COVID-19: Staying Safe While We Reopen

It has now been more than two months since we have seen the first state-wide stay at home orders. In that time, we’ve seen the COVID-19 pandemic affect every part of our daily lives. From the way we work to the way we socialize – everything has changed.

There has been incredible collective action to slow the community spread of the virus and truly heroic efforts by our front-line clinicians to support the health and well-being of communities. Now, at the end of May, states across America are lifting stay-at-home orders and reopening business.

As a country, we continue to make progress, but the hard work is far from over, and it's essential that we proceed with caution. The reopening of our communities will inevitably result in a spike of cases. How big that spike will be and how it impacts our communities depends on the actions of every individual. Everyone plays a part in stopping the spread.

With thousands of clinicians on the front lines across the country, Envision Healthcare, a leading national medical group, has valuable insights into the varying levels of the pandemic in communities across the nation. Through our collective experiences, on the front lines of this pandemic, there are certain things we’ve observed.

As the nation begins reopening, it’s important to keep the following frequently asked questions in mind.

What do we know about the virus?

The fundamentals of the virus have not changed. It is still contagious, deadly, easily spread, its symptoms are varied, and it impacts people differently.  

We also know that the virus is circulating more in the community now than it was in early March when states began to shelter in place. This means people are still just as likely, if not more so, to contract the virus when communities reopen entirely.

Can we expect a rise in COVID-19 cases following the reopening?

It is likely that there will be some rise in cases as states reopen. Many communities were seeing upward trends in reported cases before reopening. It will be important to monitor those trends and respond appropriately.

We know social distancing is effective, and we have seen a flattening of the curve by averages. When some of those measures are loosened, we will likely experience a new spike of COVID-19 hospitalizations. We should expect to continue seeing spikes until we have more consistent testing or a vaccine.

However, spikes may not always be immediate due to the long incubation period of the virus. Hospitals should prepare for an increase in COVID-19 patients two to three weeks after a community reopens.

What about viral testing? How will it affect reopening?

The more we test, the more we know, and the more we know, the faster we can begin to return to a degree of "pre-COVID-19" normalcy. There are primarily two types of COVID-19 tests:

·      Antibody Tests – are more commonly available and can be used to test for a past infection. As with many antibody tests, these can deliver a high number of false negatives and false positives, resulting in some uncertainty. With more tests in production, we should see more consistent results soon.

·      Antigen Tests – may tell us if someone is infected with COVID-19. Antigen tests are more reliable, but have some limitations (e.g., patients sometimes require multiple tests to be positive despite being infectious for days).

How long will we have to be socially distant? Can we expect any changes in the coming months?

It's nearly impossible to put a timeline on the development or eradication of the virus. Unlike the flu, COVID-19 doesn’t appear to have significant declines in warm weather. Right now, we are seeing an increase in cases in the southern hemisphere, Caribbean (Haiti) and China. That means broad-based immunity, either through prior infection or vaccines, will be required to see a significant decline in risk or infection rates.

Vaccines can take a long time to develop, even under aggressive timelines and demand. Depending on the type of vaccine, it could be months, or even years, before it ready for public use. Communities should expect to see "rolling orders" of social distancing based on viral testing and surveillance until a vaccine is available.

What can we do to protect ourselves from COVID-19?

The most effective way to avoid contracting COVID-19 or passing it on to someone else is to remain socially and physically distant. It’s important to remember that symptoms do not always present themselves, so without knowing it, people could have the disease and spread it. Everyone should keep in mind the following precautions:

·      Wear a mask – both surgical and cloth masks have been proven effective.

·      Remain 6-feet apart – avoid and physical contact and maintain distance from others.

·      Wash hands frequently and thoroughly – in soap and warm water for at least 20 seconds; use hand sanitizer when possible.

·      Avoid public places – like the office and grocery store if you feel sick or have had a positive antigen test.

The last thing to keep in mind is that this will not go on forever. At some point, the virus will decrease to levels that will allow for a "new normal." How and when we arrive at that point will depend on the collection of accurate information, scientific advancement and collective action in protecting our communities.

Together, we can overcome this challenge.

To access the most current and accurate information about COVID-19, visit www.envisionhealth.com/Coronavirus

Adam Brown, MD, MBA, FACEP

Dr. Adam Brown is the President of Emergency Medicine for Envision Physician Services and leads the National Coronavirus Task Force for Envision Healthcare. He is a board-certified, practicing emergency physician living in Washington, D.C.