X-FDA Commissioner Scott Gottlieb and four other experts have published a roadmap to re-opening the US economy from Coronavisus shutdowns. Here Nextbigfuture reviews the details of the next phase.
Trigger for Moving to Phase II
A state can safely proceed to Phase II when it has achieved all the following:
A sustained reduction in cases for at least 14 days,
Hospitals in the state are safely able to treat all patients requiring hospitalization without resorting to crisis standards of care
The state is able to test all people with COVID-19 symptoms, and
The state is able to conduct active monitoring of confirmed cases and their contacts
What is Phase 2 at the High Level – Phase II: Reopen, State by State
In Phase II, the majority of schools, universities, and businesses can reopen. Teleworking should continue where convenient; social gatherings should continue to be limited to fewer than 50 people wherever possible. Other local restrictions should be considered, such as those that limit people from congregating in close proximity.
For older adults (those over 60 years old), those with underlying health conditions, and other populations at heightened risk from COVID-19, it should still be recommended that they limit time in the community during Phase II. This recommendation may change if an effective therapeutic becomes available.
The goals of Phase II are to:
Lift strict physical distancing measures in a concerted and careful fashion,
Allow the vast majority of businesses and schools to open, and
Continue to control SARS-CoV-2 transmission so we do not revert back to Phase I.
This is what we do until we have really good and abundant vaccines and/or enough good drugs to prevent almost all of the worst-case results with coronavirus.
Below Are the Details for Test, Monitor and Contact Trace
Increase Diagnostic Testing Capacity and Build Data Infrastructure for Rapid Sharing of Results. Same-day, point-of-care diagnostic testing (widely available in outpatient settings) is crucial for identifying cases, including those with asymptomatic and mild infections. To move from community-wide interventions that focus on large populations to case-based interventions that target and isolate individual people who are infected, capacity should be sufficient to test:
Hospitalized patients (rapid diagnostics are needed for this population);
Health care workers and workers in essential roles (those in community-facing roles in health and public safety);
Close contacts of confirmed cases; and
Outpatients with symptoms. (This is best accomplished with point-of-care diagnostics in doctors’ offices with guidelines that encourage widespread screening and mandated coverage for testing.)
We estimate that a national capacity of at least 750,000 tests per week would be sufficient to move to case-based interventions when paired with sufficient capacity in supportive public-health infrastructure (e.g., contact tracing). In conjunction with more widespread testing, we need to invest in new tools to make it efficient for providers to communicate test results and make data easily accessible to public-health officials working to contain future outbreaks.
Medical System Minimums
Ensure Functioning of the Health Care System. Ensure sufficient critical-care capacity10 in hospitals to be able to immediately expand capacity from 2.8 critical-care beds per 10,000 adults to 5–7 beds per 10,000 adults in the setting of an epidemic or other emergency, allowing for regional variation. This target is a minimum.
Expand access to ventilators in hospitals from 3 per 10,000 adults to a goal of 5–7 ventilators per 10,000 adults. This target does not include transport or anesthesia machines. This target is a minimum, must be adequate for the current and forecasted level of demand, and must be accompanied by adequate staffing.
Increase Supply of Personal Protective Equipment
The Centers for Disease Control and Prevention (CDC) recommends, at a minimum, N95 respirators for hospital staff expected to have direct contact with COVID-19 patients, plus disposable procedural or surgical masks for all other clinical personnel in any health care setting.
Implement Comprehensive COVID-19 Surveillance Systems
The move toward less restrictive physical distancing could precipitate another period of acceleration in case counts. Careful surveillance will be needed to monitor trends in incidence.
A high-performing disease surveillance system should be established that leverages:
1. Widespread and rapid testing at the point of care using cheaper, accessible, and sensitive point-of-care diagnostic tools that are authorized by the Food and Drug Administration (FDA);
2. Serological testing (antibody blood tests) to gauge background rates of exposure and immunity to inform public-health decision-making about the level of population-based mitigation required to prevent continued spread in the setting of an outbreak; and
3. A comprehensive national sentinel surveillance system, supported by and coordinated with local public-health systems and health care providers, to track the background rate of infection across states and identify community spread while an outbreak is still small and at a stage in which case-based interventions can prevent a larger outbreak.
ILINet, the surveillance system for influenza-like illness in the United States, is a potential model for SARS-CoV-2 surveillance. To enable rapid and more effective detection and case management, SARS-CoV-2 surveillance will also benefit from data sharing and coordination with health care providers and payers.
Massively Scale Contact Tracing and Isolation and Quarantine
When a new case of COVID-19 is diagnosed, the patient should be isolated either at home or in a hospital, depending on the level of care he or she requires. Have cell-phone monitored quarantines for 14 days.
Nextbigfuture notes that 14 day cellphone monitored quarantines are the standard in Taiwan and South Korea. The national survellance systems are also standard in those countries.