make them better than they are.” But in case you need to backtrack, this good news only policy is not going to help. “This is a situation where you can’t promise too much and you can’t promise less. You have to be very honest with the changing risks week after week. ” Osterholm agrees: “Only by denying [another shutdown] is going to happen is not preparing. ”

For now, it looks like any decision to shut things down again will be play and go, similar to the first time. Will Humble, director of the Arizona Public Health Association, who also served as director of state health services from 2009 to 2015, says that if he were still in charge, the plan to shutdown would be to address the root of the problem with the obligation to use masks, more tests and contact tracking. Otherwise, he says, the state will likely have a 10 to 14-day warning of hospitalization numbers before things get ugly. Boni agrees that hospital admissions will be an important indicator: “If you see hospitalizations have doubled in the past week, it is a clear sign that the Health Department must take action.” Mobility data, the number of people moving, can also play a role, says Boni. If people’s cell phone data shows they are resuming activity without a spike in new cases, it’s a good sign that community outreach has slowed.

As cases and the number of hospitalizations increase, the lack of a closure plan may not be a problem if governments are unwilling to close again. Texas Governor Greg Abbott’s plan to “pause” functional reopening very recently; It maintains the current trajectory, which is what has raised the numbers in the first place. “Closing Texas again will always be the last option,” he said in a recent interview. Humble is also concerned about Arizona Gov. Doug Ducey’s willingness to shut down. “There is no appetite to make another order to stay home; I think they would implement the emergency plans, “says Humble, noting that in early June, the state asked hospitals to activate their emergency plans rather than make other adjustments. (The Arizona Department of Health did not respond to my request for comments) “That’s my analysis: I don’t think [Ducey] you have an appetite to do it again. “With a lack of plan and an apparent lack of will, there is a very real chance that some areas will not close or phase back even if the numbers suggest they should, and that’s a recipe for more deaths.

Future Tense is an association of Slate, New America, and Arizona State University that examines emerging technologies, public policy, and society.