By overwhelming margins, American want to open the country back up safely. That means deliberately, step by step, and guided by the tools that only a month ago the White House recommended be in place.
Meanwhile a vocal minority are visibly pressuring governors into going faster than their health commissioners recommend. While their tactics aren’t always the best, there is a validity to the debate about how fast to open, but the safety of the public must be the priority.
There are 21 of us (and the list is growing) from a variety of political and other perspectives, who felt it was important to speak to the public’s desire to open safely, define what it means, and to explain the resources needed to get there. Opening recklessly is easy. Opening safely takes more work. But as other countries have shown, it can be done. And our country deserves nothing less.
After several weeks of discussion and research we launched our #OpenSafely Initiative today by sending a letter to every governor which we placed in the USA Today as a full page op-ed. We started by expressing our understanding of public sentiment. Below is what we believe based our work on:
Americans want our country to open up safely.
We have been at this for a number of difficult weeks since the global coronavirus pandemic began, and it has taken a toll.
It has been a time of unprecedented challenge. To our health. To our jobs. To our social connections. To our health care communities.
We have sacrificed with great unity to #StayHome in order to reduce the infection rate and save lives.
We want a sense of normalcy back — to go to work, to go to restaurants, to see sports again, to send our kids to school, to hug our families — but not at the expense of the lives of our friends, families and neighbors.
We want a good economy and public safety, but we are afraid if we open too quickly, or don’t have plans to adjust if spread recurs, we will have neither.
We don’t believe we need to wait until everything is completely perfect or there is zero risk before we open again. The reality is that many states are already taking the first steps toward opening, and this must happen in the safest way possible.
Americans should still #StayHome whenever possible and continue social distancing. Now we need to get on a path to #OpenSafely that gets it right.
We went on to lay out what the state of the virus that we think is important to keep in mind as we go through various stages. It is tempting to let our guard down but history and science tell us not to.
COVID-19 is still spreading, but at a steadier rate. While it is shrinking in places like New York, it is still growing rapidly in some areas where there had been fewer cases. The virus is still equally contagious. The virus is still lethal to many. The virus still spreads through unsuspecting asymptomatic people. Some places are especially hard hit: nursing homes, meatpacking plants, prisons, detention centers, public housing, and the communities around them as people move in and out. People are still dying at an alarming rate, and that will continue unless we follow the path like the one outlined by Dr. Deborah Birx at the White House: a steady, gated reopening that avoids accelerated growth in cases, hospitalizations and deaths.
Tens of millions of Americans are now out of work. Many businesses have closed; others are in danger. Americans are facing hunger and the inability to pay their rent or mortgage at levels not seen here since the Great Depression. Congress and the administration have passed laws to support Americans through this, but support isn’t the same thing as a job. And the support still leaves voids that need to be filled.
Yet opening the country before we have the conditions like those outlined in the White House plan can put Americans at risk unless we take further steps. It won’t help the economy if we end up having to pull back hard or close again because the virus starts spreading toward the point where it threatens our health care systems and further disrupts our health. The things that will bring us back — consumer spending, business hiring, signing leases, travel and capital investment — won’t happen unless Americans feel confident they can do these things without a substantial risk of harm to themselves or their loved ones from getting and spreading COVID-19.
We are asking decision-makers at all levels to #OpenSafely — to move along the path of opening up our communities again as deliberately as necessary and as quickly as can be safely accomplished.
The ingredients to #OpenSafely have been laid out in a number of places. There is generally broad consensus. But there’s a wrinkle. Many states have already jumped the gun or aren’t following them closely. And the White House laid out a plan but haven’t implemented it. Here is what we suggest:
Opening up safely means:
- Following the plan laid out by Dr. Birx to begin opening communities up with two weeks of declining case counts and the other gating criteria met — or explaining how there is an alternative plan for containment if that condition is not met.
- Creating adequate diagnostic testing availability so that people who need a test can get one — particularly people with symptoms, and those without symptoms in high-risk settings like nursing homes, prisons and meatpacking plants.
- Implementing improved safety standards and protocols to avoid outbreaks and slow spreading in potential hot spots.
- Having adequate public health infrastructure to contact trace and offer voluntary isolation to contain the virus when it is detected — not necessarily to trace all cases successfully, but enough to minimize potential outbreak clusters and keep getting better over time.
- Protecting vulnerable and at-risk populations and hard-hit communities, and not putting essential workers at needless risk.
- Obtaining sufficient personal protective equipment (PPE) to protect our first responders and health care workforce, including by expanding access to testing in the community
As the reopening process begins and moves forward, states should be carefully monitoring hospitalization trends and their hospital capacity. If the rise in cases is on track to threaten hospitals’ capacity to care for COVID-19 or other acutely ill patients in the state, states should immediately take steps to slow or pause reopening efforts. The lag between infection and serious complications is typically eight days or more, so there is little time to wait if such trends emerge.
Additional important areas to make progress on that will reduce risk of transmission and support continued opening up:
- Widespread use of high-quality masks.
- Surge capacity in the health care system with sufficient PPE to protect health care workers.
- Evidence-based mitigation measures and screenings in offices and public spaces, using guidelines from the Centers for Disease Control and Prevention, or comparable ones.
- Controls at major air and rail entry points.
- Continuous monitoring at the state and county level for indications of potential emerging outbreaks, including symptom-checking apps, digital thermometers and other syndromic surveillance tools as they become available.
- Test, trace and isolate most active cases and their closest contacts, using vacant hotel space where necessary.
- Coordinated response with neighboring states.
- Widespread use of telemedicine to improve health care access and reduce the use of PPE.
- Readiness to respond quickly to new community spread.
This solicited a significant amount of debate, ideas, and wordsmithing. It was important to the people working on this letter that #OpenSafely not only apply to the few states that haven’t opened, but provide guidance everywhere. The ability to contain spread, knowing when to slow the pace or dial back, and knowing what metrics to consider, are all going to remain important in every state and to every person.
There is so much we don’t know and will still learn. Some activities we believe to be safe — if we all observe the guidelines — we’ve been doing. Some need to be adjusted. And some will not be safe for a long time.
Areas that can most safely open up (with appropriate distancing and risk mitigation steps) if states have met the Dr. Birx gating criteria but have not yet initiated the reopening process are:
- Doctor offices, clinics and surgery centers with sufficient community PPE.
- Workplaces like retail and manufacturing.
- Parks and other outdoor recreation, lakes, gardens and bike trails.
- Shopping areas and coffee shops where people don’t congregate in large numbers or for extended periods.
- Outdoor weddings and funerals with small groups that physically distance and wear masks when close together.
Additional areas that we hope can open up successfully under significantly modified conditions, but that will benefit from further technical assessment on how processes should be modified that would allow them to operate with lower risks:
- Day care centers
- Summer camps and youth sports
- Movie theaters and small entertainment venues
- Sporting events with very limited or no crowds
- TV and film production
- Colleges and universities
Areas that should remain closed until risks can be significantly reduced:
- Large-scale events like concerts, sports with high attendance
- Large conventions and other activities involving significant travel and congregation
We believe these lists can be refined and adjusted locally based on conditions, proximity to hot spots, density and other factors.
We are asking public officials and decision-makers to #OpenSafely by quickly getting the conditions in place so we can move forward. We are encouraged that other countries, including Germany, Italy and New Zealand, as well as parts of the United States, are implementing strategies to begin to open safely and closely monitor a step-by-step opening. We believe a safe step-by-step opening can happen across the United States.
We believe Americans want to remain united in the fight against COVID-19, as we were in the initial response after 9/11. We can overcome this epidemic with smart policies and committed actions.
I am indebted to each of the people who worked on this letter.
- Dr. Mark McClellan, director of the Robert J. Margolis Center for Health Policy, Duke University; and former administrator, Centers for Medicare and Medicaid Services
- Tom Daschle, former U.S. Senate majority leader
- Dr. Bill Frist, former U.S. Senate majority leader
- Kathleen Sebelius, former U.S. secretary of Health and Human Services; former governor of Kansas
- Dr. David Shulkin, former U.S. secretary of Veterans Affairs
- Emily Barson, executive director, United States of Care
- Dr. David Brailer, chairman, Health Evolution; former National Health Information Technology coordinator
- Jim Douglas, former governor of Vermont
- David Durenberger, former U.S. senator from Minnesota
- Bill George, professor of management practice and Henry B. Arthur Fellow of Ethics, Harvard Business School; former chairman and CEO of Medtronic
- Penny George, co-founder, Penny George Institute for Health and Healing; board chair, George Family Foundation
- Dr. Sandra R. Hernández, President and CEO of the California Health Care Foundation
- Dr. Tom Inglesby, director, Center for Health Security of the Johns Hopkins Bloomberg School of Public Health
- Juliette Kayyem, former U.S. assistant secretary of Homeland Security for Intergovernmental Affairs
- Dr. Robert Kocher, former assistant to the president, National Economic Council
- Dr. J. Mario Molina, former CEO of Molina Healthcare
- Dr. Janice E. Nevin, president and CEO, ChristianaCare
- Caitlin M.Rivers, assistant professor and senior associate, Johns Hopkins Center for Health Security
- Dr. Eric Topol, founder and director of Scripps Research Translational Science Institute, professor of molecular medicine, and executive VP, Scripps Research
- Dr. Leana Wen, visiting professor of health policy and management at George Washington University Milken Institute School of Public Health; former Baltimore City health commissioner
- Dr. Penny Wheeler, president and CEO, Allina Health
This #OpenSafely initiative must be contrasted with Trump’s new ‘open at all cost’ strategy. On May 8th I suggested that Trump was going to put together an effort to discredit scientists who wanted to proceed with any caution. These Trump doctors are part of this effort:
How Trump Plans to Discredit Health Experts and Play Politics With a Crisis
Climate change denialism created the playbook to stoke fear and confusion — it is being put to use again
Trump has broken up the Task Force and the President has declared it’s time to move on. His wants to get the economy moving at all costs.
- Discredit the scientists
- Blame the governors
- Blame the Chinese
- Executive Orders in battle ground states
There is a lot of distance to go. Places that have had no problems, could have many. Places that have had troubles, could do well. Places we expect trouble may be OK. And we will be surprised by all we don’t know. There is a rational, careful path to get much of our lives back. Step by step. As long as we are prepared to adjust as we learn more.
I was asked several times today for the most important thing a state can do. There isn’t one thing. Pandemics aren’t a one thing moment, as Ronald Klain, who led the response to Ebola, told me on this podcast episode.
The virus spreads fast and can do its most damage when you don’t see it. According to research from Columbia University, 36,000 people’s lives would have been saved if we acted one week earlier. Ultimately no matter what political leaders say or do, we have to have the ultimate say about how to #OpenSafely. Yes we want our normalcy back. But not at the cost of people’s lives. We are going to get through this together.