States are opening their doors again, some more slowly than others, and some without meeting minimum CDC guidelines for a phased comeback.
Chief among those criteria is a downward trajectory of COVID-19 cases reported within a 14-day period. Although some states are fighting their governors to reopen in spite of rising cases — Wisconsin’s Supreme Court overturned the stay-at-home order overnight Wednesday — Louisiana has met CDC guidelines. And on Friday, the state moved into the first phase of reopening.
The only question now is how to do this safely so we don’t create unnecessary health risks and precipitate a spike in cases so severe that healthcare institutions are overwhelmed.
“Phase one doesn’t mean it’s 100 percent safe,” said Dr. Joe Kanter, assistant state health officer at the Louisiana Department of Health in Baton Rouge. “It’s an exercise in balancing very challenging objectives all together and reducing risks to the extent that it’s possible and practical.”
Trying to reopen with required social distancing mandates, meeting the challenges of heightened sanitation protocols, and keeping occupancies to 25 percent — the limit in Gov. John Bel Edwards’ phase one order — requires planning.
Whether you’re an Ochsner Fitness Center with multiple locations, conducting temperature checks at the door, disinfecting equipment, and encouraging mask-wearing to protect employees, or you’re a restaurant that has suddenly had to reconfigure the entire seating arrangement, businesses know that this is an opportunity to keep the economic wheels spinning, provided the public can feel and be safe. That will require cooperation from both sides — the businesses must comply with new regulations and Louisianians must wear masks to protect workers who are continually exposed.
“We don’t know exactly how many particles it takes to become infected, but we do know that one infected person can spread it to a lot of people,” explained Angela Amedee, professor of microbiology, immunology and parasitology at LSU Health, New Orleans School of Medicine. “I’m sure you’ve heard about the choir outbreak in Washington state where one individual ended up infecting 52 others. It was an unusual event because many people in one room were all singing together. It probably wasn’t droplets in this case which were the culprit, but rather aerosolized particles. Our data doesn’t bear out that one person can infect this many others, but perhaps this person was a super-shedder.”
‘This is all about risk tolerance’
The choir practice rehearsal was held on March 10, before the state implemented a stay at home order. The singers were sitting six to ten inches apart for over two hours. Two choir members have since died, and the event has become the subject of a CDC report.
The virus has always been thought to be transmitted through droplets when an infected person coughs or sneezes, but scientists have theorized that a fine mist of particles may be emitted when someone is shouting or singing. And according to a new study from the National Academy of Sciences, the airborne lifetime of small droplets generated by speaking at normal levels is up to 14 minutes.
“When we speak of reopening our state, this is all about risk tolerance,” said Dr. Susan Hassig, associate professor epidemiology at Tulane University’s School of Public Health and Tropical Medicine. “People should know that
they’re probably at medium risk going inside of a restaurant, but much depends upon the spacing of the tables, how many people are wearing masks [and they should stay on except when you’re eating], and how well the establishments adhere to guidelines.”
Dallas Mavericks owner Mark Cuban recently decided to secretly monitor some of the Dallas businesses that opened on May 1 under restricted guidelines. A company named Shiftsmart that helps workers discover new job opportunities, was hired to audit about 300 open businesses that were under new restrictive orders, some protocols mandatory, and some suggested. All sorts of mandates were evaluated — from single-use condiments to marked waiting spots, disinfected surfaces as well as other criteria.
Only about 60 percent of mandatory protocols were followed, and 54 percent of the suggested ones. In one instance, a secret shopper was approached by a restaurant manager to see how his meal was. But, the manager wasn’t wearing a mask, which flies in the face of CDC recommendations. Cuban said he embarked on this study to determine how safe it was for him and his family to return to a marketplace which was re-opening.
And that’s just the restaurants. Ninety-six percent of retail stores were not compliant with the protocols.
“This is a respiratory virus, so if we go back to our old ways of crowding people together who are unmasked, we will see cases spiking,” said Robert Garry, M.D., Professor of Microbiology and Immunology at Tulane Medical School. “What’s a worst case scenario? 1,000 new cases a week? Or, 2,000 new cases as we were in the peak? Is that a reason to impose restrictions again?”
It’s certainly nothing businesses want to see. Hair salons like H2O in Old Metairie are working to ensure that their clients are as safe as they can be. Opening on Saturday, there’s been a push to conform to every guideline and beyond, said one stylist who works there. Stylists there are now working different shifts with less hours to accommodate a 75 percent reduction in clients in a shop that’s normally buzzing with people.
“I’m now only working 3 days a week,” said Rhonda Braquet, a longtime stylist with the salon. “Everyone will wear masks, both stylists and their clients. There will be no waiting anymore. You will be brought in one person at a time. If your stylist isn’t ready, you will have to wait in your car. There’s a big push to keep everyone safe.”
‘We cannot completely protect the population from this’
There are still many Louisianians who want everything open, in spite of the risks. The concept of herd immunity — in which a significant percentage of the population has been exposed — would take a very long time to reach, and there would likely be many deaths. Ochsner recently completed a prevalence study, and while data is still being compiled, a source familiar with the results said that fewer people than expected have been exposed, and we’re a long way from any sort of herd immunity, at this point.
“We cannot completely protect the population from this,” Amedee said. “But what we need is a balance between herd immunity and total protection. In the scheme of things, SARS was deadlier, but the big difference was that you had to be symptomatic to spread it. The fact that Covid-19 is being spread by people who have no idea they’re infected makes this treacherous. We just need to get through to people that wearing a mask protects everyone. … My mask protects you, and your mask protects me. Long before Covid-19, Asian people wore masks. They’ve dealt with bird flu, the South Koreans with MERS, and there’s just no stigma there in wearing a mask.”
“Science has been bashed now for years,” Hassig said. “Masking has become partisan, hard as that is to believe. The Republicans in the Senate hearings were not wearing masks as if to make a statement. This isn’t about politics, it’s about public health.”
In the interest of public health, some businesses have chosen not to open, in spite of the government’s release of the shutdown order. Some restaurants are playing a wait-and-see game, and other venues like the independently owned Broad Theater will wait until the end of the month to re-open in order to figure out seat spacing, traffic flow inside the theater, and leaving time in between feature films so there’s no cross traffic. Meanwhile, the Audubon Zoo and Aquarium will wait until June to see guests again. Crowd control with social distancing and limiting the number of people inside the zoo are all factors to be dealt with before an exact opening date will be determined.
“Everything must be well thought out ahead of opening up, and it’s a challenging situation in terms of enforcement because there won’t be a police officer in every business,” Kanter said. But, it’s our personal responsibility to protect those who serve us in restaurants and stores by wearing a mask. And we all need to use common sense. The lakefront has been closed down multiple times because crowds are congregating, violating social distancing recommendations. So, if you go to the lake and you see large crowds, it’s incumbent upon you to leave.”
Scientists who spoke to The Lens praised Edwards’ handling of the crisis thus far. In a little more than a month, the state went from having the highest case growth of anywhere in the world to meeting federal guidelines to reopen. But, they said, it’s no time for getting careless.
“This virus will teach us a lot about innate immunity,” Amedee said. “We are experiencing everything now in a rather dramatic way. Sure, we have little clues about how our immune system works, but we don’t know why some people get sick, and some don’t, even when we exclude pre-existing conditions from the equation. Is there an immune deficit in some people? It may be that you can live in the world ordinarily with no problems, but you may not know just how well you’re protected by your own immune system until a virus like this comes along.”
As some begin to venture out into the world, it’s important to remember a few basics.
“It used to be heroic to work through sickness and simply tell your colleagues to stay away from you because you had a cold,” Garry said. “That’s certainly not a good sound practice anymore, and can be downright dangerous.”
All the doctors agreed that it’s still safer to eat outdoors in the fresh air than it is to eat inside a restaurant where you cannot be sure of the air filtration system.
“And whether you’re indoors or out, remember that less than six feet away from anyone for more than 10-15 minutes puts you in the close contact category and increases your risk,” said Kanter. “And, even though we’re in phase one, staying home is what all high risk people should be doing.”
Using Mardi Gras as a big lesson, we now know that being part of a big crowd when the virus is still present means it’s only a matter of time before it comes roaring back.
“Everyone needs to think very consciously about their actions — and we’re not used to doing that,” Hassig said. “We all know the cases will mount now that we’re reopening society, but it’s critical that we keep the numbers down to a tolerable level.”