Gov. Doug Ducey’s “Stay Home, Stay Healthy, Stay Connected” order to mitigate the COVID19 pandemic has dramatically “flattened the curve,” reducing spread and protecting our hospital system and health care professionals. But, the order was set to expire April 30. As Arizona looks toward re-opening, it is important to consider how we re-enter without jeopardizing the gains achieved by a month in lockdown.
In an ideal world, states would re-open only after a sharp and sustained reduction in new COVID19 cases. We would exit lockdown armed with widespread testing to detect new infections, infrastructure for contact tracing and antibody testing to determine those who have been infected, recovered, and now have some immunity to the virus. But we are far from the ideal situation. Arizona’s largest counties are just approaching the peak in new infections. Testing for infection has not yet been extended beyond those who are sick. Without testing and contact tracing, we lack the classic tools deployed in tamping down pandemics.
In an ideal world, the decision to re-open would be driven by data. But the data are not coming fast enough to inform decisions and SARS-CoV-2 is here to stay. Until there is an effective vaccine or antiviral, we will not be free to resume pre-pandemic life. Further, controlling the COVID19 pandemic poses unique challenges due to its propensity for asymptomatic spread (possibly up to 25% of all infections), making infections difficult to identify and isolate. We must learn how to find a new normal to re-build life and the economy amidst the pandemic.
Social distancing (6 feet of separation), restricting the size of gatherings and diligent hand-washing must continue as a primary means to combat spread of SARS-CoV-2. Return to work needs to be a primary focus for re-entry to bolster the economy. But we must have a phased strategy to put the workforce back in place, starting with jobs where social distancing is possible for risk management, then gradually working up to jobs where distancing is less attainable.
Face coverings are critical in communal or public spaces, especially where 6-feet distancing is not possible. Work hours need to be staggered and flexible to minimize contact, and activities that can be done remotely should remain remote. Implementation of each successive phase should be separated by two weeks to assess the resulting rise in cases. When numbers of new cases spike, restrictions will have to be reinstated.
The relaxation of restrictions should be slower and more controlled in more densely populated cities, which are at greater risk than more sparsely populated rural areas. Activities that draw high densities of people together, such as concerts and sporting events, will remain a tenuous proposition for many months to come. Travel too remains a large source of risk.
A recent Washington Post poll shows that Americans are twice as worried about opening the country too fast than too slow. This suggests that the majority of people are concerned about the risk of COVID19. This level of concern will hopefully translate into sustained attention to social distancing and hand washing.
Whether or not we can safely exit lockdown amidst the pandemic – in the absence of testing and tracing – remains a big question. The lockdown has come at great economic and personal expense. It is important that the sacrifices made in the interest of public health are not for naught. For Arizona to roll the dice and re-enter society requires a well-designed plan to lift, monitor and re-implement restrictions once we have gone too far.
Felicia Goodrum Sterling is a virologist, president-elect of the American Society of Virology, and a professor and scientist at the University of Arizona. James Alwine is a virologist, a fellow of the American Academy for Microbiology, and a professor emeritus at the University of Pennsylvania and a visiting professor at the University of Arizona.