After nearly a month of sheltering in place in the Bay Area, most of us are wondering: when—and how—will we ever emerge from our homes? It feels daunting, impossible, and scary. If you agree, we suggest reading this piece in TBI today by two doctors who lay out a clear, rational, step-by-step proposal that would allow us to both manage Covid-19 and start to come out of an absolute order to stay home.
A Step-by-Step Plan to Reopen California
By Rajiv Bhatia, MD, MPH and Jeffrey Klausner MD, MPH
On March 19, facing uncertainty as to whether the state’s hospital capacity would meet the needs of the Covid-19 epidemic, the California Department of Public Health ordered everyone in the state to stay home, effectively ending normal economic and social routines. Weeks after that indefinite order, the pace of the epidemic has thankfully slowed, and many hospitals — now retooled to manage increased Covid-19 demand — are well under capacity.
Without either proven pharmacological treatments or an effective vaccine, we’ll be living with Covid-19 for the foreseeable future.
California needs to quickly establish a consensus for the next steps to manage the epidemic in ways that are least restrictive to individual liberties.
California, and other states for that matter, should not wait for nor rely on a national strategy. The epidemic will have different dynamics in different regions at different times. By more effectively using monitoring data, the intensity of the response can be determined based on the needs of each geographical region.
Shelter-at-home orders were a decisive and precautionary maneuver in the face of uncertainty about our capacity for a medical response.
Yet the current order to stay at home is blunt, is no longer required everywhere, and will be harmful in myriad ways if continued.
Epidemics are always local and regional phenomena; in parts of the state where case rates are low, where new hospital admissions have been low or are now declining, and where adequate hospital reserve capacity exists, people should be able to safely exit home quarantine.
We believe it’s now imperative to advance a public discussion on how we proceed from here, not only to improve and refine our strategies but also to mobilize the necessary talent and collective action to realize them.
Our goal in the near term should be to monitor and moderate the pace of the Covid-19 epidemic so that we can ensure both maintaining adequate hospital capacity and preserving basic human needs and constitutional freedoms. This will be a balancing act. We can aim for a state in which some will continue to acquire Covid-19 and where our health care system can manage this demand.
We take these positions as physicians deeply committed to protecting health, as health scientists viewing events critically, and as former deputy health officers of San Francisco who are well aware of the responsibilities and challenges of public servants.
Executing this strategy will require closely monitoring the pace of the epidemic, expanding our capacity to promptly test, supporting those required to isolate, and stepping up and down from different intensities of public interventions when needed.
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