The COVID-19 global pandemic continues to spread and impact the lives of the children who are out of school, the senior citizens who are most vulnerable to the virus, and pretty much everyone in between. To halt the spread, much of the nation has been social distancing and sheltering in place for over a month now.
The good news is the curve is starting to show signs of flattening in certain parts of the country, bringing to light the urgent question on everyone’s mind: when can we reopen? The most compelling reason to reopen is the need to reinvigorate our economy and provide some hope to the countless Americans whose businesses or jobs are either at risk or have already been lost. However, while racing to salvage our economy, we are still in the battle to beat the pandemic. Therefore, it is still critical that a safe and effective reopening strategy backed by science is used to minimize the potential loss of lives and mitigate the effects of the ongoing pandemic which still threatens to overwhelm our hospitals.
In considering when and how to reopen, much of the current focus has been on the need for robust testing and vigorous contact tracing to contain the spread. While this is certainly sound reasoning, testing and tracing capacity remains woefully inadequate in most parts of the U.S. Moreover, testing and tracing is not going to be the sole panacea for COVID-19. Unfortunately, the asymptomatic carriers who spread COVID-19 before they even feel sick will easily undermine even the most robust testing and tracing infrastructure due to the sheer number of people who would be affected.
This is in fact exactly what happened in Singapore, which has been lauded as the best testing and tracing effort in the world. There, the spread from asymptomatic carriers still resulted in temporary lockdowns to contain the virus. Nonetheless, testing and tracing helped them to avoid the severe economic harms happening in less prepared countries like ours and should be used as widely as possible as part of a multi-modal strategy to protect lives and livelihoods.
As our states start to reopen, we cannot stress enough the importance of not going back to “business as usual.” In order to contain the spread, stay open, and manage the risk of weathering an ongoing pandemic, we still need to rely on proven community interventions to contain the spread of Covid19. Here are ways that we can reopen responsibly
1. Stay 6 feet apart whenever possible. This includes when in line at a store or on the street. Stores should consider using “markers” to indicate 6 feet apart in a line. This also applies to workers in break rooms, stock rooms, and workspaces. A business that protects its workers protects its patrons and its bottom line.
2. Wash your hands. While simple, this is one of the most effective ways of making sure that people do not infect themselves. The Center for Disease Control and Prevention recommends washing your hands for at least 20 seconds (sing Happy Birthday) or using an alcohol-based rub with at least 60 percent ethanol or 70 percent isopropanol. Businesses can implement hand hygiene stations upon entry of their store or near high traffic areas.
3. Wear masks or face coverings. This cannot be stressed enough given that the virus spreads before someone knows they are sick. For this strategy to work, everyone has to wear a mask or face covering. In other words, you wear a mask to protect others if you become infected before you know it, and they wear a mask to protect you if they become infected before they know it. Stores should not allow those without face coverings to enter their store period.
4. Avoid mass gatherings at all costs. Even if mass gatherings are occurring in your state, you should avoid them. While we respect the right to protest, consider alternative forms of expressing yourself that do not put your health and the health of others in jeopardy. Remember, even if you feel completely well, you could be contagious right now. You just don’t know.
5. Limit the number of people in businesses at the same time. Just because your state may be reopening does not mean you should make the mad dash to the office or the store. Some of you may continue to work remotely to help reduce the number of people in an office space. Even if remote work is not possible, a business can stagger their staff in shifts to reduce the number of people in their space at the same time.
While we have always been accustomed to just going to the store whenever it is open, it is time to rethink that strategy. Not only will you avoid a long line, but the likelihood of getting sick also goes down. Stores should enable “appointment” times for customers so that the maximum number of people in the store to enable social distancing is not exceeded.
Controlling the spread of COVID-19 should be seen as a marathon, not a sprint. COVID-19 will surely have long term impacts on the lives of our citizens, and the economy. To minimize the impact on all, a strategic plan to reopen the economy is necessary to not only save lives but also salvage our economy. In other words, reopening responsibly requires going beyond business as usual.
Emily Landon M.D. is an associate professor of medicine, in the section of infectious and disease and global health, the executive medical director of infection prevention and control, and the chief hospital epidemiologist at the University of Chicago Medicine where she is leading the health system’s Coronavirus response. She is also affiliate faculty of the MacLean Center for Medical Ethics.
Shikha Jain, M.D., is an assistant professor of medicine in the Division of Hematology and Oncology and the physician director of social media and communication at the Rush University Cancer Center.
Vineet Arora, M.D. is the Herbert T. Abelson Professor of Medicine, a board-certified academic hospitalist, and associate chief medical officer for the Clinical Learning Environment at the University of Chicago Medicine. She is a co-founder of the group IMPACT.