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Community Checklist for Reopening

Community Checklist
 
 

FIVE-POINT CHECKLIST TO OPEN UP SAFELY

Selected key references

1. Is the timing safe to remove precautions?

1b. Are we consistently, for 14 days, showing decreased numbers of new Coronavirus cases, past the peak and on the downward slope of the transmission curve?

• United States, CDC, The White House. “Opening Up America Again.” Apr. 2020. https://www.whitehouse.gov/wp-content/uploads/2020/04/Guidelines-for-Opening-Up-America-Again.pdf. These guidelines offer gating criteria (re: symptoms, cases, and hospitals) that must be satisfied before proceeding to a phased opening. Three phases are described, with guidelines for individuals and employers.

• State of California. “California’s Roadmap to Modify the Stay-at-Home Order.” Apr. 2020. https://www.gov.ca.gov/wp-content/uploads/2020/04/California-Roadmap-to-Modify-the-Stay-at-Home-Order.pdf

This presentation outlines six indicators that should be met before modifying California’s stay-at-home order. These include the ability…

1. To monitor and protect via testing, contact tracing, isolating, and supporting those who are positive and/or exposed

2. To prevent infection in people at risk for more severe COVID-19

3. Of hospital and health systems to handle surges

4. To develop therapeutics to meet demand

5. For businesses, schools, and childcare facilities to support physical distancing

6. To determine when to reinstitute certain measures if necessary, e.g. stay-at-home orders

1c. Do we have enough hospital ICU beds and ventilator reserve capacity to handle a flare up in cases?

• Waldman, Annie, et al. “Are Hospitals Near Me Ready for Coronavirus? Here Are Nine Different Scenarios.” Pro Publica, 17 Mar. 2020, https://projects.propublica.org/graphics/covid-hospitals This article features the analysis and modeling work done by the Harvard Global Health Institute to provide an interactive model for local hospital leaders and policy makers to understand their specific situation and need around hospital capacity.

2. Are our communities prepared to prevent a new flare-up, especially in high-risk situations?

2a. Do we have effective public health measures implemented in all locations where groups of people gather?

This article highlights the system used by OSHA and NIOSH to reduce risk in situations such as hazardous chemicals in the workplace and how it might be used to block exposure to COVID-19 too. The five steps include:

  1. Hazard elimination – Stay home to prevent contact
  2. Personnel substitution – Designate core staff
  3. Engineering controls – Optimize building ventilation, filtration, and purification
  4. Administrative Controls – De-densify through A-B schedules and interaction protocols
  5. Personal Protective Equipment (PPE) – Use face coverings, respirators, etc. to reduce risk in shared spaces
  • Viner, Russel M., et al. “School Closure and Management Practices During Coronavirus Outbreaks Including COVID-19: A Rapid Systemic Review” The Lancet Child & Adolescent Health, 6 Apr. 2020, https://www.sciencedirect.com/science/article/pii/S235246422030095X

This literature review provides a summary and discussion of data on school closures and other social distancing practices during coronavirus outbreaks (SARS, MERS, COVID-19). It addresses what the data could mean for the effectiveness of school closures in the context of COVID-19.

This slide deck offers several frameworks and detailed examples of how local governments, companies, and organizations can plan and manage COVID-19 responses. It includes information about return-to-work readiness as well as sector-specific impacts.

2b. Do we have mass testing implemented, with enough tests and testing locations to quickly identify newly infected individuals?

This report outlines four primary capabilities that every region should build to move beyond the current physical isolation measures in place across the U.S.

  1. Test and Trace Infrastructure
  2. Syndromic Surveillance
  3. Serologic Testing
  4. Rapid Response

It also includes recommendations for the CDC, CMS, and States.

This white paper makes the case for investing tens to hundreds of billions of dollars in testing, combined with an intelligent use of tracing, to achieve a safe end to the current U.S. “lockdown.” Their proposal challenges those published by the American Enterprise Institute (AEI) and the Center for American Progress (CAP). It specifically highlights the importance of a common acceptance of the need for millions of tests a day in order to bolster perceived demand and supply to scale up the testing supply chain.

It includes an analysis of infection rate if Untargeted Testing is used, as well as analyses of the percentage of cases tracked given Precise Tracing vs. Imprecise Tracing methods. It also includes cost estimates for the recommended amount of testing and contact tracing.

3. Is our health system ready to save lives and contain a flare-up?

3a. Do our hospitals have enough PPEs to handle a surge for a month?

This tool provided by the CDC is a spreadsheet-based calculator that can help healthcare facilities plan and optimize the use of PPE as well as estimate how long the remaining supply of PPE will last in their facilities.

3b. Do we have contact tracing strategies and enough contact tracers to identify at-risk individuals?

This plan outlines a vision for how to achieve the implementation of a robust and comprehensive system to identify all COVID-19 cases and trace all close contacts of each identified case in the U.S. Its estimates include:

  • The U.S. public health workforce needs to add ~100,000 (paid or volunteer) contact tracers
  • Congress will need to appropriate approximately $3.6 billion in emergency funding to state and territorial health departments (100,000 contact investigators at $17/hour)

The CDC provides a consolidated list of resources from internal and external sources to support local health departments in their planning and implementation of contact tracing.

3c. Do we have enough support and resource managers to help ensure safely isolating and quarantining infected individuals, and enough community spaces outside families?

Fineberg’s editorial outlines six steps to mobilize and organize the nation toward defeating COVID-19 by early June. The fourth step is highlighted below:

Differentiate the population into five groups and treat accordingly:

  1. Who is infected
  2. Who is presumed to be infected
  3. Who has been exposed
  4. Who is not known to have been exposed or infected
  5. Who has recovered from infection and is adequately immune

Groups 1-4 should be identified via symptoms, examination, PCR tests, and exposures. Recommendations for these groups are provided, and they include creating quarantine centers to house those who have been exposed for two weeks.

Group 5 can be identified by developing, validating, and deploying antibody-based tests. This work is still in progress.

This editorial highlights concerns about the capacity for safely isolating and treating COVID-19 patients as they transition from the hospital setting to their homes or other care settings. It discusses several policy recommendations around postacute care that could support preparedness.

4. Are we ready to establish and enforce requirements, set expectations, and clearly communicate those to the public?

This paper provides insights from the past century of work in the social and behavioral sciences that may help public health officials mitigate the impact of the current pandemic. Topics include threat perception, social context, science communication, aligning individual and collective interests, leadership, and stress and coping.

 

5. Are there clear guidelines to help government determine when to reinstate stay-at-home precautions?​

This report outlines a four-phase approach to reopening the U.S. Each phase has unique goals, thresholds for action, steps required, and measurable triggers for moving to the next phase or returning to the prior phase.

  1. Phase 1 – Slow the Spread
  2. Phase 2 – Reopen, State by State
  3. Phase 3 – Establish Protection, Then Lift Restrictions
  4. Phase 4 – Rebuild Readiness for Next Pandemic

This presentation outlines six indicators that should be met before modifying California’s stay-at-home order. These include the ability…

  1. To monitor and protect via testing, contact tracing, isolating, and supporting those who are positive and/or exposed
  2. To prevent infection in people at risk for more severe COVID-19
  3. Of hospital and health systems to handle surges
  4. To develop therapeutics to meet demand
  5. For businesses, schools, and child care facilities to support physical distancing