Policymakers around the world are in a triangular tug of war between fighting COVID-19, economic rehabilitation, and ensuring societal normalcy, well-being, and health.
There are no easy answers or cookbook recipes, and each question of how, why, and when to open the economy is more daunting than the last. However, it is becoming increasingly evident that we cannot make decisions based on social, cultural, religious, or economic preferences alone. Also, decision-making cannot be an absolute top-down approach but a regionally driven strategy with citizen engagement. So, here are a few suggestions for our leaders and the public:
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First, make decisions that make sense locally. Analyzing regional data on COVID-19, such as the number of cases and deaths, the racial/ethnic distribution of the disease, the age and gender of groups most affected, and the social and medical history of those who are affected, will help define the unique nature and extent of the disease’s spread among communities and to strategize for customized prevention priorities. We need more testing based on population density so that the maximum number of infected people can be quarantined to break the chain of the spread (the “three T” model of “trace, test, treat”).
Second, focus on data. The key data points to consider in making a decision on opening the economy should be: the number of COVID-19 cases, deaths, and recoveries mapped by the smallest geographic unit, the total population of the region with sociodemographic distribution, the number of primary care and emergency services, the number of hospitals and healthcare facilities, the COVID-19 testing capacity, and the healthcare-related assets available (i.e. materials, devices, and human resources).
Third, watch the trends. The rates of increase or decrease in COVID-19 cases play a major role in estimating regional transmission patterns. If a geographic region does not witness a case for more than a week, that’s positive news. Once the two-week mark is crossed without a positive case, plans to allow many essential human activities should be formulated and implemented. Additionally, regions should be classified as high risk, moderate risk, and low risk. Those regions that should qualify as high risk should exhibit high numbers and rates of cases or deaths that remain the same or increase over time (call them “hot spots”).
Fourth, reopen in stages. Categorize services as highly essential, needed, and wanted. Based on relative importance, we should use a staggered, time-phased opening approach. These classifications should keep in view, for each service, the amount of human-to-human contact, needs, and capacities, the potential for large gatherings, the demand versus the supply of the service, the cost versus the benefit of these services, and the preparedness at service facilities as it relates to practicing aggressive hygiene and sanitation measures and social distancing for the clientele served. There should be ways to enforce the use of temperature screening devices, masks, sanitizers, and social distancing for all clients.
Fifth, increase the base of healthcare workers in communities. Make a priority of rapid, swift measures to educate and train lay health workers, nonphysician professionals, and qualified volunteers. Academic-community partnerships and the use of professional organizations to provide data and scientific services should be done as soon as possible. All of this can be done remotely by data transfer and coordination between regional healthcare facilities, health departments, and state or federal agencies. Existing data are assets that must be utilized.
Sixth, be prepared to shut down services again based on real-time regional evidence on COVID-19. We must also make an estimate for, after we reopen the economy, how long it will take for businesses and industries to flourish and how much time it will take to bring normalcy to life. Despite phased openings, we will still see fewer workers, fewer service demands, and fewer clientele.
It is time to utilize these strategies and aggressively prepare for the next phase: opening the economy and looking into the future. We have saved millions of lives by avoiding the disease and cannot lose our gains.
However, we also have to be mindful not to lose lives due to other diseases, poverty, and psychological upheaval. Based on regional data and the unique nature of COVID-19 in a community, decisions should be left to counties and local governments on opening the economy.
Such decisions should also engage regional healthcare providers, scientists, business owners, and representatives of the general public.
Jagdish Khubchandani, MBBS, Ph.D. is a professor of health science at Ball State University and has doctorates in both medicine and public health.
