The “Suppressed” CDC Guidance for “Opening up America”

Many friends are trying to figure out if/how to reopen their businesses and activities in the context of SARS-CoV-2 pandemic. The information (and bravado) that we need to think through these decisions as safely as possible — balancing the competing interests– has been made more difficult because of a decision by the US government (White House) to not include the complete recommendations by the CDC. These recommendations documents were developed by the US CDC to provide step-by-step advice designed for local authorities on how and when to reopen public places during the SARS-CoV-2 pandemic. If you have questions about childcare, summer camps, workplace guidance for “vulnerable” workers, guidance for restaurants and bars, and mass transit you might find the specifics in these documents helpful. These are important, difficult decisions and we need information. Note: The recommendations were obtained from a federal official who was not authorized to release them publicly. The official explanation is that the CDC guidance is too prescriptive.

I have provided background – perhaps too much for you and if so skip it– about the context because I had questions. For example, the recommendations refer to phases of the epidemic that I believe come from the document from the White House called “Guidelines for opening up America again”.

There are criteria – the “Proposed State or Regional “Gating” criteria– that should be satisfied before proceeding to phased opening. It cannot be said enough that none of the states “reopening” have met these criteria. We need to agree on what we will watch to determine how the steps are going because if it matters, measure it. It cannot be said enough that none of the states “reopening” have met these criteria.

Symptoms: Downward trajectory of influenza-like illnesses (ILI) reported within a 14-day period AND Downward trajectory of COVID-like syndromic cases reported within a 14-day period

Cases: Downward trajectory of documented cases within a 14-day period AND Downward trajectory of positive tests as a percent of total tests within a 14-day period (flat or increasing volume of tests)

Hospitals: Treat all patients without crisis care AND Robust testing program in place for at-risk healthcare workers, including emerging antibody testing.

Moreover, it is said that prior to these phased openings there are “core state preparedness responsibilities” that should be in place.

1. Testing and Contact Tracing

-Ability to quickly set up safe and efficient screening and testing sites for symptomatic individuals and trace contacts of COVID+ results

-Ability to test Syndromic/ILI-indicated persons for COVID and trace contacts of COVID+ results

-Ensure sentinel surveillance sites are screening for asymptomatic cases and contacts for COVID+ results are traced (sites operate at locations that serve older individuals, lower-income Americans, racial minorities, and Native Americans)

2. Health Care System Capacity

-Ability to quickly and independently supply sufficient Personal Protective Equipment and critical medical equipment to handle dramatic surge in need

-Ability to surge ICU capacity

3. Plans in Place

-Protect the health and safety of workers in critical industries

-Protect the health and safety of those living and working in high-risk facilities (e.g., senior care facilities)

-Protect employees and users of mass transit

-Advise citizens regarding protocols for social distancing and face coverings

-Monitor conditions and immediately take steps to limit and mitigate any rebounds or outbreaks by restarting a phase or returning to an earlier phase, depending on severity

This may be more background that you need to simply dive into the materials from CDC. The first link 17 page document describing the type of place and the actions by phase of the pandemic. This is followed by a link that takes you to graphic decision support flowcharts.

“Guidance for Implementing the Opening Up America Again Framework,”

As I have been working with people trying to decide how to determine if they can have horse-camp, restaurants/bars, music lessons…. just to name a few I have been asking them the following issues

a. What are the recommendations and laws where you live?. This epidemic is national but also very local.

b. Can you follow the primary recommendations about hand washing, physical distancing, wearing masks while nearer than 6 feet, and helping people not touch their face?

c. Finally, if you have a case of COVID-19 (either asymptomatic or symptomatic) after you open how many people will be shuttled into quarantine? Can you afford to lose the staff and deal with the fallout? What changes can you make to your operations that reduce exposure so that if there is a case you can maintain operations? This might include keeping people in smaller groups, using barriers, and working in shifts. This is where innovation really makes a difference. Knowing about how case investigation and contact tracing works might help you figure out ways to work more safely and make sure you do not lose staff.

Note, the information that I have provided here is the best I have been able to piece together about the phases and placement of CDC guidance. I want to be sure these recommendations are available to people. If you know more details about the background of these materials, how they connect, and what happened to make them generally unavailable I would appreciate it if you can leave comments or links. Taxpayers paid for some smart people to put their heads together to think deeply about these issues and we should have access to them.

Published by sharon Mcdonnell

Medical Epidemiologist and Community Memeber

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