White House guidelines for reopening garner mixed reviews

President Trump’s plan to reopen the country garnered mixed reviews from health experts and governors, who praised the broad outline but found some details lacking.

The new guidelines, announced Thursday, are aimed at helping states decide when and how to loosen coronavirus restrictions and allow their residents to begin returning to work and public life. 

But much is left to the governors, and the guidelines give little specificity on how the federal government will provide support for key components of the plan such as increased testing and contact tracing.

“We have current, large unfulfilled order requests with the federal government for both [personal protective equipment] and testing materials,” said Oregon Gov. Kate Brown (D) in a statement. 

“These are vital components to reopening Oregon and remain necessary to prevent a resurgence of the disease,” she added.

Former Food and Drug Administration commissioner Scott Gottlieb on Twitter called the guidelines “sensible” and “broadly consistent with state plans.”

However, Gottlieb noted that the Trump administration put a lot of emphasis on reopening gyms and large entertainment and sporting venues in the initial phase. 

“States are likely to exercise more caution than these guidelines might allow,” Gottlieb said. “Those may not be permitted until we have seen that work can safely return without a resurgence.”

Two places where states are likely to exercise more caution than these guidelines might allow are the reopening of gyms and sports venues and some other large entertainment gatherings. Those may not be permitted until we have seen that work can safely return without a resurgence.

— Scott Gottlieb, MD (@ScottGottliebMD) April 16, 2020

Ashish Jha, director of the Harvard Global Health Institute, tweeted that the plan is a “measured approach that starts slow and builds. That’s right.”

The President just released “Opening Up America Again” slides and I have some initial thoughts:

1. There’s a lot to like here. Its measured approach that starts slow and builds. That’s right.

2. The proposed gating criteria – the heart of this — is a problem

1/n

— Ashish “I’m still focused on testing” Jha (@ashishkjha) April 16, 2020

However, he took issue with the plan’s criteria for moving from one phase to another. The plan has no specific criteria for testing — when a state sees cases dropping consistently for 14 days, the plan allows for a governor to move into the next phase. 

“That’s a huge problem,” Jha said, because it doesn’t account for a state’s testing abilities. If a state tests fewer people, then it won’t see as many cases. 

Trump said states would be taking the lead on the testing, but the guidelines left unanswered questions about how capacity will be expanded and supply shortages will be eased. 

“Yesterday I laid out what’s required for North Carolina’s path to gradual re-opening, and it’s good the White House has shared similar guidance, but we still need the federal government to help with testing and personal protective equipment [PPE],” North Carolina Gov. Roy Cooper (D) said in a statement. 

While Trump continues to tout the U.S. testing capabilities as the best worldwide, labs say they are running short on supplies needed to collect and process tests, like swabs, chemicals and PPE. 

“The governor of Washington was saying he can’t find cotton swabs,” Trump said, referring to the global shortages of swabs needed to collect samples from patients. 

“The federal government shouldn’t be forced to go and do everything,” Trump said. 

Health experts have warned the United States needs to massively ramp up testing and contact tracing capabilities throughout the country so officials have enough data to determine when it’s safe enough to work and lift some physical distancing measures. 

Continued testing beyond that point will help officials detect and hopefully prevent future outbreaks.

“A significant expansion of tests, testing, personal protective equipment (PPE) and other medical supplies, and public health workers is still needed to reach the level of testing and surveillance necessary to safely reopen the country,” the Infectious Diseases Society of America said in a statement Thursday. 

Trump has publicly lauded the U.S. testing system as the “most expansive and accurate” in the world, and last week downplayed the need for a significant expansion in testing, especially in areas of the country that haven’t seen large numbers of COVID-19 cases. 

Health officials have performed around 3 million tests to date. But experts, including former FDA commissioners Gottlieb and Mark McClellan, have said the U.S. needs to test almost 1 million people a week. 

They have also advocated expanding the narrow criteria, which currently prioritizes testing for very sick people and health workers, but the Centers for Disease Control and Prevention has not committed to that. 

Testing people without symptoms right now is a “non-priority,” according to the agency’s website.

Administration health officials expressed confidence they have the ability to do that.

Deborah Birx, who leads the White House coronavirus response, said that if all hospitals and clinics that have the capability move to point-of-care tests, officials believe that they could perform at least 1 million more tests per week.

Ultimately, the decision to relax coronavirus restrictions will fall to state and local officials who implemented them. 

Washington Gov. Jay Inslee (D) said Thursday the state needs the infection rate to continue to decrease and testing and contact tracing capacity to increase dramatically before relaxing physical distancing requirements. 

Multiple regional coalitions have formed this week as states turn to one another to determine how best to lift advisories that called for limits on public gatherings, closures of nonessential businesses and other restrictions to curb the spread of the virus. 

All but seven states have issued stay-at-home orders to prevent people from spreading the virus, and many have recently extended those orders. 

The deferral to governors is a far cry from Trump’s assertion on Monday that he had “total authority” to dictate to states when to begin loosening social distancing guidelines that have hampered the economy. But Trump had in recent days reversed course and said he would “authorize” governors to move forward as they saw fit.

Some governors seemed relieved the president backed off his claim.

“I do want to extend … appreciation for what I heard from the president as it relates to recognizing the differentiation that exists … across this nation, and a willingness to recognize and extend that very directly to governors of the need for a phased approach,” California Gov. Gavin Newsom (D) said Thursday.