I spent a little time over the weekend walking through “Opening Up America Again”, the guidance recently released by the White House. One of the immediate and most obvious things that you can see is that the White House anticipates a federated approach to managing through the recovery from this crisis. This is due, in part, to the differences in how the impact of this pandemic is being experienced across the country. We have areas that are currently experiencing extraordinarily difficult times while other areas are experiencing relatively moderate impacts, for now. In fact, the gating system is designed to operate at the local, state, region or national level on the basis of high level metrics around symptoms and cases with a special focus on hospitals and their relative capability to support standard operations and testing programs.
This approach will enable the country at large to reopen, when and where it makes sense, while ensuring that hotspots are able to continue to adopt the measures needed to flatten the curve in the places hardest hit by the virus. It will also be heavily influenced by the abilities of states to meet core preparedness responsibilities. This is essentially relies on a three legged approach that includes:
- Testing & Contact Tracing – the ability to adequately test individuals in order to forecast future case loads related to the virus. Testing will enable forecasting to support state and local governments to reopen and to stay open or determine where shutdowns are required. Hand in hand with this is contact tracing, essentially the ability to rapidly identify and monitor contacts of positively infected people in order to contain outbreaks before they reach a crisis point that would cause another shutdown.
- Healthcare System Capacity – the ability to handle surge capacity requirements. This pairs with testing and tracing in order to establish the infection thresholds that can be withstood by a state or local government prior to requiring more comprehensive measures that would impact the ability of those economies to stay open. Simply put. testing thresholds will be based on the ability of local health infrastructure to support and manage normal patients and any coronavirus related surge.
- Regional, State & Local Plans – much is left to the expertise and unique requirements of specific State and local governments. This includes the ability to protect critical industries, protect those at high risk, and to develop the tools that will enable each level of government to have the situational awareness necessary to manage their economies and activities in the context of their public health circumstances.
Testing & Contact Tracing
This component of the plan is all about identifying and containing spread. The combination of highly available testing paired with diligent and continuous monitoring for symptoms is a critical component of getting open and staying open. Monitoring for symptoms means that citizens at home, employers and employees will all need to be diligent in monitoring the behaviors that help prevent the spread of the virus as well as ensuring that we actively monitor for symptoms. The combination of a long gestation and asymptomatic spread means that education and more important ensuring action will be critical. The biggest mechanism for accomplishing this beyond the cooperation of the American people in general, is putting appropriate processes in every place of employment and every venue where we meet and mix. Ensuring key hygiene, distancing and behavioral activities are occurring will ensure we can stay open. In many businesses this will mean adding education and training as well as automating, auditing and inspecting the actual execution of these processes.
We touched on some of these topics in a webinar we held on April 17 talking about the specifics of some of this using Salesforce and ExAM in “ExAM4Inspections: Supporting COVID-19 capabilities in the field”. The overall concept however is simple. We can enable each level of government from local to federal, collect the information they need from the business America runs on to help ensure we are able to stay open. Almost every business where Americans regularly congregate is already subject to significant regulation in order to maintain safe facilities and working conditions, coronavirus simply dictates that a specific set of actions be taken now in order to reduce the risk of the spread of the virus.
By creating a simple training, certification and inspection program that simply extends existing services being provided to for example inspect restaurants localities can efficiently deliver services to support ensuring appropriate steps are being taken to meet the existing threat those issues can be delivered in the context of existing services and in keeping with the needs of that community. By underpinning this approach with technology we can provide the situational awareness to govern effectively at each level of government and to ensure that appropriate planning and coordination can occur.
Healthcare System Capacity
No matter how careful we are by reopening we all but ensure that we will have further outbreaks until there is a vaccine. In order to stay open we need to build and maintain more supply to ensure proper care can be provided to patients so that crisis care doesn’t end up costing someone who would otherwise have lived their life. Some of this probably means building additional permanent capacity to ensure we are better prepared for the future, however some of this also means planning to support temporary and surge capacity capable of handling regional, state or local surge requirements.
Enabling this kind of ability to handle surges, allows us to create the capacity more rapidly by leaning on mobile and temporary facilities, as well as creating shared resources within regions that can lower the overall costs of delivering services in combating an outbreak. This is only possible however if you can depend on being able to rapidly deploy and operate these capabilities. The ability to rapidly get data from people and into the decision making process will be critical.
Understanding where mobile units have been deployed, their relative capabilities, progress towards being fully operational and ongoing inventory levels across resources in the field will be critical. There is an informational backbone that is required to ensure we can marshal resources when and where we need them. The hospital systems capable of keeping America open will not only need to be expanded at its base, but perhaps more importantly it will need to be able to coordinate across regions and the nation to rapidly address hotspots and to share and move resources as required to meet the challenge.
Regional, State & Local Plans
At each level of government and within every community there will need to be appropriate planning for the threat and across the board there will need to be plans put in place to help people at home, work and at play. In particular, we will need to reopen without unnecessarily jeopardizing the safety of the most vulnerable. This will mean putting into practice the lessons we have learned while shut down to ensure we don’t have to shut back down again. For every business, meeting hall and other places that people meet, greet and congregate we will need to have plans in place and mechanisms for auditing those plans so that we can ensure they are being put into action.
This means providing the core steps necessary to contain the virus to audiences in a way that is tailored to them, gyms will need different guidance than buses and restaurants – but all will need to adjust their business if we all want to stay open. On a citizen by citizen basis, that means things like washing hands and covering our faces. At work the adjustments may need to be more drastic. Clear supplemental training should be devised on the core practices needed to be successful and pushed into the community. Compliance with core guidance should be tracked and made publicly available with mechanisms for businesses to show that they have adopted best practices. We need a carrot model and so does business. The news is full of stories of places reopening in other parts of the world to scant shoppers and people. In order to get American open and doing business, people need to feel safe.
A part of the above is businesses adopting safe practices and the public being able to show those practices are in place and as a consequence feeling safer about interacting with those businesses. I’d love to know that all of the workers at my store have been trained on safe practices and that the city has audits those practices. I’d love to see “Safe Services” badges being displayed in businesses that adopt and practice the types of Safe Service delivery that we hope everyone will provide so that we can stay open. We want to walk into grocery stores and see markers indicating queue positions in lines, easily accessible hand sanitizer and see masks and gloves deployed where they should be. Adopting these processes and ensuring they are followed across industries and communities are the key to not only reopening, but staying open.