How to "reopen"? - Printable Version
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How to "reopen"? - BostonCard - 04-12-2020
As it seems like we are at or close to the peak (hopefully) of coronavirus activity and the rate of new infections starts to decline, it is probably a good time to start planning for what reopening looks like. The administration has set a goal of May 1, which I think is aspirational. But regardless of when the date is, it is worth starting to think of how to relax restrictions so that the economy can start to come back without triggering a new outbreak. I think there's a tendency to think of reopening the economy as an event (as witnessed by setting a date for it), but it's more like a process. And Teejers post about people pursuing various low risk activities got me thinking that really there are three or four dimensions on which you can judge activities.
1) How essential is it? We dichotomize activities into "essential" and "non essential" but in reality there are gradations involved, from critical (healthcare services) to completely non-critical (leisure activities) with a whole host of things in between. Public transport, for example, might not be critical per se, but if that's how a doctor or nurse normally gets to the hospital, it's critical. School is not immediately essential, but it is very important (forget for a moment that it probably also carries a high risk for transmission, I'm trying to rank it in terms of how essential it is).
2) How risky is it? Some critical activities are very risky because they bring together lots of people, some who may be sick, in an enclosed area (hospitals are a good example); others are very low risk (Teejers example of socially distant golf, for example). So, note that you can have high-risk essential services and low-risk leisure activities.
3) What is the individual risk? By this I don't just mean the individual risk of getting sick, but also the individual risk of having or spreading infection. A worker in a high contact essential occupation (grocery store clerks, hospital personnel), even if they are young and otherwise low risk themselves would have a high risk of passing the virus along and therefore should minimize exposures, even if relatively low risk exposures. On the other hand, individuals who have recovered from the virus are probably low risk (assuming they can get immunity) and can probably do what they want without putting themselves or others at risk. Kids themselves are probably fairly low risk, but higher risk if they live in a multigenerational family with their grandparents.
4) What is the local prevalence of disease? Tightening or relaxing of restrictions has to be dependent on how many cases are out there. There are probably many parts of rural California that are very low risk and for which local shutdowns may not have been necessary. Even as much of the rest of the country opens up, there will be local hotspots that won't be able to.
5) What kind of risk mitigation measures are possible. These might include things like limiting occupancy to allow effective social distancing (I'm thinking for example of the Dish, which was closed because too many people went). The Dish probably could be reopened, but only if there are guards allowing one person in for every person who goes out and has hand sanitizer at the entrance and hikers are willing to take risk reduction steps such as using masks.
And of course all of this is predicated on having testing and contact tracing.
So what does "reopening" look like? It probably means starting important but not essential lower risk activities with some risk mitigation measures in place, and then if the infection rate remains low, allowing higher risk important activities and lower risk non-important activities until, hopefully, by the end you are able to allow even high risk leisure activities (like large sports gatherings). As I said, a process, not an event.
BC
RE: How to "reopen"? - chrisk - 04-12-2020
A guide to reopening pro basketball: Taiwan
Can the N.B.A. Learn From Taiwan’s Basketball Bubble?
https://www.nytimes.com/2020/04/10/sports/basketball/taiwan-pro-basketball.html
RE: How to "reopen"? - teejers1 - 04-12-2020
(04-12-2020, 04:07 PM)BostonCard Wrote: As it seems like we are at or close to the peak (hopefully) of coronavirus activity and the rate of new infections starts to decline, it is probably a good time to start planning for what reopening looks like. The administration has set a goal of May 1, which I think is aspirational. But regardless of when the date is, it is worth starting to think of how to relax restrictions so that the economy can start to come back without triggering a new outbreak. I think there's a tendency to think of reopening the economy as an event (as witnessed by setting a date for it), but it's more like a process. And Teejers post about people pursuing various low risk activities got me thinking that really there are three or four dimensions on which you can judge activities.
1) How essential is it? We dichotomize activities into "essential" and "non essential" but in reality there are gradations involved, from critical (healthcare services) to completely non-critical (leisure activities) with a whole host of things in between. Public transport, for example, might not be critical per se, but if that's how a doctor or nurse normally gets to the hospital, it's critical. School is not immediately essential, but it is very important (forget for a moment that it probably also carries a high risk for transmission, I'm trying to rank it in terms of how essential it is).
2) How risky is it? Some critical activities are very risky because they bring together lots of people, some who may be sick, in an enclosed area (hospitals are a good example); others are very low risk (Teejers example of socially distant golf, for example). So, note that you can have high-risk essential services and low-risk leisure activities.
3) What is the individual risk? By this I don't just mean the individual risk of getting sick, but also the individual risk of having or spreading infection. A worker in a high contact essential occupation (grocery store clerks, hospital personnel), even if they are young and otherwise low risk themselves would have a high risk of passing the virus along and therefore should minimize exposures, even if relatively low risk exposures. On the other hand, individuals who have recovered from the virus are probably low risk (assuming they can get immunity) and can probably do what they want without putting themselves or others at risk. Kids themselves are probably fairly low risk, but higher risk if they live in a multigenerational family with their grandparents.
4) What is the local prevalence of disease? Tightening or relaxing of restrictions has to be dependent on how many cases are out there. There are probably many parts of rural California that are very low risk and for which local shutdowns may not have been necessary. Even as much of the rest of the country opens up, there will be local hotspots that won't be able to.
5) What kind of risk mitigation measures are possible. These might include things like limiting occupancy to allow effective social distancing (I'm thinking for example of the Dish, which was closed because too many people went). The Dish probably could be reopened, but only if there are guards allowing one person in for every person who goes out and has hand sanitizer at the entrance and hikers are willing to take risk reduction steps such as using masks.
And of course all of this is predicated on having testing and contact tracing.
So what does "reopening" look like? It probably means starting important but not essential lower risk activities with some risk mitigation measures in place, and then if the infection rate remains low, allowing higher risk important activities and lower risk non-important activities until, hopefully, by the end you are able to allow even high risk leisure activities (like large sports gatherings). As I said, a process, not an event.
BC
1. I just hope people in governor's office and in county offices are thinking along these lines/planning;
2. I actually would put a greater premium on "is it safe?" vs. "is it essential or important?" I've repeatedly said I think golf courses and driving ranges should not have closed down. They could have remained open with a few prudent precautions. Now, you may say golf is completely unimportant in Big Picture (and I'd probably agree with you). However, if you give people (a) option to exercise/get out in open, (b) a small group of proprietors the ability to get back to work, and © do so safely, then it should be allowed. And please remember that everything we do outside the house "increases risk" incrementally, even if it is infinitesimal.
Let's be prudent and reasonable whenever we start to turn things the other way; but not ultra-fearful, either.
RE: How to "reopen"? - Goose - 04-12-2020
(04-12-2020, 04:07 PM)BostonCard Wrote: 4) What is the local prevalence of disease? Tightening or relaxing of restrictions has to be dependent on how many cases are out there. There are probably many parts of rural California that are very low risk and for which local shutdowns may not have been necessary. Even as much of the rest of the country opens up, there will be local hotspots that won't be able to.Really important point. One size doesn't fit all, and many areas will start resisting the shutdown if they are low risk and financially damaged. Reason must prevail in both reopening and not reopening. Areas that were not hotspots can become hotspots and will have to go back to shutdown. Everyone needs to understand this going in, or there will be problems.
Quote:5) What kind of risk mitigation measures are possible. These might include things like limiting occupancy to allow effective social distancing (I'm thinking for example of the Dish, which was closed because too many people went). The Dish probably could be reopened, but only if there are guards allowing one person in for every person who goes out and has hand sanitizer at the entrance and hikers are willing to take risk reduction steps such as using masks.
Maybe a minor point, but AFAIK it wasn't too many people. It was how people behaved. This is the Stanford press release.
"Last week, we implemented additional health and safety measures at the Stanford Dish to allow us to be able to keep the area open as long as possible. Extensive signage and increased staff presence were intended to reinforce and educate Dish users to act responsibly in the interests of the entire community. While many visitors have taken those measures to heart, unfortunately, there have been a persistent minority of individuals who have not complied with these rules and have, therefore, put others at risk. Many community members have expressed their concerns about what they have experienced at the Dish.
We have a responsibility to ensure that anyone on Stanford property follow state and county social distancing guidelines to protect public health and safety. At this time, we regretfully believe the only way to do so is to close the Dish area. We will close all entrances to the Dish at 5 p.m. today, Friday, April 3rd."
Quote:And of course all of this is predicated on having testing and contact tracing.This is the sine qua non of reopening. Without that, another outbreak is inevitable.
RE: How to "reopen"? - burger - 04-12-2020
In light of the news about Ziaire Williams, I am now in favor of any plan that allows for a full slate of NCAA basketball practices and games for next season.
RE: How to "reopen"? - 2006alum - 04-13-2020
In terms of how to re-open, we do not yet seem to be doing the basic steps necessary to get widespread testing available, which basically everyone agrees is the necessary first step to reopening. A month later, most of the feds' promises have gone unfulfilled:
[tweet]https://twitter.com/DrDenaGrayson/status/1249657904770306048?s=20[/tweet]
RE: How to "reopen"? - BostonCard - 04-13-2020
So apparently, the San Mateo County Public Health department had a drive through testing site on the San Mateo fairgrounds, which they are now apparently closing because not enough people were coming. It turns out that although testing capacity was increased, the site, which was set up to take people getting referrals from Google's testing website (Verily's "project baseline"), was not getting enough referrals, because the testing criteria were too strict.
https://www.smdailyjournal.com/news/local/san-mateo-county-officials-thinking-of-changing-testing-criteria/article_d35e7096-7ba5-11ea-b0d5-9fcde6885d41.html
I don't know if they have done it yet, but now they are thinking of relaxing the criteria to one symptom:
Quote:Right now, to get a free test at the Event Center, you must exhibit two symptoms like a cough, scratchy throat or a headache to be tested. Callagy suggested that could be reduced to one symptom, with a belief of possible exposure. He also suggested that the list of those eligible for testing currently limited to typical first responders be expanded to include other frontline workers like grocery clerks and pharmacy workers. And it might be a matter of rotating testing through the grocery stores, he added.
BC
RE: How to "reopen"? - Farm93 - 04-13-2020
(04-13-2020, 07:27 AM)2006alum Wrote: In terms of how to re-open, we do not yet seem to be doing the basic steps necessary to get widespread testing available, which basically everyone agrees is the necessary first step to reopening. A month later, most of the feds' promises have gone unfulfilled:POTUS45 has already stated he is just the backstop.
[tweet]https://twitter.com/DrDenaGrayson/status/1249657904770306048?s=20[/tweet]
In baseball, if you are any good you can play the game without any throw or pitch hitting the backstop.
So, here I will trust my CA government to be good. In February my opinion of Newsom was rather low, but I will take his judgement every day over the apparently alternative of trusting the federal backstop.
Make the calls for CA by listening to experts (a.k.a. not WH). Follow the data, have solid testing and aggressive tracing and be ready to retreat if there is even a hint we went too far on any specific part of the reopening plan.
RE: How to "reopen"? - Genuine Realist - 04-13-2020
(04-13-2020, 08:51 AM)Farm93 Wrote:There's going to be an enormous amount of self-censorship whenever any re-opening occurs. A brobdingnagian number of people will continue to be very cautious.(04-13-2020, 07:27 AM)2006alum Wrote: In terms of how to re-open, we do not yet seem to be doing the basic steps necessary to get widespread testing available, which basically everyone agrees is the necessary first step to reopening. A month later, most of the feds' promises have gone unfulfilled:POTUS45 has already stated he is just the backstop.
[tweet]https://twitter.com/DrDenaGrayson/status/1249657904770306048?s=20[/tweet]
In baseball, if you are any good you can play the game without any throw or pitch hitting the backstop.
So, here I will trust my CA government to be good. In February my opinion of Newsom was rather low, but I will take his judgement every day over the apparently alternative of trusting the federal backstop.
Make the calls for CA by listening to experts (a.k.a. not WH). Follow the data, have solid testing and aggressive tracing and be ready to retreat if there is even a hint we went too far on any specific part of the reopening plan.
RE: How to "reopen"? - Mick - 04-13-2020
(04-13-2020, 08:43 AM)BostonCard Wrote: So apparently, the San Mateo County Public Health department had a drive through testing site on the San Mateo fairgrounds, which they are now apparently closing because not enough people were coming. It turns out that although testing capacity was increased, the site, which was set up to take people getting referrals from Google's testing website (Verily's "project baseline"), was not getting enough referrals, because the testing criteria were too strict.
There was a testing site at the Santa Clara County Fairgrounds but they limited it to people with severe headaches and severe temperatures and severe respiratory issues. That was a few weeks back, not sure what it is now.
RE: How to "reopen"? - 2006alum - 04-13-2020
(04-13-2020, 09:16 AM)Mick Wrote:(04-13-2020, 08:43 AM)BostonCard Wrote: So apparently, the San Mateo County Public Health department had a drive through testing site on the San Mateo fairgrounds, which they are now apparently closing because not enough people were coming. It turns out that although testing capacity was increased, the site, which was set up to take people getting referrals from Google's testing website (Verily's "project baseline"), was not getting enough referrals, because the testing criteria were too strict.
There was a testing site at the Santa Clara County Fairgrounds but they limited it to people with severe headaches and severe temperatures and severe respiratory issues. That was a few weeks back, not sure what it is now.
This is what drives me crazy. Those criteria suggest they are only testing for the purposes of treatment, not testing for the purposes of public health. We need to expand testing so that anyone who wants to get tested can, which I think Pence promised us well over a month ago. Until that happens, I don't know how we "re-open" the economy.
RE: How to "reopen"? - dabigv13 - 04-13-2020
https://www.governor.wa.gov/news-media/washington-oregon-and-california-announce-western-states-pact
WA, OR, CA forming a group to coordinate reopening. Northeastern states doing the same. This is heartening in absence of federal leadership, but no matter what happens, a looooot of money will be necessary and for that we will need federal action I think.
RE: How to "reopen"? - burger - 04-13-2020
These regional alliances are a good idea given the circumstances. There's no need for each state to reinvent the wheel vis-a-vis contact tracing.
But wouldn't it make far more sense for the federal government to come up with a plan and guidelines instead of each state or region having to do it for themselves? My guess is that between CDC, NIH, FDA, etc, the feds probably have a lot more expertise in disease management than any state or group thereof. Do we really need 6 regional plans or contact tracing apps or testing systems? How about just one? Or, at worst, a single template that each state or region can run with. Duplicating these efforts is so inefficient.
On top of that, there's a much bigger problem with leaving all of the contact tracing etc. to the states: they are all about to go broke. States can't run deficits, and tax revenue is going to plummet. Where will the money for all this apparatus and the army of contact tracers going to come from? In Congress, Dems are trying to get more money for states into the next covid response bill but McConnell and Trump are saying that's a non-starter. Having states responsible for the next stage is not going to work unless they start getting big cash infusions.
RE: How to "reopen"? - OutsiderFan - 04-13-2020
It's comical how the White House thinks it has any say in how things open when its position was states are all in charge and the Federal Government is a backup.
NY, NJ, PA, CT, DE, and RI have announced their own alliance today. I'm curious why MA hasn't joined in. Maybe it will.
[tweet]https://twitter.com/GovMurphy/status/1249765507131232257[/tweet]
RE: How to "reopen"? - 2006alum - 04-13-2020
Yeah, Our Elected Leader really seems to want to have his cake and eat it too - blame the states for all shortcomings but claim the power to make all the important decisions.
As for why no Massachusetts, I'm sure it's because the two states with the most interstate travel from MA are NH and ME. Indeed, there are Boston bedroom communities in both NH and ME, so it wouldn't be responsible for MA to commit to this compact without bringing NH and ME on board. And in terms of regional transit and public infrastructure co-dependencies, the PA-NJ-NY-CT corridor has far more overlap than the MA-RI-CT one. I'm actually a little surprised RI is joining this compact, but not at all surprised MA isn't, at least without NH and ME.
RE: How to "reopen"? - OutsiderFan - 04-13-2020
MA and CT have the 4th and 5th worst confirmed case outbreaks per capita in the U.S. I see merit in them working together.
We have a stay at home order in CT until May 20 at the moment.
RE: How to "reopen"? - 2006alum - 04-13-2020
MA is now on board. Now that there's an R on board, I imagine VT and NH will join, along with ME.
[tweet]https://twitter.com/annagronewold/status/1249806614837760000?s=20[/tweet]
Looks like federalism/regionalism is starting to do its job. If not for border control and stimulus support (states can't run deficits due to state constitutional requirements), maybe it'd be possible to look past the feds altogether.
RE: How to "reopen"? - Goose - 04-13-2020
(04-13-2020, 04:50 PM)2006alum Wrote: MA is now on board. Now that there's an R on board, I imagine VT and NH will join, along with ME.I am 100% in support of federalism. Obviously the individual states and regions know a lot about what they can and cannot do, and what will work for them. Getting together and sharing best practices is always a good idea.
[tweet]https://twitter.com/annagronewold/status/1249806614837760000?s=20[/tweet]
Looks like federalism/regionalism is starting to do its job. If not for border control and stimulus support (states can't run deficits due to state constitutional requirements), maybe it'd be possible to look past the feds altogether.
However, looking past the "feds" altogether is a bad idea, even when it comes to strategy of reopening and the epidemiology of the epidemic. The "feds" are not Donald Trump, although at times he seems to believe they are. Fauci is parts of the "feds". So is CDC and, more importantly, USPHS. Believe it or not, the system is designed for the Counties and the States to do the heavy lifting. However, the "feds" do have expertise and broad skills in these areas. The States should use these resources when appropriate, but should always make their own decisions based on the data available and their unique situation. Ignoring such resources would be stupid. Relying on them would be equally stupid. Pissing contests, whether Federal-State or State-County helps nobody.
RE: How to "reopen"? - Mick - 04-13-2020
(04-13-2020, 12:18 PM)dabigv13 Wrote: https://www.governor.wa.gov/news-media/washington-oregon-and-california-announce-western-states-pact
WA, OR, CA forming a group to coordinate reopening. Northeastern states doing the same. This is heartening in absence of federal leadership, but no matter what happens, a looooot of money will be necessary and for that we will need federal action I think.
One of our lawyers is super plugged in to the Northeastern states. NY/NJ/CT governors committed to cooperating with each other, PA was supposed to be right on their heels.
RE: How to "reopen"? - burger - 04-13-2020
(04-13-2020, 08:12 PM)Goose Wrote:(04-13-2020, 04:50 PM)2006alum Wrote: MA is now on board. Now that there's an R on board, I imagine VT and NH will join, along with ME.I am 100% in support of federalism. Obviously the individual states and regions know a lot about what they can and cannot do, and what will work for them. Getting together and sharing best practices is always a good idea.
[tweet]https://twitter.com/annagronewold/status/1249806614837760000?s=20[/tweet]
Looks like federalism/regionalism is starting to do its job. If not for border control and stimulus support (states can't run deficits due to state constitutional requirements), maybe it'd be possible to look past the feds altogether.
However, looking past the "feds" altogether is a bad idea, even when it comes to strategy of reopening and the epidemiology of the epidemic. The "feds" are not Donald Trump, although at times he seems to believe they are. Fauci is parts of the "feds". So is CDC and, more importantly, USPHS. Believe it or not, the system is designed for the Counties and the States to do the heavy lifting. However, the "feds" do have expertise and broad skills in these areas. The States should use these resources when appropriate, but should always make their own decisions based on the data available and their unique situation. Ignoring such resources would be stupid. Relying on them would be equally stupid. Pissing contests, whether Federal-State or State-County helps nobody.
I don't know where you're getting your news, but no one is turning down federal help in the next phase because there is no federal help. Trump's offer to the states was the same as Michael Corleone's to that senator--nothing. There's no pissing contest between the states and the feds. The feds are absolutely ***** useless with Trump in charge, so the states HAVE to go it alone.