With Covid-19 racing through the country, the United States is virtually locked down. At the same time, the yearning among Americans to reopen their communities grows, as does their desire to return to some semblance of normality.

In an effort to chart a path toward that goal, public health experts laid out two new roadmaps over the weekend.

The first, from Ezekiel Emanuel, a health policy expert and vice-provost of the University of Pennsylvania, suggests lockdowns could ease up in June. The second, from former Food and Drug Administration commissioner Scott Gottlieb and colleagues, doesn’t set a date, but rather outlines the evidence that communities would need to begin lifting some of the more draconian restrictions.

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Both road maps are predicated on the United States sharply ramping up testing for the disease and hospitals acquiring sufficient supplies at a time of extraordinary global demand and growing shortages — both of personal protective equipment to shield health workers from infection and ventilators to help the gravely ill to survive.

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The road map from Gottlieb and several co-authors, including Caitlin Rivers, an assistant professor of epidemiology at the Johns Hopkins Center for Health Security, envisions four phases. Phase 1 represents the current situation, in which the outbreak is growing. Only once certain thresholds are met — hospitals are able to cope with the flow of incoming patients and new cases have dropped in a particular area for at least 14 days — could Phase 2 begin.

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During that stage, physical distancing efforts will have slowed the spread of the disease to the point at which schools and some other types of societal functions can resume, though people 70 and older and others at highest risk from the virus would still need to restrict their movements.

The report suggests counties or states may move from Phase 1 to Phase 2 — and back to Phase 1 if containment starts to erode — at different times, based on local conditions.

Rivers acknowledged that won’t be anytime soon.

“I don’t think we are close to moving out of Phase 1,” she said. “I think staying home is what we need to be doing right now. And how fast we get to Phase 2 will really depend on how effective our interventions are now and how aggressively we are able to scale up our capacities.”

Phase 3, the lifting of all restrictions, would only occur when a vaccine to prevent infection and therapeutics to save people who become infected are available. Gottlieb said he thinks vaccines might be two years away, but feels confident some therapies will be shown to work by the summer. Phase 4 would entail planning to build the country’s capacity to respond to the next biological threat.

Gottlieb, now a fellow at the American Enterprise Institute, acknowledged some aspects of its 20-page road map report may seem unrealistic at the moment. There is, for example, an extraordinary global demand in protective gear for health care workers. But he said that shouldn’t lessen the importance of the road map.

“What I wanted to do with this was set out very clear measurable milestones and very clear objectives of what can improve when those milestones are reached,” he told STAT. “And give people something to shoot at. Because I think that reports that aren’t very granular aren’t very useful.”

Emanuel, who outlined his road map in an opinion piece in the New York Times, estimated that if spread of the virus isn’t slowed, almost one-third of Americans will be infected by early May. If Covid-19’s fatality rate is 1%, that level of transmission would lead to 1 million deaths, he noted. (There is much debate and no consensus on the fatality rate, though 1% is nearer the lower range of current estimates.)

Based on China’s response to the virus, he suggested that a national shelter-in-place order over the next eight to 10 weeks, excluding essential services workers, should, bring transmission of the virus way down.

In the interval, health officials will need to deploy “thousands of teams to trace contacts of all new Covid-19 cases using cellphone data, social media data, and data from thermometer tests and the like,” Emanuel wrote. “It would be easier to lift the national quarantine if we isolate new cases, find and test all their contacts, and isolate any of them who may be infected.”

Michael Osterholm, former state epidemiologist for Minnesota and director of the Center for Infectious Diseases Research and Policy at the University of Minnesota, said resource-starved public health departments do not currently have the manpower to operate at this scale.

He suggested if departments had the resources to hire and train thousands of newly unemployed people, perhaps this work could be done.

More broadly, Osterholm worried that neither of the new road maps adequately captured the impact supply shortages will have on containment efforts.

“I welcome these kinds of discussions. They need to happen right now. And I think they need to be aspirational, which I think both Ezekiel’s and Scott’s plans strive to be. But they also have to be based on reality,” he said.

While Gottlieb and Rivers believe testing in the United States is increasing substantially and that tests will be more available going forward, Osterholm has warned shortages of the chemicals needed for the tests loom.

Likewise, the report from Gottlieb and Rivers calls from nearly doubling the number of ventilators hospitals have at their disposal — moving from the current three per 10,000 people to a goal of five to seven per 10,000 — in its Phase 1. But every country in the world needs more ventilators now. Ramping up production of these complicated machines is not likely to be easy — and certainly not as easy as tweets instructing General Motors to start making them would imply.

Osterholm noted that Medtronic, a maker of the machines, sources 1,500 parts from between 14 and 20 countries for each ventilator.

Some of the recommendations from Gottlieb and Rivers could be easier to put in place. They suggest, for instance, that the public should be urged to start wearing fabric masks in public — not paper surgical masks that are already in short supply in hospitals, but masks that could be made at home or bought online.

“We did not and would not recommend the use of proper personal protective equipment” for the public,” Rivers said. But she noted that because people can transmit SARS-CoV-2, the virus that causes Covid-19, before they develop symptoms, having them wear masks when they are out in public might slow spread of the disease.

“We don’t think they’re going to be very effective at keeping healthy people healthy, but what they would be better at is preventing people who are asymptomatic or pre-symptomatic from spreading. They’re more useful for source control,” she said.

  • This was an informative article. Thank you. I, just as many am getting quite fed up with the shelter in place orders, and as many do, I hope that this can get dealt with as quickly as possible. Sadly, no one can tell the future so we must all wait. All good things to those who wait.

  • This epidemic of coronavirus need to be cautious everyday. Lots of business are affected by this whats going on around the world especially workers that earning more money by the tips of customers by the way of service. Precautions is advice n always positive n whatever old passion way how to tolerate this coronavirus and improve more how to resolve this situation what we’re facing right now 2020. The government need to improve there medicines very thorough to save a lot of people especially all retirees.

  • This lockdown could drag on past June, past this year into next. No one knows how long this virus will last or if they find a vaccination or a cure. What is the purpose of life when I can’t hug my kids or grandkids. Will I ever be able to again . I had told my parents I love them through a window as I stand on their porch. No one knows how long this isolation will last.. it’s ridiculous, we can clone a human but can’t get rid of a virus.. why do they say social distancing when they stand shoulder to shoulder in the briefing ….touching their face. But I can’t be in the same room as my kids and grandkids or my parents. What is life without a purpose without Sunday worship ,without family, without working and feeling a sense of pride for what I earn.. not much longer anyone can live like this. We start to die when we stop living

    • First of all there is no “Lockdown” going on. We’re being ordered to shelter in place, depending where you live. You are free to go outside any time you want. Go to the grocery store, take a hike, ride a bike around the block, or listen to a podcast while you stroll around the neighborhood. A lockdown would require you to stay in your house permanently. I’m assuming from your stories about not being able to hug your grandkids or see your parents through a window, that someone in your family has tested positive? For that, I am truly sorry and pray for your family. I understand the frustration you must feel, if that is the case. If everyone is healthy it is quite okay to hug them. As far as the virus is concerned, there has been significant data coming out of the San Francisco Bay Area that the sheltering at home is starting to have an effect. Keep in mind that area of 9 million people was the first place to implement these strict measures. And the models are showing, at the end of the week assuming the final few states issue the shelter orders, at the end of April and into May, we will have gone through the peak and we will no longer need to stay at home. The only way, and the quickest way to overcome this crisis is to stay home for just 30 more days. We each have to make a sacrifice, you will survive no church for a month, so that all of our families and our country and economy will survive. Thanks

    • I think this wasnt specifically about anyone in the family having the virus, it’s about how older people are being locked away from everyone else, and how THEY might feel about that. This thing is sneaky, lots of people are probably (or will be) asymptomatic, those seemingly healthy kids and grandkids might have caught it and not know, or even be surprised if they test positive for the antibodies in the future. So by that logic, to hug grandma is to kill her now, so better keep away.

      My mom is in her late 60s and I haven’t hugged her in months, and its sad. Now, my mom is the one demanding that distance in this case, where it seems like the commenter feels quality of life for everyone matters more, both people are entitled to their opinions. I do think we aren’t hearing from nearly enough older/at-risk people about how they feel, because I wonder how many might say something that conflicts with the current narrative- that life without their loved ones isnt living at all? You might think, oh now grandma, just tough it out a few weeks…months…now a year…18 months…the psychological/emotional damage of being kept from those loved ones is truly incalculable. I wonder if some people stop fighting in the end because nobody was allowed in their rooms to spend time with them, hold their hands, hug them, encourage them, make them laugh- to love them?

      This comment I think was made to reflect what we’re losing as humans, severing ourselves from others based on age statistics, and without considering that we might be doing more harm than good when we cut the elderly off from all the things that bring them joy. Because let’s be honest- this isnt smallpox, this isnt tb. Other pandemics in the past have destroyed whole families, whole towns and cities. A hug was fatal to everyone, not just grandma. We’re very lucky this thing is as limited as it is, that it seems to virtually ignore children, that it’s even possible for people, lots of us, to have it and not display symptoms. So maybe the truly at risk people, like the elderly, should have more of a say in how they’re being “handled” by everyone.

      Nobody is really talking about the ways we can fight this on our own, and it CAN be fought if we choose our arsenal well, at any age. What does it do? It causes a mid range fever and inflames the lungs, makes it hard to absorb oxygen. Dry coughing rips up lung tissue, which leads to pneumonia. All that coughing and stress takes a toll on the heart and raises blood pressure, and that plus pneumonia is where this thing can turn really deadly. So, instead of hoarding toilet paper, we should invest in a humidifier (and a nebulizer if possible), and make sure to have fever reducers, liquids (water, pedialyte) and menthol cough drops/vapo-rub at home. If you do get sick, water vapor is your friend! Use that humidifier, turn your bathroom into a steamy sauna, drink lots of hot tea with honey, breathe it in. Aim to keep coughs as non-damaging as possible. It might keep you from a hospital bed.

      And to be honest, I would GLADLY catch this thing right now if I could, but there are few cases locally. I truly welcome it, I’m tired of being forced to cower in fear, I just want to get it over with. I’m young and healthy, i can isolate at my apartment, it will suck but know I’ll tough it out, ive got nothing better to do, and afterwards, I’d be a documented covid survivor! Documented survivors are going to be HIGHLY employable in the near future, and i dont want my future to rot on the vine like everyone else’s- theres going to be a market for people who can prove they cant carry this disease, and the benefits of catching covid greatly outweigh the risks for me.

  • This shutdown is pure insanity at this point. I think the people who still want it have no need to work for money and are likely on welfare (so to them its business as usual, which is sitting around and getting a check). Stats show that the majority of Americans dont even have $1000 in savings. How can people withstand this mandatory economic suicide?

    Self respecting people who own businesses and work for a living NEED to get back to work. If this garbage continues for much longer there will be thousands of businesses closing its doors FOREVER. Suicides will be up, unemployment will be up beyond most peoples comprehension, divorces, and other mental illness will pervade society.

    The lockdowns are worse than just letting the virus do what all viruses before it and all viruses after it will do. If they are doing this now, whose to say it wont happen every year with every new mutation of virus? BOTTOM LINE: OPEN BUSINESSES ALREADY.

    • Your argument that there will be suicides, divorces, and mental health problems is irrelevant to the virus problem. We can’t open up our businesses and treat the pandemic at the same time. It’s one or the other. And if you chose business well then you won’t have any sales because 2 million Americans will die and the rest will be on unemployment. Do you think we want to lose our retirements and income to sit at home. The only and fastest way you and the rest of America can open back up is to listen the scientists. Sheltering in place is working. In fact it’s the only solution. We only have 4-6 weeks left before we reach the peak new cases and then begin to level off. Will there be irreversible harm done to the global economy? Of course there will be. But that’s why congress is preparing by pumping in 2 trillion dollars. There will be tons unemployed but there will be jobs available! Guarantee, 18-24 months after we open back up, we will be recession free and Back to normal and the market will be bullish for several years. But unfortunately my friend, we need to stay home and avoid any people for just one more month. I’ve already been sheltered for the longest time in the country, San Francisco. A month. So what’s one more month if it saves the god damn country. This isn’t some recession we can work our way out of. This is a highly contagious and deadly virus that has to run its course and The more people who stay home the faster it will be over with and we can look forward to working again. Still a long way to go. But if you want any customers and want your business to make some money, then you have no choice.

    • No issues here and enjoying the shelter in place. As a good American I saved a year’s living expense so I can face unemployment. Working from home ready. I don’t need government hand outs.

  • Bankruptcy aside, these are great roadmaps for an authoritarian future. We have never willingly ceded our own leaders such powers over our everyday lives, even in wartime. Society-wide lockdowns at the whim of a chief executive are a very bad precedent for an open society. America has been through far worse than this health crisis, even if the most extreme scaremongerers are right (have they ever been?). Of course most Americans used to realize life entails risk and happiness doesn’t come from absolute safety. If we lock down the country indefinitely we could safe lots of lives from disease, car accidents, and more. We’ll just all die of heart disease or suicide instead.

  • These people who think this is not going to be so bad and want to go back to work shortly or back to social gatherings, etc. are about to get a rude education. These people that think this virus is only deadly to those older than 60 need to get the facts. Yes, it’s more likely to be deadly to the older generation and those with underlying conditions but it can also be just as deadly to younger people. Even if they don’t die, they will infect others, who may not be so lucky. This virus is about to explode and unless our Government takes drastic action NOW. We are most likely going to see 100,000. to 200,000. deaths if we take drastic actions now and 1,000,000 to 2,000,000. if we don’t! This patchwork of actions like “stay at home” suggestions, etc. is ridiculous and will not work. Some people will follow them but others will not and we all will pay dearly for those who refuse to follow suggestions. It may not be easy and it will certainly be unpleasant but it will make this a lot less destructive with a lot less deaths. Due to the drastic measures, we will get through this together and in a lot less time, which will be much easier on all of us and on the economy. The fact that it seems to be working for China with it’s enormous population and other Countries that took bold and aggressive tactics, should be a lesson for the U.S. We need BOLD and AGGRESSIVE actions by our leaders. In the long term, the virus will be a lot less damaging and the American people will appreciate the leadership from our officials. Close our boarders and order a “Stay-at-home”, except for essentials. I would rather go through a a few months with a lot less upheaval to our lives than to prolong this Pandemic for 6 months, a year, who knows?

    • How dare you lecture anyone and then cite China as exemplary in the same paragraph. Move along, Red.

  • I agree that what we need for the less vulnerable population to get back to work is respirators combined with good hygiene practices. The Chinese and other asian countries that have done better seem to have everyone wearing respirators whenever in public and presumably at work. Once we get enough respirators for the general public, we can start going back to work. It will be a long time before we have big crowd events though.

  • Any strategy has to align with health care supplies, which are relatively easy to produce given proper leadership. But we lost two months not listening to the experts and now are caught short, while other nations are doing just what the experts in America have laid out for such a pandemic and have already stemmed the tide and saving 10’s of thousands of their citizens.

    It’s not rocket science and the plans for attack are all well documented by the health care and economic experts.

    The America of my youth would have been leading the global charge, directing a global response out of the white house, and 3 months into this thing would now be over producing enough medical supplies to save 10’s of thousands in the US and millions around the globe with our excess. But alas we now spend most of our time talking about how great we are, when reality we are somewhere between Britain and Italy, second, perhaps 3rd rate at best.

    Millions dying because America is not what she used to be. Greatness requires great action, not talk.

    • The experts at WHO told the world it wasn’t human transmissable weeks after they knew it was. The experts at CDC insisted on developing their own test rather than using existing ones and barred private labs from testing. The experts in NYC never bothered to write up an epidemic response plan for the city. Now our experts tell us the only thing we can do is imprison everyone in their homes. The first 500 names out of the phone book have more common sense than our “experts”.

    • Health is more important than money. If Americans don’t have $1,000 in savings!!? that is a concern and it is worst than the CV itself. How can you work to live above your means, drawn in debt and not have savings or emergency plan? Wow! That on itself is causing stress before the CV arrived. May be take time to re evaluate how to become wise managing money. Do not blame this emergency and unique disruption as the cause of suicidal thoughts and so forth. In this blessed country CV is 19 compare to third world countries or less powerful countries face.

  • These scientists have no grasp of the economic realities involved in all this. If you don’t ease up on lockdowns until June the state of the economy will make the Great Depression look like a picnic.

  • I don’t agree with the conclusions Emanuel has reached at all. If we wait until June to lift the lockdown, we will all be bankrupt permanently by the fall. The evidence is that the virus is not very pathologic except for those over 60 and with chronic illness or immunologically suppressed. These are the only individuals who need strict isolation from others and it can be done, as I’m doing it myself. All others, including workers should be going outside, mixing, and most importantly getting back to work. There is also no need to continue to test for Covid-19 viral DNA, as it is rapidly going through the entire population. It is not going to be stopped or isolated. Much better is to start large scale IG immunoglobin blood testing to measure the number of individuals who carry the virus yet have no clinical signs(probably at least equal to the serologically positive case numbers), and use this testing to measure degree of protection and resistance to reinfection a second time. Correlate the IG immune response with actual clinical protection from the disease and one will have a better measure of the effects of the virus on the world’s population. By the way, isn’t Emanuel the cheerleader for the disastrous Obamacare that we are still having to endure after all these years? Retire him!

    • I think that we need to go back to work but apply all the infection control policies that are well known in hospitals. That includes masks, shields, gowns, gloves, handwashing etc. Together, supplements should also be suggested such as vitamin C and Zinc. All these techniques may be taught to the public each day and night at TV’s by professionals. Only kids and elderly may be kept at home. Regards

    • My thoughts exactly, Mark Smith. No Sez Tom, he is not dense. You need to get things in proportion.
      I am from the UK and I suspect that when/if we get around to antibody testing 70% of the population the “expets” will be shocked at the extent of those who have had covid-19, most of them not noticing. Yes, lots are going to die which is unfortunate but the UK has an average 17,000 deaths from Seasonal Flu every winter. Five years ago we lost 28,000 to flu. Actually that was just England and not whole UK.
      We are now making a big deal about 1000 and wrecking the economy for years to come.
      Are we going to shut down every flu season to try to save some of the 17,000? Or let Nature take its course?

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