The decisions we make in Hillsborough & Pinellas over next few weeks will have ramifications for months to come as we find ways to coexist w/COVID19

Hillsborough and nearby Pinellas county have reached a plateau in new COVID19 cases (the log scale in this figure demonstrates how flat the two counties have been). In general, the daily number of new cases in Hillsborough County has declined and the total number of cases is flat in both areas.

Local governments, institutions (hospitals, school districts, businesses) and the public have done a good job at the flattening the curve. Reasonable conversations about relaxed social distancing interventions are warranted. However, the virus is still present and nothing significant has really changed since February 2020 in regards to our ability to pharmaceutically fight the virus or prevent transmission.

Here are some key considerations as we move forward:

1. We should begin examining data for what worked and what did not and use that information to guide policy decisions now and over next year. For example, municipalities in Pinellas (e.g. St. Pete) did not close parks while Hillsborough did as part of the safer at home ordinance. From the data we have right now, this difference does not seem to have made Hillsborough any safer. We should consider reopening of parks in the City of Tampa. In addition, a curfew that was initiated temporarily in Hillsborough County likely only angered a population that overall already supported the safer at home ordinance and distracted law enforcement from a public safety/public partner mission.
2. We must also pay close attention to states and other populations (e.g. Denmark, Germany, Georgia) that have initiated relaxed social distancing strategies ahead of us in standardized days and be ready to act on those observation. Some of those populations are not as well prepared as us (e.g. Georgia with less per capita testing and no evidence for a coordinated surveillance strategy) and some are likely more prepared (e.g. Germany).
3. The Pinellas County Sheriff is supporting the reopening of beaches and some pools. If social distancing and hygiene practices are followed, this also seems reasonable given the current mix of cases and hospital capacity. There is not convincing data that banning socially distanced park, pool, and beach visits are helpful in decreasing transmission at this time. It is reasonable to consider these approaches given current new case volumes.
4. Governor DeSantis is sending a concerning message when he insinuates that the predictive models were wrong or that they overestimated the impact of COVID. Instead, the message from the Governor should be that social distancing had clear impacts on the incidence of COVID19 and we are fortunate that his own public policy (at least after April 3, 2020) helped us get to a place where we *look* over prepared. Remember that the exact predicted impact of a successful public health intervention is very boring - it is the exact lack of overwhelming surges of new cases that we have had in most of Florida that suggests the public health interventions were appropriately chosen.
5. The statewide ban on elective surgeries will expire on May 9, 2020. Hospitals that implement house wide surveillance (employee screening, employee antibody testing, patient testing in both symptomatic and asymptomatic patients) should be able to safely consider reopening. Hospitals that begin to allow elective surgeries should also participate in community surveillance to monitor for outbreaks. Look at the Florida curve again - we still had a sporadic high case day recently secondary to a clustered outbreak in Lee County. These are going to occur and hospitals may need to help monitor those with deployment of testing resources.
6. A coordinated surveillance/testing model designed by some hospitals may be an example of how we can scale up similar approaches for other organizations, municipalities, the state, and the nation. University leaders, school districts, corporations and municipalities should look to hospital leaders as potential examples of how they can dial up participation and engagement at their own organizations.
7. There are problems with widespread antibody surveillance testing when the prevalence is low. Thus, targeted testing may still be better - even though there is documented asymptomatic spread of virus (more on this in a separate post). Surveillance technology (e.g. cell phone data, contact tracing/notification, self-reported screening symptoms) may be more useful in Florida/Hillsborough-Pinellas for determining who should be tested and when - as well as what contacts of potentially infected patients or infected patients should be tested. The use of computer surveys/phone apps/automated-anonymized tracking technology should be used across the population as a passport to reopening specific businesses/areas.
8. There is still no FDA approved treatment for COVID19. There is convergence around some treatment strategies though. Broadly, I will tackle what we know about treatment in a separate post but the whole toolbox involves public health/social distancing measures, ways to approach/support sick patients with COVID19 (e.g. ways to intubate/not intubate/oxygenate/prone), potential pharmaceutical approaches/targets, and post pandemic outbreak/reopening surveillance/testing strategies. Pharmaceutically, approaches for treatment are revolving around a two phases of the virus - anti-viral and anti-inflammatory.
9. Herd immunity is a long long long way away. Even if there is a lot of undiagnosed patients out there, we would probably need to infect another 50% of the population to reach herd immunity. How can we do this without causing excess deaths? There has not been a clear strategy put forward yet that would allow this approach (and even Sweden is beginning to retract some earlier math).
10. We should be skeptical that a vaccine will be developed within a year or at all. There are a lot of deadly viruses that coexist with us that have no vaccine, despite decades of trying (e.g. HIV).
11. As some people begin to return to work, watch for social inequalities to become even more magnified and COVID19 to wreak havoc on those most vulnerable. Service workers can not work from home and will be first to return to workplaces when overall mitigation strategies are still being developed and will bear brunt of newly emerging outbreaks (as will those in group and crowded living situations).