Reopening States Need to Be Ready to Reclose

(Bloomberg Opinion) -- The U.S. is at a turning point in its response to Covid-19. Most states are taking steps toward reopening their economies. The big and challenging question is whether they’ll be able to keep moving in this direction.

It’s tempting to assume that the world will see a consistent and linear progression toward normalcy. But that might not happen. As efforts to mitigate Covid-19 are relaxed, new infections are inevitable, and these in turn may multiply fresh outbreaks. Deadly surges of Covid-19 remain possible during the long wait for a vaccine. 

To ensure that these don’t become unmanageable, states and cities need to design circuit breakers — thresholds of viral activity that, when reached, prompt them to impose renewed restrictions. 

Many governors who have begun reopening have done so without meeting the data-driven benchmarks set by the White House. An important one of these is a 14-day downward trajectory of documented Covid-19 cases. States are advised to continue to follow this guideline as they consider further loosening business restrictions — that is, wait until they see a another two-week decline before moving ahead.

It’s possible the data will send a very different message, however, and states need to be ready to move in the opposite direction when it does. If hospital capacity is strained, if there’s a sustained five-day increase in infections, or if health officials observe a substantial number of new cases that aren’t traceable to known outbreaks, then states should return to stricter control measures, according to a reopening plan from former Food and Drug Administration Commissioner Scott Gottlieb that inspired the Trump administration reopening guidelines.

Other countries have demonstrated how to respond to such circuit breakers in the data. China, for instance, is reacting to a relatively small number of new Covid-19 cases in one region by amping up restrictions there. Germany, as it reopens, is watching to see whether any region exceeds 50 new infections per 100,000 residents over the course of seven days; if so, limits on movement and behavior will be reinstated there. 

America’s high rate of coronavirus infections only amplifies its need to draw such lines. States need circuit breakers in place well before autumn, when a possible surge in Covid-19 could combine with an emerging flu season to produce dangerous new outbreaks. 

A renewed threat to hospital capacity should be one key circuit breaker, but it should not be the only one. Escalating spread of Covid-19 should also trigger targeted restrictions, to provide hospitals and contact tracers a chance to keep up. As New York City and other heavily affected areas have demonstrated, hospitals take a whole lot longer to empty than they do to fill, and a great deal of suffering and death occurs long before all the intensive-care beds are full. 

In future surges of Covid-19, health care providers should not be expected to return to working grueling hours. They should be kept safe, rested and able to care for patients with conditions other than Covid-19. The amount of such care put on hold during the pandemic is surely contributing to the excess mortality seen in several regions of the world. To the extent that hospitals and other health care facilities can return to the normal business of medicine, they should not be interrupted by fresh coronavirus outbreaks. 

Any renewal of stay-at-home restrictions would be unpleasant and unpopular. But if states monitor the data carefully and respond in time to keep the coronavirus under control, they can avoid much greater pain in the long run. 

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Max Nisen is a Bloomberg Opinion columnist covering biotech, pharma and health care. He previously wrote about management and corporate strategy for Quartz and Business Insider.

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