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Dear MEPNs ,

We hope you and your families are staying well and that you are getting adjusted to the ‘Stay at Home’ orders. Here’s what you need to know about COVID-19.

The MEPN Team

SITUATION

Around the world and across the country, leaders are looking for how and when to lift the lockdown. Citizens are longing to get back to their normal lives. Nevertheless, as with treating the virus itself, there is no simple solution:

• State officials have started charting their own paths to re-opening.
• Governors on the East and West coasts began creating and coordinating their plans to roll back emergency orders, when the time comes. While there is a sense of urgency, these officials aim to prioritize public health in order to minimize the likelihood of additional outbreaks and give health systems a reprieve from the onslaught of the virus.
• While officials in these states expect to forge ahead with their own planning, it is unclear if the Federal government will issue their own guidelines and orders and how these declarations may potentially impact the governors’ plans.

What is going on in other countries?

• With daily cases and deaths lowering, Spain and Italy began lifting some of its lockdown restrictions in an effort to reinvigorate their economies by allowing select workers to return to work. The decision has been met with criticism from other EU leaders and public health officials as potentially dangerous.
  • The EU Commission is warning that loosening lockdown measures will lead to an “inevitable” increase in COVID-19 infections.
  • Today (April 15.2020)  in Germany, Chancellor Angela Merkel will hold talks about when to lift restrictions.
• Nationwide lockdown orders have been extended until May 3 in India and until May 11 in France.

BACKGROUND

We all want an end in sight. But, if restarting America means that some people will die, what’s the exit strategy?

The answer is, of course, uncertain. Here are a few unknowns about the virus that, if solved, could give us a better idea:

• How will the virus respond to seasonal weather differences?
• How will the virus mutate over time?
• For how long are those who get infected subsequently immune?
  • Korea’s CDC has indicated that the virus may reactivate in “cured” patients.
• When can we expect a vaccine?
  • One writer described an endgame scenario where the world “plays whack-a-mole with the coronavirus, suppressing it until a vaccine can be produced.”

What can we learn from history?

• In the past, flu pandemics have seen their ends by achieving herd immunity. However, some scientists warn that waiting for this to happen is not a viable option.
• Previous pandemics have required continued cooperation and communication at every level of government and citizenship. Governments and populations cannot afford to take a fragmented approach.

ASSESSMENT

Despite initial hopes that the U.S. could open as early as Easter weekend, this has proven to be unrealistic. However, teams from the Federal Emergency Management Agency (FEMA) and the CDC have created a public health strategy to combat COVID-19 and re-open parts of the country.

• The plan does not give dates for reopening’s, but it specifies this will not happen before May 1.
• The plan outlines three phases:
  • Until May 1: Prepare the nation to reopen with a national communication campaign and community readiness assessment.
  • Through May 15: Ramp up manufacturing of testing kits and personal protective equipment and increase emergency funding.
  • After May 15: Begin staged reopenings, depending on local conditions.

RECOMMENDATION

The best path forward is a cautious one. Re-opening some parts of the country before the end of April would go against guidelines in their current form.

• Recommendation: Providers should continue to advise all patients to stay at home, and encourage patients to exercise caution not only for their own health and safety, but also of those around them.

In the end, some cities and states may recover sooner than others cities.

• Recommendation: Experts say there are four benchmarks to determining how states will know when it’s time re-open:
  • Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care.
  • A state needs to be able to test everyone who has symptoms.
  • The state must be able to conduct monitoring of confirmed cases and contacts.
  • There must be a sustained reduction in cases for at least 14 days