The White House on Thursday introduced what President Donald Trump called a “phased and deliberate approach” to lifting the social-distancing requirements intended to slow the spread of the pandemic disease Covid-19 in the US. At least three coalitions of states are already trying to work out their own approaches to reviving their economies—something the president initially said wasn’t up to them, before recanting—and the White House plan, finally released into the wild, still seems to be playing catch-up. Surprisingly, it aligns with the ideas those state coalitions have already discussed, but it lacks specific guidance on how to accomplish those goals—with no offers of financial or structural aid, and no milestones to determine success. That makes public health experts think the plan is intended not so much to help states succeed, but to scapegoat them if they fail.
Scientists, public health experts, policymakers, and businesspeople have been urging caution over rolling back stay-at-home orders, limits on mass gatherings, and school closures; some research has shown that even in places with the most hardcore social-distancing implementation, the disease could return cyclically for the next two years. But pressure from Republican lawmakers and small but vocal groups of protesters in some states (fomented, on Twitter, by the president) has pushed in the opposite direction.
“Based on the latest data, our team of experts now agrees that we can begin the next front in our war, which we’re calling, ‘Opening Up America Again.’ And that’s what we’re doing: We’re opening up our country,” Trump said at a press conference introducing the plan. “As I have said for some time now, a national shutdown is not a sustainable long-term solution. To preserve the health of our citizens, we must also preserve the health and functioning of our economy. Over the long haul, you can’t do one without the other.”
Economists and public health researchers largely dismiss this dichotomy as false. Even under the coldest benefit-cost calculations, losses to the economy so far still haven’t outweighed the lives saved by social distancing. And research into the “nonpharmaceutical interventions” like social distancing and business closures that followed the 1918 influenza pandemic shows that these fast, aggressive interventions resulted in faster, bigger economic bounces when the pandemic was over. Still, it’s clear that people are suffering—5.2 million people made unemployment claims the week of April 9, according to the US Department of Labor, and a $349 billion federal program to lend money to small businesses in coronavirus-related trouble officially ran out of money on Thursday. California governor Gavin Newsom on Friday described his state’s economy—the nation’s largest—as being in a “pandemic-induced recession.”
But pretty much everyone agrees that getting rid of these interventions too soon would mean that Covid-19—which has in five months killed 150,000 people around the world, 35,000 of them in the US—could roar right back. So what to do? The Trump administration thinks everyone just has to ease into it. “Our approach outlines three phases in restoring our economic life. We are not opening all at once, but one careful step at a time. And some states will be able to open up sooner than others,” Trump said. “Now that we have passed the peak in new cases, we’re starting our life again, we’re starting rejuvenation of our economy again, in a safe and structured and very responsible fashion … We’re establishing clear scientific, metric, and—benchmarks on testing, new case growth, and hospital capacity that must be met before advancing to each phase.”
Under the plan, states and localities have to fulfill certain “gating criteria” before starting any of the phases. Those criteria include a two-week downward trajectory in new cases of Covid-19 and reports of the broad category of influenza-like illnesses that could be Covid-19, absent a confirmatory test. And the states must have what the plan calls “a robust testing program in place for at-risk health care workers.” States are also supposed to have facilities ready to go for testing the general population, enough personal protective equipment for all health care workers, and the “ability to trace contacts of COVID+ results”—meaning, presumably, a system that can find everyone who tests positive for the disease and track the people they’ve come into contact with, to let them know they’ve been exposed. They’re also supposed to set up “sentinel surveillance”—ongoing testing that looks for the disease, to identify asymptomatic and presymptomatic infections, especially in vulnerable places like nursing homes, because infected people can transmit the disease to others before they themselves know they’re sick.
Once those conditions are met, in phase one things stay mostly the same as under shelter-in-place rules—especially for schools and vulnerable populations—but employers can start to send people back to work with appropriate physical distancing measures. Gyms can open, and hospitals can resume the elective procedures that can account for 80 percent of their revenue. In phase two, more places can open after another 14-day downward trajectory, non-essential travel can resume, and schools can reopen. And phase three? “It’s essentially returning to our new normal, with all of what we talked about through all phases—continuing the good hygiene practices, continuing the respect for spaces between individuals—because we know that we still have an issue with asymptomatic spread,” said Deborah Birx, US Coronavirus Response Coordinator, at the same press conference.
It all sounds OK, broadly. “The White House set standards higher than what some may have imagined after the president’s comments about wanting to reopen things right away,” says David Postman, chief of staff to Washington governor Jay Inslee. “It does appear to align with what the governor, and the other West Coast governors, have been talking about for some time. The criteria that need to be met ‘before proceeding to phased opening’ has key pieces of what you’ll see in our own framework. And it’s clear to me from those criteria that we aren’t yet ready to proceed to phased opening.” It’s true; the outlines, at least, of the White House plan broadly comport with the framework that Governor Newsom laid out on Tuesday. (California, Washington, and Oregon have joined to work together on Covid-19 and an economic reopening, as have multiple states in the northeast and another group in the midwest.)
That means the federal approach is pretty much what everyone at the state level was anticipating. “I had a chance to work some on the plan that CDC developed, and I think that is essentially what the administration put forward today,” says Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officers. “We are still analyzing it, but so far it seems consistent with what we were expecting.”
Public health experts, though, were nowhere near as sanguine. Ronald Klain, who ran the Obama administration’s response to Ebola and is now advising Joe Biden’s campaign for president, tweeted that the idea of using phases “isn’t a plan. It’s barely a Powerpoint.” Others pointed out that a “downward trajectory” in new cases doesn’t necessarily mean the numbers are falling to safe, post-pandemic level. At the press conference, Vice President Mike Pence called the downward-trajectory metric “the best criteria that our experts have developed.” But a place with a high peak—like, say, New York City—could have a sky-high new-case count two weeks post-peak. Does that pass the gate?
Also, the White House plan uses testing availability as a “gating factor,” but not necessarily widespread testing. In fact, it doesn’t specify what percentage of the population should be getting tested at all, even though some experts have suggested that the US should be doing anywhere from 500,000 to millions of Covid-19 tests a day. The plan makes contact tracing a gating factor, but by one estimate nationwide contact tracing would require 100,000 people to do the tracing and would cost $3.8 billion (a bargain if it saves thousands of lives, but someone has to set it up). The plan orders states to have enough tests and PPE for health care workers, but it doesn’t explain how to get them, offer funding to pay for them, or propose that the federal government could help—the whole reason three regional alliances of states have come together, absent that kind of aid.
Most tellingly, though, while offering state governors some coverage to make their own determinations about when to reopen, the plan also puts the onus on them for procuring equipment, setting up tests, and creating a contact-tracing system—all preconditions for any easing of nonpharmaceutical interventions. “There is no—zero, zip, zilch—way to upscale testing, PPE production, hospital readiness, the public health workforce … without robust federal leadership,” Jeremy Konyndyk, senior policy fellow at the Center for Global Development, tweeted. “States don't have the capacity or resources to achieve these things on their own.” That’s what things like the Federal Emergency Management Agency, the Centers for Disease Control and Prevention, and the Defense Preparedness Act are for.
The president himself seemed to confirm this gap between authority and responsibility on Friday morning via Twitter, writing that “states have to step up their TESTING!” (The emphasis is, you will be unsurprised to hear, the author’s.) Anyone who was awaiting a federal response to Covid-19 is still waiting.
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