After the U.S. abruptly shut down in the spring, states gradually announced their plans to reopen. Some have adopted careful phased reopenings, where counties or regions must show progress in specific metrics, like a downward trajectory of COVID-19 cases. Others simply let their stay-at-home orders expire, allowing businesses to reopen with minimal restrictions.
Now, weeks after the first reopenings, some states that were quick to open are seeing a marked COVID-19 rebound. In a memo this week, Utah’s state epidemiologist Angela Dunn detailed a surge both in cases and in the percentage of positive tests since late May. She warned that the state may need to move back a phase if the numbers don’t change drastically soon. Texas, too, has seen a surge in cases, positive test percentages and hospitalizations, prompting the state’s governor, Greg Abbott, on Thursday to pause the state’s reopening. “The last thing we want to do as a state is go backwards and close down businesses,” he said in a statement.
But going backward may become necessary. For all states’ carefully laid plans with reopening, what plans do states have to shut down again if necessary—and how will they look in comparison with the country’s hastily executed first shutdown? In an April report, experts from the University of Minnesota’s Center for Infectious Disease Research and Policy recommended that “government officials should develop concrete plans, including triggers for reinstituting mitigation measures, for dealing with disease peaks when they occur,” and that “government officials should incorporate the concept that this pandemic will not be over soon and that people need to be prepared for possible periodic resurgences of disease.” But after talking with experts and reviewing several areas’ reopening documents, I’ve learned that it appears there are no specific criteria in place for what would—or should—trigger a selective or mass shutdown. And even worse, local, regional, and state governments seem unwilling to broach the topic with citizens, despite experts’ predictions that the virus will ebb and flow for the next several months.
That’s not to say the experts aren’t keeping tabs on it. For example, the Public Health department in King County, Washington, where I live, is tracking metrics like reported cases, testing capacity, and hospital occupancy. Those metrics are part of Washington state’s very specific standards—a county applying to move from Phase 2 to 3, for instance, must show that every hospital in the area has 20 percent surge capacity and that the county has 15 trained contact tracers per 100,000 citizens, among other things.
But in the state’s document outlining the criteria, there’s just one short sentence hinting at the potential for revoking phase advancement. When I contacted the department, it reiterated that it could ask counties to move back a phase if there’s a significant outbreak, inadequate contact tracing, or poor access to testing, among other things, but did not provide more information about whether there are specific thresholds for those metrics that might trigger those discussions.
Many states’ public-facing reopening plans make no mention of closing again at all. (I reached out to the New York State Department of Health and Arizona State Department of Health to ask about their plans for halting reopening or shutting down again, but neither returned my requests.) The most detailed treatment of this appears in the Centers for Disease Control and Prevention’s May report on reopening, which lays out some vague standards that might signal a “rebound” of the virus: five consecutive days of increased cases or hospital visits, and multiday increases in the percentage of positive test results, assuming testing remains at the same levels. Many states have already met those metrics. Yet the CDC does not provide guidance on what to do in case of a rebound. It’s similar to calling a foul in basketball—calling it is the first step, but what happens next? COVID-19, of course, isn’t as simple as basketball, and there are no rules for what’s next in the playbook.
The experts I spoke with all agreed it would be good to have a plan, but it’s unclear who might make such a plan. COVID-19 “begs for a national response,” says Mike Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. “We need to do much more to coordinate the national response, so we can all be working on the same page.”
But right now, it’s falling to individual states, regions, counties, or cities to decide what’s best for them. And those same experts and government officials are up to their ears with just managing the crisis—there’s not a lot of time for thinking about Plan B, because Plan A is to try to keep everything under control. “Everybody has been so busy with alligators to the south side that nobody has thought about draining the swamp right now,” says Osterholm.
Take, for instance, the plan for reopening schools. When I talked with Michaela Miller, deputy superintendent in the Washington state Office of Superintendent of Public Instruction, she told me about the state’s plan for schools, and the many areas that must be coordinated: school meals, transportation, and new standards for classrooms like mask-wearing and social distancing, among other things. They have 10 weeks to figure this out before the new year is supposed to start. I asked whether their plans for reopening included contingencies for closing, should there be an outbreak in a particular school or district. She said that it’s on their mind, but in a big-picture way; in its reopening planning guide, the state advises schools to be prepared for online learning in the event of closures. Miller tells me districts will be in close contact with county health departments for guidance, and the state hopes to develop consistent policies across counties. But as for the specifics about when schools might shut down? “Those convos are yet to be had; so much energy is focused on the reopening,” says Miller.
It’s certainly possible that behind the scenes, some states, regions, counties, or cities have explicit criteria in place that would trigger a shutdown, but if that’s the case, there’s the question of why they aren’t sharing this crucial information with the public. Maciej Boni, a mathematical epidemiologist at Pennsylvania State University, says this is driven at least in part by politics and optics. Leaders want to seem hopeful, and there’s pressure to “deliver good news when there isn’t good news,” he says, or “to repaint or recolor results to be better than they are.” But in the event that moving backward becomes necessary, this good-news-only policy isn’t going to help. “This is a situation where you cannot overpromise and you cannot underpromise. You have to be very honest with the changing risks week by week.” Osterholm agrees: “Just denying [another shutdown] is going to happen is not being prepared.”
For now, it appears that any decision to shut things down again will be touch-and-go—similar to the first time around. Will Humble, the director of Arizona’s Public Health Association who also served as director of the state’s health services from 2009 to 2015, says that if he were still in charge, the plan for shutting down would be to address the root of the problem with compulsory mask-wearing, more testing, and contact tracing. Failing that, he says, the state will likely have 10 to 14 days of warning from hospitalization numbers before things get dire. Boni agrees hospital admissions will be an important indicator: “If you see hospitalizations have doubled in the last week, that’s a clear signal the Department of Health needs to take action.” Mobility data—how much people are moving around—may also play a role, Boni says. If people’s cellphone data shows they are resuming activity without a spike in new cases, that is a good sign that community spread has slowed.
As cases and hospitalization numbers rise, the lack of shutdown plan might not be an issue if governments are unwilling to shut down again at all. Texas Gov. Greg Abbott’s plan to “pause” reopening functionally does very little; it maintains the current trajectory, which is what has driven up numbers in the first place. “Closing down Texas again will always be the last option,” he said in a recent interview. Humble is also concerned about Arizona Gov. Doug Ducey’s willingness to shut down. “There’s not any appetite to do another stay-at-home order; I think they would implement the surge plans,” says Humble, noting that in early June, the state asked hospitals to activate their emergency plans rather than making other adjustments. (The Arizona Department of Health did not respond to my request for comment.) “That’s my analysis: I don’t think [Ducey] has the appetite to do it again.” With a lack of plan and an apparent lack of will, there’s a very real possibility some areas may not shut down or move back phases even if the numbers suggest they should—and that’s a recipe for more deaths.