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Careful, phased approach needed to reopen or Ohio pandemic cases could resurge

Coronavirus: Gov. DeWine provides latest in COVID-19 with Monday briefing
Coronavirus: Gov. DeWine provides latest in COVID-19 with Monday briefing

Health experts concurred with the DeWine administration’s plans for a cautious, phased reopening — which won’t look quite like things were before the outbreak until a vaccine.

By social distancing, Ohio has managed to spread out cases so they didn’t all hit at once and it bought time for the health care system to prepare and expand resources, said Dr. Zach Jenkins, Cedarville University Associate Professor of Pharmacy Practice.

“The concern is if we turn too many things on at once too quickly, you could still have a surge that gets through whatever health care capacity we’ve built up,” Jenkins said.

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Ohio is now still working on slowing the spread of cases to a manageable level, while building up capacity for treatment, testing and response.

Cases
Cases

American Enterprise Institute has created a widely circulated report "National coronavirus response: A road map to reopening" released March 28 that's outlined what a phased reopening could look like. Authors include two former FDA commissioners, former FDA chief of staff, and infectious disease and health security experts with Johns Hopkins.

Right now, Ohio is in what the report describes as “Phase 1,” where the goal is to slow the spread of the disease.In Phase I, people are getting sick who can’t trace where they got sick from because it is difficult to tell where the virus is or isn’t.

Phase II is when a more typical life starts to slowly resume in a phased and careful approach. In this next phase, AEI says populations at heightened risk like older adults will need to still limit time out in the community, teleworking should continue as convenient, and limits on gathering sizes will still be needed to prevent spread from accelerating all over again.

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When will states be ready to move into Phase II? Similar to the DeWine administration’s approach, American Enterprise Institute authors say states will need to be able to safely diagnose, treat, and isolate COVID-19 cases and their contacts.

The report authors say the cues for when it is safe to move to from where we are to Phase II will be:

• A sustained reduction in cases for at least 14 days;

• Hospitals in the state are safely able to treat all patients requiring hospitalization without resorting to crisis standards of care;

• The state is able to test all people with COVID-19 symptoms;

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• And the state is able to conduct active monitoring of confirmed cases and their contacts.

To move past Phase II, the report advises there would need to be therapies or vaccines. DeWine also said Tuesday that while there are ways to carefully pull back restrictions, this won’t be truly over until a vaccine is available.

Jenkins said to reopen the public health officials also need more manpower to track down the contacts of who has the disease so they can be quarantined and tested.

“The challenge with the pandemic is that it requires an immense amount of manpower with the size of the issue at hand and people can actually walk around with no symptoms for a long period of time,” Jenkins said, adding that in Ohio there’s efforts to get health care students involved in the tracing effort to scale up this ability.

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It’s also hard to make decisions when health officials have a hard time telling who is currently infectious and have a hard time telling who has already been infected and has developed antibodies, according to Jenkins. More of this data means a more targeted response, he said. The CDC had started efforts to do antibody testing from samples of people as part of studies to get a better picture.

After reopening, there may be communities that start to see a surge of new cases where public health officials can’t trace where the cases came from.

“You might not have wide-scale social distancing. But if there’s a local outbreak, they may actually implement some of those measures on a smaller scale,” Jenkins said.

The urgency of the situation was apparent at the Ohio House of Representatives’ Economic Recovery Task Force in a virtual meeting Tuesday.

Ohio Restaurant Association estimated 3% of restaurants won’t re-open. An advocate for hotels said occupancy rates of 21% are the worst in history. An advocate for behavioral health agencies said most of their members will run out of cash in eight weeks because they can’t provide and bill for services.

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“These professionals are making significant sacrifices,” said Tony Fiore, executive director of the Ohio Salon Association of the employees and owners of 12,000 salons and barbershops across Ohio. “They need to see the light at the end of the tunnel.”

The task force, led by state Rep. Paul Zeltwanger, R-Mason, was set up to plan how best to re-open Ohio’s economy after the shutdown. It won’t happen with the flip of a switch, trade groups said Tuesday.

John Barker, president of the Ohio Restaurant Association, said restaurants that stayed open have seen massive revenue decline and noted that restaurants are one of the state’s top employers with about 585,000 workers.

Joe Savarise, executive director of the Ohio Hotel and Lodging Association, said his industry has lost $200 million and that number will grow as planned vacations and events continue to be canceled.

Savarise suggested the state could offer an emergency grant program similar to what Illinois is doing, help local governments put front-line workers in hotels to prevent the spread of COVID-19 to their families, and help hotels with tax deferrals.

Barker and Savarise both expressed concern that changes meant to help displaced workers by boosting unemployment payments could incentivize people to stay out of the workforce longer than needed.

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Neil Tilow, president and CEO of Talbert House, said behavioral health businesses and agencies like his are losing hundreds of thousands of dollars because they can’t provide services. His agency has lost more than a quarter of its revenue, he said, and “we are one of the lucky ones.”

He asked lawmakers to make changes to insurance so they can bill for more telehealth service and changes to speed up payments.

Zeltwanger said his main message for his constituents and industries across Ohio is they need to start planning now for how they can safely resume business while minimizing the risk of the spread, and what kind of supports do they need.

“How do we begin to think about the pivot?” He said. “How do we safely and smartly begin to get back? “