Editor's Note: This is a complimentary research note published by Healthcare Policy analyst Emily Evans. CLICK HERE to get daily COVID-19 analysis and alerts from our research team and access our related webcasts
A few weeks ago, we described a risk-based approach - derived from about half a dozen plans developed by Washington's many think tanks and policy leaders - for relaxing current CDC guideline on social distancing, among other things. Tuesday, and reiterated yesterday at the daily COVID-19 press briefing, the president announced that the White House would be releasing the guidance to governors this afternoon and to the public later in the day, a "Big Day." The president's comments and those of Dr. Deborah Brix support the idea that that guidance will take a risk-based approach based on a number of factors.
At the press briefing yesterday, Dr. Birx also explained that there were quite a number of states that had fewer than 3,000 cases and several reporting fewer than 30 cases a day.
The implication is that the administration believes that certain states, by dint of their geographical characteristics - Wyoming - or as a result of aggressive public health interventions - Kentucky (maybe) - have a good enough handle on the disease that new, more relaxed guidance is appropriate. A risk based approach allows each state to consider its circumstances and adopt more relaxed guidelines as the situation warrants, sometimes adopting differing standards within a state.
Using Kentucky as an example - and I admit to being a bit dubious that they have sufficient data to know whether or not they have managed the disease - there are three areas of the state that would likely adopt more liberal CDC guidelines only if it has in place sufficient surveillance systems. These are Louisville, Lexington, Clarksville and the Cincinnati suburbs.
In affected urban areas, current CDC guidelines on social distancing such as limitations on public gatherings are likely to persist. While low-risk businesses such as those that are not open to the public - professional services as one example - are likely to be opened immediately with few restrictions Bars and restraurants will have a longer glide path. Restrictions on low risk businesses will include implementation of a hygiene program, requirements that sick workers go home immediately and periodic testing. Restaurants are likely to open first with reduced occupant loads with bars following a similar path on a lag, provided case volumes do not increase in an unmangeable way.
Test capacity will continue to be the rate limiter for many states but it is improving rapidly. In addition to DGX and LH's capacity contributions, the administration has identified 18,000 high through-put test platforms, including the ABT's m2000, that can, in effect, be commandeered by state governments to expand capacity further. The administration is optimistic that test capacity will meet demand, Governors are not so sure.
Another limitation will be personnel available to trace contacts of suspected and confirmed COVID-19 cases. Contact tracing is standard public health practice. The scale at which it would need to be implemented is daunting but certainly not impossible and perhaps not even difficult in some places. The current unemployment benefit would seem to discourage interest in starting a new public health career but there is no arguing with the availability of people. However, they will need to be trained in public health practices which is a hybrid of science and detective work. That could take some time.
A third area of concern will be interstate traffic. Commercial traffic has moved unabated throughout the crisis so that should not change. However, business and leisure traffic will have to be regulated to some degree and it is not clear how that can be accomplished. Governor Ron DeSantis of Florida has threatened to curtail traffic between his state and New York, New Jersey and Connecticut. Rhode Island, sandwiched between two hotspots has also attempted to limit movement. The constitutional questions are significant so it is likely to come down to self-regulation with people from highly infected areas voluntarily limiting travel with the encouragement of employers.
The non-urban areas of Kentucky can probably go about their business almost immediately. However, the impact of relaxed guidance is going to be muted by the reality that many of these communities are engaged in Critical Infrastructure Industries and so not much will change. Businesses that support these industries will, of course, welcome the new guidance.
We will update you after this evening's press conference.