Opening Up America Again. On 17.4.20 US President Donald Trump presents the plan to return to a 'new normal' after the lockdown imposed by Covid-19. The process is divided into three phases, the application of which is entrusted to the responsibility of the governors in the 50 states of the federation. (1) How and especially When? Brief notes and reflections.
Ground zero is the tragic starting point in the United States below lockdown. Almost 1 million are registered infections, between 1,7 and 3,3 million those that can be inferred. Taking into account the number of deaths (> 50) and the average mortality rate from SARS-CoV-2 (1,5-3%).
The new coronavirus has had and is having a deadly impact on the first economy on the planet. Because of tardiness in the reaction to the first signs of the global emergency, communicated by WHO (World Health Organization) in the first days of January 2020.
To continuous growth of the new infections registered there is the problem of the scarcity of swabs performed so far, which prevents us from framing the actual extent of the infection. The positivity rate in the United States is in fact estimated in 20% of exams, but only 1% of the population has been subjected to exams. In the meantime, several states - Colorado, Ohio, Georgia, Alaska - declare their readiness to ease containment measures.
The reboot plan of the activities in the USA is divided into 3 phases following the current 'phase 0'. Phase One overseas therefore corresponds to 'phase 2' in the European lexicon (where 'phase 1' means that of lockdown, still current in Italy and other EU Member States).
The first phase of reboot, in the plan adopted by the White House, presupposes the achievement of the so-called gating criteria (access criteria). Essentially, a steady decrease in coronavirus positivity cases. If in the 14 days following the first easing of the measures the trajectory of the contagion data continues to decline, one can move on to Phase two. And so, applying similar criteria, to the Phase three. To follow, the criteria and recommendations of the W to the federal states.
I gating criteria, i.e. the Phase One activation criteria of the plan are as follows:
A) declining trajectories, both symptomatic and diagnosed cases of COVID-19, for a period of 14 days,
B) system capacity hospital to treat patients,
C) solid analysis program on health care workers. By means of molecular biology tests on swabs and serological tests, for the search for antibodies in the blood.
On these premises, the guidelines 17.4.20 indicate the measures to be adopted in the three phases of gradual restart of activities in the USA.
States and Regions that satisfy i gating criteria can start the Phase one, applying the following measures.
All vulnerable people they should continue to stay indoors. Their family members should be aware that they can transmit the new coronavirus upon returning from work or from environments where they are interpersonal safety distances are not guaranteed. Precautions should also be taken to 'isolate' vulnerable people from other residents.
They are considered vulnerable elderly people and those with chronic lung diseases, hypertension, diabetes and obesity, asthma. As well as those whose immune systems are compromised, also due to drug treatments. (2)
All individuals - when in public spaces (e.g. parks, outdoor recreation areas, shopping malls) - they should maximize physical distance from other people. Social contexts with more than 10 people should be avoided when appropriate distance cannot be guaranteed. Unless other (suitable) precautionary measures are observed.
Avoid socialization in groups of more than 10 people in circumstances that do not allow adequate physical distancing (eg receptions, fairs).
Minimize travel non-essential and respect the guidelines of the CDC (Center for Disease Control and Prevention) on travel and subsequent isolation.
Teleworking he must continue to be encouraged in all situations where this is possible and compatible with the needs of the organization.
The return to work it should be organized gradually, by phases and by shifts.
The areas municipalities where staff are likely to meet and interact should be closed. By applying, more generally, rigorous protocols of social distancing.
Reduce minimize non-essential travel and follow CDC guidelines regarding post-travel isolation. Strongly consider the possibility of special accommodation for staff belonging to vulnerable categories.
1.3. Specific recommendations
Schools and organized activities for young people (eg kindergartens, camps) currently closed they should remain closed.
Visits to facilities for the elderly and hospitals should be banned. Anyone who interacts with residents and patients must still adhere to strict hygiene protocols.
The great spaces (e.g. restaurants, sports centers, places of worship, cinemas) can operate according to strict physical distance protocols.
The surgery elective (i.e. different from the emergency and urgent ones) can resume - on an outpatient basis (without overnight stay) - at facilities that adhere to the CSM guidelines (Center for Medicare & Medicaid Services).
The gyms they can open if they adhere to strict health and physical distancing protocols.
The bars they should remain closed.
States and Regions with no signs of virus resurgence - and that they continue to satisfy gating criteria, After the Phase one - they can then activate the Phase two. As follows
All vulnerable individuals they should continue to stay at home, with precautions of isolation from family members who leave in conditions where social distances cannot be guaranteed.
Physical interpersonal distance it must always be maintained. Social contexts with more than 50 people where distancing between people is not practicable should be avoided, subject to observing the precautionary measures.
Non-essential travel they can resume.
Lo smart working it must continue, when it is possible and compatible with the organizational operations.
Keep closed common areas where staff are likely to gather and interact, or apply moderate social distancing protocols.
Resume trips not essential.
Consider strongly the possibility of workstations dedicated to personnel belonging to the vulnerable categories.
2.3. Specific recommendations
The schools and activities organized for young people (eg kindergartens, camps) can reopen.
Visits to facilities for the elderly and hospitals should remain banned.
The great spaces (e.g. restaurants, sports centers, places of worship, cinemas) can implement moderate social distancing protocols.
Surgical interventions in election they can also resume in hospital, in structures that adhere to the CSM guidelines.
In the gym strict health and physical distancing protocols must be maintained.
They can reopen the bars, reducing room seats where possible and appropriate.
The 3 phase it is gradually applied in States and Regions where the virus has no recurrence and the contagion curve continues to decline. This is how the post-emergency daily life takes shape.
Vulnerable people they can resume public interactions. However, they must maintain physical distancing and minimize exposure to social contexts where it cannot be guaranteed, unless additional precautions are taken.
The low-risk population he should in any case consider minimizing the time spent in crowded environments.
They can reopen workplaces with full employees.
3.3. Specific recommendations
Visit at elderly facilities and hospitals can resume. Those who interact with residents and patients must diligently follow hygiene practices.
The great spaces (restaurants, ..) can operate following protocols of limited physical distance.
Standard protocols of sanitization can be applied in gyms.
Standing room in bars can be increased.
The political challenge to the virus - by Donald Trump in the USA, like Jair Bolsonaro in Brazil, Boris Johnson in the UK, Attilio Fontana in Lombardy, Giuseppe Sala and Nicola Zingaretti in Milan - it has tragically failed. The 'gray swan' Covid was predictable, as seen, and it had to be intercepted at least in a timely manner.
The jester management of the risk left tens of thousands of innocent victims on the ground. In addition to causing the worst economic crisis in history after the Great Recession and World War II. The legal, as well as political, responsibilities of risk managers will therefore have to be investigated. For having failed or neglected his due evaluation, with willful misconduct or gross negligence.
The guidelines under consideration are inevitably tainted by The Donald, which on April 23.4.20, 3 proposed to scientists to inject disinfectant into the veins of patients to kill (also) the virus. (XNUMX) Therefore, it is not surprising their vagueness - which also discounts, in the USA as in the EU and in Italy, the concurrent jurisdiction of the central level with the regional one - and the inconsistency, in the Phase 3 mostly.
The When - more than the How - in any case deserves attention. Where the overseas CDC has managed to maintain a position of even minimal caution, to prevent the resumption of the contagion, which not even the European Commission has had the courage to indicate in its guidelines.
Dario Dongo and Alessandra Mei
(1) L.Hoy. One Vital Metric Trump's 'Opening Up America Again' Plan Ignores. 17.04.2020. BCC. https://www.ccn.com/one-vital-metric-trumps-opening-up-america-again-plan-ignores/
(2) CDC. guidelines. Opening Up America Again. https://www.whitehouse.gov/openingamerica/
(3) Eliza Relman. Trump directs experts to see whether they can bring 'light inside the body' to kill the coronavirus, even as his own expert shuts him down. Business Insider. 24.4.20, https://www.businessinsider.com/trump-wants-bring-light-inside-the-body-to-kill-coronavirus-2020-4?IR=T
Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT - Food Times) and Égalité.
Graduated in Law from the University of Bologna, she attended the Master in Food Law at the same University.