A Science-Based Strategy to Lift Stay-at-Home Orders in Small to Mid-Sized Communities

We’re more than a month into quarantine, and communities across the US are beginning to talk about relaxing stay-at-home orders. My town of 100,000 is tucked in between the Cascade Range and high mountain desert of Oregon, away from large urban areas. In our mostly rural half of the state, people are getting antsy.

My County Commission will be meeting on April 23rd to discuss a strategy for reopening our community. Other elected officials will do the same in coming weeks.

All of us want to get back to “normal,” to open businesses, and to see our friends and family, but we must proceed with caution. If we don’t, the results could be catastrophic.

I write this as a trained scientist with a PhD in population genetics, a field closely aligned with epidemiology, and the author of a book about pandemics. I want to share some considerations that should guide the strategy for moving forward in communities like mine. The safety and wellbeing of our communities depends on it.

First, let me recap some crucial scientific facts, which should guide decision making. The novel coronavirus known as SARS-CoV-2, which causes the illness COVID-19, has a set of characteristics that epidemiologists have long identified as being necessary for a pandemic. Make no mistake, SARS-CoV-2 is much more dangerous than the flu.

  1. It has a long silent period in which an infected person has no symptoms but can still spread the virus to others. (Estimates are hard to pin down but from 10–48% of transmissions could be by people without symptoms.)
  2. It is highly infectious, meaning that an infected person can spread the infection easily. Consider the case of the woman from Charlotte, who was infected by touching a contaminated pin pad at her pharmacy.
  3. It is highly variable in its effects. For some, the virus is lethal. Others have barely a sniffle. This variability increases the likelihood of spread.

At some point, we will likely be able to manage this disease in the same way we manage the flu or chickenpox, through a combination of widespread vaccine use and herd immunity (a state in which most people in the community have been exposed to the virus and developed immunity to it).

Unfortunately we are at least 18 months, and probably longer, from this point. What do we do in the meantime? The reality is that for the next 18–24 months life will not be “normal,” but we can survive it. We must urge our elected officials to take steps now to help our communities stay safe during this critical period of time. I have seven specific areas that should be part of our strategy for reopening businesses.

  1. Push for increased testing capacity. Without widespread testing of asymptomatic people, we are blind. Widespread testing would tell us how many silent carriers are in our community. If silent carriers are widespread, easing social distancing will cause an explosion of cases. If silent carriers are few and far between, then we would be at less risk. Unfortunately, we have no idea how many carriers are in our community because only very ill people are being tested. (This is true in most US communities, but Oregon is among the bottom four states in testing capacity.) We are very lucky locally that OSU and the Benton County Health Department have chosen our community in which to launch their door-to-door testing research. Can we partner with similar groups to expand test in counties throughout the country? Can we pressure state and federal leaders for more resources?
  2. Develop a system for contact tracing. If we can identify carriers through testing, ask them to quarantine, and then trace back to all the people they had contact with for more testing, we would have a chance to stop those people from spreading the virus to others. This will be inconvenient and feel frustrating to some, but without contact tracing and targeted quarantine, we can’t protect our community. Can the County Health Departments lead this initiative in partnership with hospitals and other groups? Can we allocate more funding for these efforts?
  3. Communicate the importance of continuing social distancing. Even if we begin to open up business, we need to keep our distance from others. I urge you to watch the public service announcement put out by the Ohio Department of Health that depicts the efficacy of social distancing to stop viral transmission. How can elected officials reinforce the importance of continued distancing within our communities?
  4. Show our community the importance of developing new “life skills.” It takes time to build new habits. One benefit of the current stay-at-home orders is that we have the opportunity to be habitualized to new behaviors such as not touching our faces, not shaking hands, sanitizing our groceries, using our elbows to open doors, bringing our pens to sign credit card slips, wearing masks, etc. Even after we begin to open businesses, we need to keep practicing these behaviors. Can our leaders find ways to communicate and encourage these safety practices?
  5. Implement preventative sanitation standards in all businesses and public spaces. We need to be wearing masks. The people that make our food and stock grocery store shelves and help us at the bank need to be wearing masks. Everyone will be much safer if we do. And we need to keep wearing them, even after we reopen more businesses. Can leaders, through oversight of restaurant safety and sanitation, push for new, temporary guidelines until we have widespread vaccination?
  6. Discourage tourism. Right now, our community is doing an extraordinary job of staying at home and taking care of each other. We have relatively few cases compared to other areas. If we stay committed to doing the right thing and if we implement the suggestions above, we can slowly reopen businesses and still keep infection rates down. But every single outside visitor to our community is a potential vector, a single spark, which could ignite a new wave of infection. In this regard, my county is NOT like any of the other rural counties, who do not, under normal circumstances, have significant tourist influx. Can we encourage city governments in vacation areas to prohibit short term rentals? Can our leaders build support among business associations and tourism promotion groups to support continued restrictions?
  7. Pressure the state and federal government to allocate financial support. Our local elected officials need to advocate for our communities. We need to fund testing, contact tracing, public health service announcements, and provide support for community members who are sick and need to stay home from work. How will our leaders advocate for us?

Oregon is in a much better position than many other states because we implemented stay-at-home guidelines early. We must not squander that advantage. It won’t work to just open everything and go back to business as usual. If we do that, we risk wave upon wave of infection, many more deaths of valued community members, and potentially ongoing cycles of business shutdown.

We are in a new “normal.” We have to change our behaviors and keep them changed. We need testing and contact tracing. This is the only way we can reopen safely. Most people in my state support the stay-at-home orders and are willing to do whatever it takes to keep each other safe, but we need strong leadership. I urge communities like mine across the country to pressure their elected officials to build a strategy for reopening that is evidence-based and public health focused.

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