WASHINGTON - A team of government officials - led by the Federal Emergency Management Agency and the Centers for Disease Control and Prevention - has created a public health strategy to combat the coronavirus and reopen parts of the country.
Their strategy, obtained by The Washington Post, is part of a larger White House effort to draft a national plan to get Americans out of their homes and back to work. It gives guidance to state and local governments on how they can ease mitigation efforts, moving from drastic restrictions such as stay-at-home orders in a phased way to support a safe reopening.
CDC and FEMA officials have worked on the public health response for at least the past week, and the resulting document by the two agencies has been discussed at the White House including by members of the coronavirus task force, according to two administration officials speaking on the condition of anonymity to discuss internal deliberations.
President Donald Trump wants a final detailed plan on reopening the country ready within days so he can issue suggestions for some states to reopen May 1, officials said.
"The plans to reopen the country are close to being finalized," Trump said at a White House briefing Tuesday.
Trump said he planned to speak with all 50 governors "very shortly" and would then begin authorizing individual governors to implement "a very powerful reopening plan" at a specific time and date for each state.
He said about 20 states have avoided the outbreaks that have affected others, and he hinted that some could begin restarting their economies even before May 1.
"We think we're going to be able to get them open very quickly," Trump said.
He added: "We will hold the governors accountable. But again, we're going to be working with them to make sure it works very well."
Other agencies and White House officials have drafted similar planning documents, a White House aide said. The version obtained by The Post appears to be an early draft by FEMA and contains granular instructions for a phased reopening of institutions such as schools, child-care facilities, summer camps, parks, faith-based organizations and restaurants.
Within the White House, one senior administration official said, Trump has been so insistent on the reopening that some officials worry only a narrow window exists to provide information to change the president's mind or to ensure that the effort to reopen does not significantly add to the country's still rising number of infections and deaths. The president has not committed to following the guidelines delineated in the draft.
"Beneath the bluster of the president saying May 1, and he's in charge, and all the other things, there are real efforts to figure out how we could safely and actually do this," that official said.
A federal official who spoke on the condition of anonymity to discuss evolving plans said the overall planning document has eight parts; the public health response obtained by The Post represents only two of those parts.
The public health response portion of "A Framework for Re-Opening America" is dated April 10. It runs 36 pages. An 11-page executive summary called "Focus on the Future - Going to Work for America" was the subject of discussions last week by FEMA and CDC officials, among others.
"It's a road map for if they want to do it gradually," said one participant in the planning who spoke on the condition of anonymity because the plan has not been made official.
The plan lays out three-phases: Preparing the nation to reopen with a national communication campaign and community readiness assessment until May 1. Then, the effort, through May 15, would involve ramping up manufacturing of testing kits and personal protective equipment and increasing emergency funding. Then staged reopenings would begin, depending on local conditions. The plan does not give specific dates for reopenings but specified "not before May 1."
The first priority, according to the CDC response document, is to "reopen community settings where children are cared for, including K-12 schools, day cares, and locally attended summer camps, to allow the workforce to return to work. Other community settings will follow with careful monitoring for increased transmission that exceeds the public health and health care systems."
The document also says that during phased reopenings, it is critical to strictly follow recommendations on hand-washing and wearing face coverings in group settings.
The plan also carries this warning: "Models indicate 30-day shelter in place followed by 180 day lifting of all mitigation results in large rebound curve - some level of mitigation will be needed until vaccines or broad community immunity is achieved for recovering communities."
The document says re-opening communities in this phased approach "will entail a significant risk of resurgence of the virus."
Any reopening must meet four conditions:
- Incidence of infection is "genuinely low."
- A "well functioning" monitoring system capable of "promptly detecting any increase in incidence" of infection.
- A public health system that is "reacting robustly" to all cases of covid-19 and has surge capacity to react to an increase in cases.
- A health system that has enough inpatient beds and staffing to rapidly scale up and deal with a surge in cases.
The plan describes the conditions under which it is reasonable to lift some community mitigation measures, the phased steps to reduce those measures and indicators to monitor the impact of transmission on public health and health system capacities.
Communities where it is necessary to maintain only "low mitigation" are places where the virus never spread significantly, and those locations can reopen soon, according to the document. Moderate mitigation is called for in former hot spots entering "controlled recovery." Significant mitigation is recommended in current or emerging hot spots, or moderate mitigation communities showing signs of strained capacity.
In a community following the moderate mitigation track, the report says, schools could remain open with enhanced distancing measures, such as no assemblies, no sporting events and staggered scheduling.
The document calls for the CDC to establish a Covid-19 Response Corps to help state and local health departments with key public health functions, including contact tracing, which involves locating people who may have had contact with someone infected with the coronavirus.
Health experts in recent days have called for federal and state officials to help expand capacity throughout the country for the labor-intensive work of tracing people who have come into contacted with infected patients, because local health departments lack the necessary staff, money and training. The plan also says that solutions for "app-based case and contact investigations will be necessary for augmenting the actions of public health workers and for greatly increasing the important role of slowing covid-19 transmission in the community."
Tech experts and companies such as Google and Apple are developing software that uses cellphones and apps to track people's movements. Once someone is confirmed as infected with the coronavirus, public health workers could go back and trace people the infected person has come into contact with. But the invasive nature of cellphone tracking and apps have raised sharp concerns about civil liberties.
The document calls for a workforce of 670 to support communities to do contact tracing as part of a surge staff, not nearly large enough based on plans from other groups.