IDSA: ‘Best available scientific data’ should guide decision to reopen country
In mid April, the Infectious Diseases Society of America and the HIV Medicine Association released recommendations for what they believe is needed to reopen the country, while warning that prematurely easing social distancing measures — put in place to lessen the spread of COVID-19 — could heighten the number of infections and deaths, incapacitate health care facilities and prolong economic hardships.
“The recommendations stress that physical distancing policy changes must be based on relevant data and adequate public health resources and capacities and call for a rolling and incremental approach to lessening these restrictions,” IDSA President and Infectious Disease News Editorial Board Member Thomas File Jr., MD, MSc, FIDSA, said during a press briefing. “This rolling out approach must reflect state and regional capacities for diagnosing, isolating and treating people with the virus, tracing their contacts, protecting health care workers and addressing the needs of populations disproportionately affected.”
Key recommendations from the IDSA and HIV Medicine Association include:
- National scale-up of regular COVID-19 testing to enable the expansion of rapid diagnostic tests in every community;
- Development of testing pathways that enable the identification of patients most susceptible to infection and severe illness, administration of tests, rapid analysis of test results and tracking of those who have potentially been exposed;
- A “massive investment” in, and expansion of, the public health workforce;
- Rapid expansion of the availability of rapid diagnostic tests and adoption of new technologies for case identification and contact tracing;
- A national strategy to ensure supply chains are able to respond to surge needs for swabs and essential testing materials as well as personal protective equipment (PPE);
- Creation of a national multiagency, public/private task force made up of HHS and CDC members, as well as federal, academic and industry representatives; and
- Federal funding for the development of an effective COVID-19 surveillance program and requirements that testing be covered by health insurers, with resources to cover testing for the uninsured.
The White House also released strategies this week for relaxing social distancing guidelines across the country. The new guidance includes the following regional gating criteria for states and regions to satisfy before proceeding to phased re-opening:
- A downward trend in influenza-like illness within a 14-day period and a downward trend in COVID-19-like syndromic cases within 14 days;
- A downward trajectory of documented COVID-19 cases within a 14-day period or a downward trajectory in the number of positive tests as a percentage of total tests performed within 14 days;
- The ability of hospitals to treat all patients without crisis care and have a robust testing program is in place for at-risk health care workers, including emerging antibody testing.
States and regions will then proceed to one of three phases for re-opening, depending on which parts of the gating criteria for reopening have been met.
For states and regions that satisfy the gating criteria:
- Vulnerable individuals will continue to shelter in place.
- All individuals will maximize social distancing in public, avoid social gatherings of more than 10 people and minimize nonessential travel, with adherence to CDC guidelines regarding isolation when travel occurs.
- Employers should continue to encourage working remotely and return to work in phases when possible, with enforcement of social distancing policies and a reduction in non-essential travel.
For states and regions with no evidence of a rebound that fulfill the gating criteria a second time:
- Vulnerable individuals should shelter in place.
- All individuals should maximize physical distance when in public, avoid social settings with more than 50 people and resume nonessential travel.
- Employers should follow the same guidance outlined for after they meet the gating criteria the first time.
- Schools and organized activities for youth, including camps and daycare, can reopen, but visits to senior care facilities and hospitals should remain prohibited.
For states and regions with no evidence of a rebound that satisfy the gating criteria a third time:
- Vulnerable individuals can re-engage in public interactions but should engage in social distancing and limit exposure to situations where social distancing is not possible.
- Low-risk populations should consider limiting time spent in crowded environments.
- Unrestricted staffing of worksites can resume.
Infectious Disease News Editorial Board Member Peter Chin-Hong, MD, professor of medicine and director of the transplant infectious disease program at the University of California, San Francisco, equated the unified approaches of regions like Hong Kong, Taiwan and South Korea to muscles surrounding the heart that work in unison to pump blood.
“The way I think about the White House approach in general is reflective of the U.S. culture, which is a good thing most of the time. It involves personal independence and personal destiny,” Chin-Hong told Healio. “But what we need right now is a strategy like when the heart beats — all the muscles contract together and then pump the blood through the heart.”
Chin-Hong noted that lessening the travel restrictions between state boundaries in the United States may pose an issue for effective social distancing and quarantining of the virus.
“Instituting social distancing in a region is a great move, but borders are porous in the U.S.,” Chin-Hong said. “Unless you close off borders from places where you’ve instituted these measures, it’s not really going to work.”
“It’s like you’re trying to empty a water tank, but somebody is continuously pouring water in the tank,” he added.
Chin-Hong emphasized that although social distancing measures are imperative for slowing the spread of COVID-19, not all citizens have the ability to avoid social contact.
“You could be on a horse ranch in Montana, where you could engage in social distancing all the time, but that’s not possible in New York City if you’re a frontline worker or a food service person who is trying to keep the population fed and you need to take public transportation,” Chin-Hong said. “I think we need additional guidance.”
Overall, infectious disease experts and the recommendations from IDSA and HIVMA stress that changes to current physical distancing policies should begin only when widespread testing allows for accurate surveillance of COVID-19’s spread. Expanded testing, greater availability of PPE and other medical supplies, and more public health workers are also needed to reach a level of testing and surveillance to safely — and completely — reopen the country.
“The major message to take away from this is that the decision to reopen the country and ease social distancing measures really has to be based on the best available scientific data that we have,” Tina Q. Tan, MD, FIDSA, member of the IDSA Board of Directors and professor of pediatrics at Northwestern University’s Feinberg School of Medicine, said during a press briefing. “One of the major missing data points is that we don’t know the true number of people who are infected or who have been infected with COVID-19. Easing social distancing restrictions too quickly could really have disastrous consequences, resulting in increased spread of the infection, an increase in hospitalizations as well as deaths, and the potential to again overwhelm many health care facilities.”
The IDSA noted that their recommendations will be updated in response to developments in the pandemic. – by Eamon Dreisbach and Caitlyn Stulpin
IDSA. IDSA, HIVMA recommend criteria for easing COVID-19 control efforts. https://www.idsociety.org/news—publications-new/articles/2020/idsa-hivma-recommend-criteria-for-easing-covid-19-control-efforts/. Accessed April 17, 2020.
Whitehouse.gov. Opening up America again. https://www.whitehouse.gov/openingamerica/. Accessed April 17, 2020.
Disclosures: Chin-Hong and File report no relevant financial disclosures. Infectious Disease News could not confirm relevant financial disclosures for Tan at the time of publication.