On May 1, Governor Wolf announced more details of his plan for “reopening” Pennsylvania. He announced that on May 8, 24 counties would move from “Red” (the current lock-down status) to “Yellow” (most businesses allowed to reopen, and stay-at-home orders lifted). However, all indications are that Chester County and the surrounding areas of southeastern Pennsylvania will not reopen anytime soon.
The governor’s May 1 announcement contained a little more detail about what the reopening process will be like than the previous week’s announcement did. Here are some of the specifics:
- The counties in two specific regions of the state (Northwest and North Central) will be the first to move into the Yellow phase, on May 8. These are predominantly rural areas that have not had many Covid-19 cases.
- More detail was provided about the “risk-based decision support tool” provided by a group from Carnegie Mellon University and the factors it considers.
- The PA Department of Health has developed plans for testing and contact-tracing, so that outbreaks can be contained.
- The statement explicitly states that “if we see an outbreak occur in one of the communities that has been moved to yellow, we will need to … revert to the red category until the new case count falls again.”
Testing plans. There is a web page devoted to the state’s Covid-19 testing plans. Currently, state labs and commercial labs in the state are performing about 6,000 tests per day, on average. The goal is to test about 2% of the state’s population per month, which would require over 8,500 tests per day.
That’s a good start, but far more testing than that will probably be needed as reopening continues, in order to be able to catch local outbreaks in time to reimpose restrictions as needed.
No widespread antibody testing is anticipated, pending review of the related research.
Contact-tracing plans. There is also a web page about contact-tracing plans. When a case is reported, a “community health nurse” is supposed to contact the person and determine their symptoms, risk factors, hospitalization history, and contacts.
The contacts are the hard part. Not only must patients remember who they have been in contact with, they must also be willing to divulge that information, knowing that the people involved will probably have to be quarantined or isolated. The contact tracer must reach out to all the contacts, arrange for them to be tested immediately, and (in the case of a positive test) find out who they have been in contact with. And then the cycle repeats. Contact tracing is time-consuming and requires a large staff.
The Department of Health (DOH) has 150 people it can assign to this job, and it considers that to be sufficient for the first two regions to be reopened. Those two regions are mostly rural. By my calculation, they have a combined population of roughly 1.6 million. Are 150 tracers sufficient for 1.6 million people? I’m not sure they will be. New York’s new reopening rules call for 30 tracers per 100,000 residents, which would mean almost 500 tracers would be needed, not 150. And those two regions represent only about 12% of the state’s population.
As the reopening expands to additional regions, the DOH is looking at getting contact-tracing help from new staff, from partner organizations in the state, from students, and from volunteers. For our Southeast region, with over 40% of the state’s population, contract tracing will presumably require hundreds of new recruits (or thousands, if we use New York’s approach). Recruiting, hiring, and training will all take time.
The contact tracers will use an electronic system to send email or voice messages to patients and their contacts. That will help.
The DOH is also looking into smartphone-based technology that could automatically alert people who fit certain criteria. For example, they might notify anyone who spent at least 10 minutes within 10 feet of someone who was later confirmed to have Covid-19. Cell-tower data would be used to determine relative location, and both people would need to have their cell phones turned on. Advocates of this approach say that it can be implemented without jeopardizing personal privacy. I suspect that approach won’t be instituted soon, if ever.
The Carnegie Mellon analysis. The Governor has called on Carnegie Mellon University (CMU) to provide a “risk-based decision support tool” that will help analyze the balance between the economic damage from remaining in the Red phase versus the threat to health of moving to the Yellow phase. That tool, which is described in a PDF presentation here, is based on five “risk indices” that describe the relative readiness for reopening of the six regions of the state. The indices are:
- The prevalence of Covid-19 in the region (measured as the rate of new cases per 14 days per 100,000 of population),
- The ICU capacity of the region’s hospitals (ICU beds per 100,000 residents age 60 and over),
- The population density in the region,
- The percent of the region’s population that is over 60 years old, and
- The % of workers in the industry segments that have been temporarily closed.
The CMU analysis shows that only the first three of these factors varies significantly among the regions. These factors, along with the capacity for testing and contact tracing, will be used to determine when a given region is ready for reopening.
The CMU analysis finds that our Southeast region is at risk because of two of the three primary risk factors: high population density and high disease prevalence. There are two regions (Northwest and North Central) that rank low on all the risk factors, and they will be the first to reopen.
Our region is far from reopening. Although it was not explicitly mentioned in the May 1 announcement, the Covid-19 prevalence criteria for reopening that the governor has previously specified (a 14-day period during which no more than 50 new cases per 100,000 people have been confirmed) will presumably continue to be applied. Our region’s new-case count would have to drop to one-fifth of its current level to meet that standard, and at the moment it is not dropping at all. And our region’s population density is the state’s highest.
Taken together, those factors suggest that our region will probably be the last part of the state to be reopened.
Reopening guidelines for businesses. On Monday (May 4), the governor announced guidelines for businesses planning to reopen in the Yellow phase. Since our part of Pennsylvania is still in the Red phase, and will be for the foreseeable future, I won’t go into the details of the reopening guidelines. To summarize, though, not all businesses can open; and those that can must take a variety of measure to prevent the spread of Covid-19. These include rules about disinfection procedures, social distancing, staggering of work hours, full-time mask-wearing, barriers between staff and customers, and many more.