States lack yardsticks to brake on reopening
Analysis finds 41 states lag on testing
Many of the states moving most quickly to roll back rules designed to slow the spread of the coronavirus lack benchmarks that would require them to reimpose restrictions if infections spike.
That leaves governors who are anxious to jumpstart their economies untethered to clear numerical standards, alarming even some of the top medical officials in their states, who warn that new outbreaks are on the horizon.
“There’s just a lot more that needs to be done,” said Scott Harris, Alabama’s chief health officer. “We still feel like we could do a better job with getting real-time information that would help us make those decisions. But we don’t have hard triggers at this point.”
Alabama is hardly alone. Georgia also has not built specific triggers into its reopening plan, though Candice Broce, a spokeswoman for Gov. Brian Kemp, said he “would do whatever is necessary based on our data and
the advice of public health officials.”
In Tennessee, there is “no set threshold to reimpose certain restrictions, but they’re certainly on the table if we deem a reimposition needed,” said Gillum Ferguson, a spokesman for Gov. Bill Lee.
Colorado Gov. Jared Polis has empowered local authorities to reimpose restrictions as they see fit.
In Pennsylvania, there is not a “specific metric that would trigger further restrictions,” said Nate Wardle, a spokesman for the state health department, but officials are “looking at the case counts being reported, the contact tracing occurring, and determining whether any of these steps need to be taken.”
Mark McClellan, a former commissioner of the Food and Drug Administration and administrator of the Centers for Medicare and Medicaid Services under former President George W. Bush, said state leaders know “they may need to pause or even step back.”
“But we haven’t seen a whole lot of detail on those specific plans in most states,” said McClellan, a member of the advisory group assisting Texas Gov. Greg Abbott. “It’s going to be important as the reopening occurs to track key data and move quickly if there are signs of an increase in the reproduction rate of the virus.”
Rapid, widespread testing is considered essential to tracking and containing the coronavirus. But 41 of the nation’s 50 states fail to test widely enough to drive their infections below a key benchmark, according to an AP analysis of metrics developed by Harvard’s Global Health Institute.
As health authorities expand testing to more people, the number of positive results should shrink compared with the total number of people tested. The World Health Organization and other health researchers have said a percentage above 10% indicates inadequate testing. South Korea, a country praised for its rapid response, quickly pushed its positive cases to below 3%.
Researchers at Harvard University have calculated that the U.S. needs to test a minimum of 900,000 people per day to safely reopen the economy, based on the 10% positivity rate and several other key metrics. That goal is nearly three times the country’s current daily testing tally of about 360,000, according to figures compiled by the COVID Tracking Project website.
‘REBOUND’ FEARED
Arkansas Gov. Asa Hutchinson said this week that he may pull the state back from the second phase of reopening, expected to begin Monday, after the state Thursday recorded one of the biggest jumps in new cases of covid-19 since March. “This is not encouraging,” he told reporters Thursday.
The White House’s nonbinding guidelines for a phased reopening warn of “rebound” but do not establish parameters for measuring one. That has left states to decide on their own whether to build into their reopening plans rules that would compel them to snap restrictions back into place.
A few states have taken steps in that direction, but even these states often lack firm benchmarks.
Minnesota has a “Dial Back Dashboard” setting out key metrics — from a rise in cases to the capacity for testing — informing decisions “about reestablishing restrictions to slow the spread of the virus.”
In California, Gov. Gavin Newsom is relying on six “indicators for modifying the stayat-home order,” one of which is the “ability to determine when to reinstitute certain measures, such as the stay-at-home orders, if necessary.” The state’s road map offers little about how to make that determination.
New guidance in Los Angeles County states that residents must cover their faces whenever they go outside, a top health official said Thursday.
“Masks are, in fact, mandatory across the entire county when you’re outside of your home, not with members of your household and in any kind of contact with other people,” Public Health Director Barbara Ferrer said.
Even when on a solitary walk or run, Ferrer said, “you now need to have a face covering with you, because if you came by other people, you were walking by other people, you tried to go into a grocery store, you absolutely have to have that face covering on.”
Officials also said visitors to the county’s beaches, which opened Wednesday for active recreational use, also must cover their faces unless they are in the water.
The more stringent rules come on the heels of a similar order enacted by Los Angeles Mayor Eric Garcetti.
New York’s framework is among the most detailed, dividing the state into 10 regions and evaluating each by seven metrics, such as holding hospitalization rates below 2 per 100,000 residents and maintaining a testing rate of 30 per 1,000 residents.
OFFICIALS DISAGREE
Even the detailed guidelines adopted by certain states failed to satisfy some epidemiologists.
Isaac Weisfuse, a Cornell University epidemiologist who was a deputy health commissioner in New York City during the H1N1 swine flu outbreak in 2009, said New York should expand its criteria to include earlier indicators, such as outpatient medical records for people who report “complaining of the signs and symptoms of covid-19” before they get seriously ill.
He also suggested “behavioral surveillance,” in which officials track whether the public complies with relaxed measures designed to allow people more access to life outside their homes while still keeping the virus in check.
Many experts share Weisfuse’s concerns, saying the country still lacks the tools to predict a coming surge fast enough to fend off its escalation into an unmanageable outbreak. Many of the common metrics, such as hospitalizations and even rates of positive test results, lag far behind the actual transmission of the disease.
“We need a comprehensive battle strategy, meticulously implemented,” said Tom Frieden, former director of the Centers for Disease Control and Prevention.
Not all state health officials see specific benchmarks as necessary.
“We have very robust data — number of cases, cases in nursing homes, hospitalizations, people on ventilators — but at the end of the day, I practiced medicine for 30 years, and we treat the patient, not the chart,” said Randall Williams, director of the Missouri Department of Health and Senior Services. “There’s no one threshold. Every day, we analyze the data and take that into consideration.”
Clay Marsh, West Virginia University’s chief health officer and the state’s coronavirus coordinator, said officials are examining the rate at which the virus spreads and the seven-day rolling average of new cases in each county.
A 50 percent increase in cases would be worrisome, he said, while a 75 percent increase would require designation as a high-alert county and give rise to recommendations to the governor.
Asked whether such benchmarks should be made public, he said, “I think it’d be a smart thing to do,” not just for West Virginians wondering how their state is making decisions but for other states as well.
“Eventually, we should be learning from each other,” Marsh said. “This next phase — of reopening — is much more difficult and much more dangerous.”
DISTANCING FOUND EFFECTIVE
Meanwhile, according to a study published Thursday in a peer-reviewed health care journal, areas in the U.S. that do not adhere to any social distancing policies face 35 times more cases of the coronavirus.
The study, published in the journal Health Affairs, looked at the policies mandating social distancing, and found that the longer a measure was in effect, the slower the daily growth rate of covid-19, the virus’s disease.
Researchers from the University of Kentucky, University of Louisville and Georgia State University looked at confirmed coronavirus cases in the United States between March 1 and April 27, totaling about 1 million reported instances at the time, illustrating “the potential danger of exponential spread in the absence of interventions.”
For social distancing policies that lasted at least 16 to 20 days, the daily rate of infection dropped by more than 9 percentage points, according to the study. Policies lasting 15 days and less also saw declines in the daily infection rate, researchers found.
Such social distancing measures, mandated by 95 percent of the country, include shelterin-place orders, school closures, bans on large events and the closure of gyms, bars and restaurants.
Places with no social distancing orders were at substantially higher risk for infection.
“Holding the amount of voluntary social distancing constant, these results imply 10 times greater spread by April 27 without [shelter-in-place orders] … and more than 35 times greater spread without any of the four measures,” the researchers wrote in “Strong Social Distancing Measures in the United States Reduced the COVID-19 Growth Rate.”
CHINA DEFENDS ACTIONS
Meanwhile, China said it did not know until Jan. 19 how infectious the new coronavirus is, pushing back against accusations that it intentionally withheld from the world information about the severity of the outbreak in Wuhan.
While Chinese officials knew there were signs of human-to-human transmission earlier, it was hard to ascertain the new virus’s level of contagiousness, said Zeng Yixin, vice minister of the National Health Commission, at a news briefing in Beijing on Friday. There are diseases like HIV that while infectious, are not easily transmitted from person to person, he said.
It was only on Jan. 19 that Chinese scientists concluded that the virus spreads easily among people, and China released that information to the world the next day, said Zeng.
The accounting of events from top officials came as China faces growing blame for a delay in sounding the alarm about the coronavirus, which allowed people to spread it unwittingly for some time.
Along with the U.S., countries including Australia and Germany have sought an investigation into how the previously unknown virus made the jump from animals to humans before being discovered in Wuhan last year.
The alleged delay resulted in millions of people traveling from Wuhan to elsewhere in the country and the world, seeding a pandemic that has now sickened more than 4.5 million people and killed more than 300,000.
In Russia on Friday, Moscow authorities began free coronavirus testing for all residents. Under the program announced by Mayor Sergei Sobyanin, tests for coronavirus antibodies, a marker of infection, will be conducted at 30 clinics throughout the city.
Sobyanin said that 70,000 city residents will receive invitations for testing “every few days,” and that the city will have the capacity to do 200,000 tests a day by the end of the month. The data obtained will help city authorities coordinate the work of health care facilities and make decisions on whether to extend or ease lockdown restrictions, the mayor said.
Information for this article was contributed by Isaac Stanley-Becker, William Wan, Ben Guarino and Timothy Bella of The Washington Post; by Bloomberg News; by Luke Money, Hannah Fry, Sonja Sharp, Patrick McGreevy, Colleen Shalby, Susanne Rust, Maura Dolan, Rong-Gong Lin II, Kailyn Brown and Sarah Parvini of The Los Angeles Times; and by Matthew Perrone, Brian Witte, Nicky Forster, Gary Robertson, Michael Kunzelman, Paul Weber, Felicia Fonseca and Matt York of The Associated Press.