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National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci says there is ‘no doubt’ we will see new coronavirus cases as the country reopens. (April 28)

AP Domestic

California Gov. Gavin Newsom likens the process of emerging from the lockdown required by the coronavirus to turning the lights back on, saying the state won’t abruptly flip a switch but instead slowly rotate a dimmer.

For some states it might be more like enduring a series of power outages.

Dozens of states have decided to reopen businesses amid a pandemic that has claimed more than 56,000 American lives. But although they’ve also established a number of conditions for restarting, public health experts question their ability to monitor and handle the inevitable increase in cases that will follow.

If the surge is strong enough, some may have to reimpose the social distancing restrictions that devastated their economies, making for a herky-jerky approach to recovery.

“I think they’re playing Russian roulette,’’ said Dr. John Swartzberg, clinical professor emeritus at the University of California-Berkeley and an authority on infectious diseases. “They’re hoping obviously that reopening the states is not going to lead to increased cases. They have no way of monitoring the answer to that question until it explodes.

“If they reopen the state without adequate testing and without adequate contact tracing, there will be more cases, and they won’t recognize those cases until they start appearing in the emergency room and then in the ICU.’’

Who’s reopening: US reopening: Which states have relaxed restrictions? Find out what your state is doing

On Monday, the White House unveiled a blueprint for increased testing that would allow states to recognize emerging clusters of cases and mitigate outbreaks through isolation and contact tracing. The plan leaves most of the testing responsibilities to the states, and it presupposes the availability of testing materials that have been in short supply.

Researchers at Harvard University recently concluded the U.S. would need to conduct 500,000-700,000 coronavirus tests a day to begin reopening safely. Last week the country averaged 210,000 daily tests, according to the COVID Tracking Project.

A top Trump administration health official said Monday the U.S. could perform 8 million tests in May, but that’s still far short of the 12 million-plus recommended by leading expert Dr. Anthony Fauci. Another Harvard study called for ramping up to 5 million daily tests by early June and 20 million by late July for a successful reopening. The U.S. has conducted 5.6 million tests total so far.

Swartzberg pointed out some of the states leading the charge to lift constraints – among them Georgia, South Carolina, Oklahoma and Alaska – were not doing enough testing in the first place. That left them unable to fully assess how much COVID-19 has spread, a difficult task even in the best of circumstances because asymptomatic carriers of the virus can infect others.

“They don’t know where they’re starting from, so they’re really doing this whole thing in a blind fashion,’’ Swartzberg said. “It’s like putting a blindfold on and walking forward.’’

More: US coronavirus map: Tracking the outbreak

Even for those taking careful steps, the path forward may feature a number of stumbles until there’s a widely available vaccine for the virus, which could take at least a year.

Ogbonnaya Omenka, a public health specialist who teaches at Butler University, said the only way to reopen confidently is with the immunity conferred by a vaccine or when the transmission rate dwindles to one per infected person, known as the endemic level.

Short of that, Americans can expect a number of protective measures to remain in place – such as required face coverings and limits on the size of gatherings – and stricter ones to be imposed on and off, depending on the contagion level as different regions reopen.

“Starts and stops should be expected and, in fact, planned for,’’ Omenka said. “There is really no way to determine how each jurisdiction’s plans would unfold until results start to emerge. Because the virus relies on human interactions to spread, reopening now is inevitably a gamble.’’

The federal government has issued a set of guidelines for states reopening, requiring a downward trend in confirmed cases over a two-week span and hospital capacity to treat all patients without crisis care. But it’s up to the governors to decide when and how to lift restrictions in their states.

Georgia Gov. Brian Kemp has drawn intense criticism for allowing the opening of some nonessential businesses last weekend, three weeks after issuing a stay-at-home order that was supposed to last through the rest of the month. Many of those businesses and most churches remained shuttered nonetheless.

On Monday, Texas, Ohio and Iowa were among the states that announced plans for a gradual reopening, all with stipulations meant to prevent outbreaks. With residents clamoring to get back to work and more states approaching the expiration date of their stay-at-home orders, more such announcements are expected. Newsom, though, said California is still weeks away from “making meaningful modifications” to its order. 

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New York Gov. Andrew Cuomo, whose state had recorded nearly 30% of the country’s 1 million confirmed cases through Tuesday afternoon, said manufacturing and construction jobs that don’t present a high risk for infection will be allowed to return first around mid-May, and there would be a lull after that.

Cuomo envisions upstate communities, which have not been as severely affected as the New York City metro area, resuming operations earlier as part of a phased process. Other governors are also contemplating taking a tailored approach to reopening, depending on infection and hospitalization levels in different counties.

 “I don’t want to just reopen. We learned a lot of lessons here, painfully,” Cuomo said. “How do we take the lessons we learned and say when we reopen, we’re going to be the better for it?’’

Andrea Molle, an assistant professor of political science at Chapman University, noted that politicians can’t afford to make risky decisions that may backfire in an election year.

Her recommendation for reopening would be for public health officials to implement systems of identifying people most at risk of the harshest effects of COVID-19 and those who may become super spreaders, rather than assuming all have the same capacity.

Lacking that, she expects elected leaders to try to balance the importance of public health with the increasing demands to get economies and a semblance of normal social life restarted.

“The past weeks have proven that a full lockdown is unsustainable in the long term and the pressure to reopen is mounting,’’ Molle said. “While there might be some corrections along the way, the process will necessarily be slow and aimed to maximize the trade-off between individual safety and the need to restart economic and social activities.

“Also, assuming that it is likely that if the virus is coming back in the fall, another period of lockdown could be necessary, this must be considered in planning for reopening.’’

In other words, this might not be the only round of Russian roulette decision-makers will be facing.

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