Public health experts are offering mixed reviews of the Trump Administration’s broad, nonbinding guidelines for states to gradually lift social distancing measures currently in place to slow the pandemic spread of COVID-19.

The guidelines, unveiled Thursday, aim to avoid a second, overwhelming wave of disease by easing restrictions in three progressive phases. Each of those phases is gated, meaning that a set of criteria should be met before a state can enter a specific phase. Those gating criteria include states having two-week-long “downward trajectories” of confirmed COVID-19 cases and reports of infections with symptoms similar to COVID-19. States must also have the hospital capacity to treat all patients without “crisis care” and have a “robust” testing program.

The guidelines further lay out core “preparedness responsibilities” that each state should maintain throughout the phases. This criteria includes the ability to test all symptomatic cases and trace their contacts; to set up sentinel surveillance for asymptomatic cases; to have a sufficient supply chain of personal protective equipment (masks, gloves, gowns, etc) for healthcare workers; and to have plans to protect at-risk workers and members of the public, such as healthcare workers, the elderly in living facilities, and workers and members of the public using mass transit.

The guidelines are not binding and President Trump left open to governors how and when to apply them to their states. This more hands-off approach is a reversal from Trump’s earlier claim that he had “total authority” to override governors and reopen states.

The measured guidelines are also notable for not including any firm timelines or dates. Within recent weeks, Trump pushed for states to reopen by April 12 and—after that date passed—May 1. Public health experts criticized the suggestion, arguing that easing of distancing measures should be driven by data and access to resources to quash flare ups—not artificial deadlines.

Yet, despite the unspecified timing in the guidelines, Trump still suggested that several states could begin reopening quickly—some “literally tomorrow,” he said Thursday. Experts disagreed.

Mixed reviews

Barry Bloom, a distinguished professor of public health at Harvard, offered some praise for the Trump administration’s plan overall. “It is quite a thoughtful plan,” he told reporters in a media call late Thursday night. He commended the plan’s phased nature, the continuation of some distancing measures, and its use of a data-driven timeline rather than hard deadlines.

But, Bloom noted that the plan was vague on many decisions, including the gating. Two week declines in cases is a short period for this disease, given that there can be a two-week lag between an infection and getting test results back.

The plan also doesn’t offer guidance on what to do if a state experiences a resurgence of disease, whether its from undetected spread of disease or from introduction of new cases via travelers. The latter has been a particular issue for many places that have relaxed constraints, such as Hong Kong and Singapore.

Plus, the plan ”assumes that testing will be at a level that at the moment does not exist,” Bloom said. He, like many other experts, have repeatedly noted that the country’s capacity for testing and contact tracing is below what’s needed to adequately detect and stop the spread of disease.

William Hanage, an epidemiologist at Harvard, largely echoed all the sentiments. “There is much to appreciate in this plan, including its stepwise thinking and its thoughtful nature.” But he added, “the glaring problem within it” remains the problem of testing.

Though it’s impossible to say exactly how much testing we should do or be able to do on a daily or weekly basis, Hanage notes that the World Health Organization suggests that country’s aim to do enough testing until only 10 percent or less of tests come back positive. Currently, the US has a 20 percent positive rate overall. This is difficult to interpret, however, because different places have different levels of infection and access to and criteria for testing. For instance, places such as New York and New Jersey are swamped with cases—and positive test results—while others are experiencing more sporadic cases that spur less testing.

“We may have an imperfect picture of the state of the pandemic in different parts of the country because it’s difficult to know if we are measuring actual underlying infections or testing capacity,” Hanage said. It’s difficult to disentangle this, he added, but it’s clear that we need more testing.

Further, we’re also woefully unprepared to do contact tracing, which is crucial to stopping transmission at the beginning or at the end of an outbreak.

When asked if any state should feel confident about entering phase one of the Administration’s plan, Bloom responded “no.” Hanage supplemented the response: “Hell no!”

https://arstechnica.com/?p=1669334