Instead of an “all-or-nothing” approach to disease prevention, Americans need guidance on how to safely return to school, work, and other activities mid-pandemic, said panelists at a May 13 COVID-19 Conversations webinar.

“We’re going to have to do things more safely and with a lot more awareness about the risk of transmission,” said moderator Scott Gottlieb, a fellow at the American Enterprise Institute and former U.S. Food and Drug Administration commissioner.

There’s no single metric that will inform reopening, said Chris Murray, director of the University of Washington’s Institute for Health Metrics and Evaluation. His team created projection models to predict the peak of the pandemic in all 50 states. Those models are constantly updated to reflect the latest data on cases, deaths, and hospitalizations.

“It’s not like predicting the weather and seeing what happens. We’re actually taking actions based on these models. They’re affecting policy in meaningful ways,” he said.

Murray added the caveat that while it’s important to watch trends in cases and hospitalizations, we need to factor in the scale of testing.

“Who wants to get tested but can’t? Of the people who are showing up at the hospital with symptoms, who has been tested? We also need that level of data,” said Heidi Larson, professor of anthropology, risk, and decision science at the London School of Hygiene and Tropical Medicine (LSHTP).

Reopening Workplaces and Colleges

“COVID-19 has become a massive worker safety crisis,” said David Michaels, professor of environmental and occupational health at the George Washington University.

Every workplace should have an infection control plan — and people need to trust that they’re being protected.

“It’s important that these efforts are viewed as collaborative. If people feel like workplace protections are surveillance activities or that something is being done to them, they’re not going to work,” said Mary Bassett, director of the François-Xavier Bagnoud Center for Health and Human Rights at the Harvard T.H. Chan School of Public Health.

Regular disinfecting and physical spacing are just one piece of worker safety. Health insurance, adequate sick leave, and other protections should be the norm, said Michaels, so people don’t have to choose between a paycheck and taking care of themselves. “If someone’s afraid they’re going to be fired for declaring symptoms, that’s not consistent with any logical disease control plan.”

Colleges and universities are also weighing the costs of reopening this fall. The California State University system announced its fall classes will be exclusively online, and other colleges and universities are planning to strictly limit in-person class sizes. Dorm housing and on-campus events — the usual hallmarks of the college experience — may look drastically different.

However, Bassett remains hopeful that testing capacity will catch up. “As we reopen campuses and workplaces, we have a real opportunity to do universal testing and get more information about cases,” she said.

Using Mobile Location Data — a Balancing Act

Panelists were also asked whether mobile apps and data can help contain COVID-19.

Countries like China, Taiwan, and Singapore have deployed apps to identify and alert people if they have been exposed to the virus. Local authorities across China have even rolled out health code systems, generated by popular apps like WeChat, which calculate an individual’s level of risk based on location, medical history, and other factors. Anyone with a green code — which signifies you’re symptom-free — can go past checkpoints in subway stations, restaurants, and other businesses.

But what works in other countries may not work in the U.S., panelists agreed, due to privacy concerns. These approaches may also be unnecessarily punitive, added Bassett. For example, essential workers may get a high risk score because of their daily commute, not because they are engaging in prohibited outdoor activities.  

Still, some apps can be practical, such as crowdsourcing apps that tell you where to avoid large crowds or long lines in your neighborhood.

“Online and social media forums, while not official sources, may provide early warning signs about whether and where people can get tested and treated,” said Larson, the LHTSP professor. In addition, Facebook is surveying people about how many individuals they come in contact with each week, which may provide clues about transmission trends.

Ranking Risks and Trade-offs

Is it safe to see the grandkids? How far apart should we be in a restaurant? Should I use the elevator at work? These are just some of the scenarios that Americans will be weighing as they return to school, work, and in-person social events.

Larson called for a roadmap that embraces harm reduction approaches — one that recognizes that people will take risks, instead of shaming or stigmatizing them.  Even when it is time return to reopen, “people will be looking for guidance on what to do — how to be in the world. It’s incumbent on public health professionals to explain how they can reduce their risk.”

Resources:

“Toward the ‘New Normal’ — Protecting Public Health as America Reopens” recorded webinar and webinar transcrip