‘Social distancing is not going away’

The above map of Wyoming provided by the Wyoming News Exchange shows the number of confirmed COVID-19 cases by county. As of Thursday afternoon, there were 296 confirmed cases in Wyoming, and just four in Uinta County.

What parameters need to be met to ‘re-open’ the United States?

EVANSTON — The Wyoming Department of Health announced the state’s second confirmed coronavirus fatality on Wednesday, April 15. The second fatality, like the first, was in an older male, though the most recent death was a hospitalized Laramie County patient while the first occurred in Johnson County.

As of Thursday, April 16, there were 296 confirmed cases in Wyoming, with another 105 cases listed as probable. There were still four confirmed cases in Uinta County, though Uinta County Public Health Nurse Manager Kim Proffit said all four of those cases have recovered.

Though the number of confirmed cases in Wyoming has appeared to slow in recent days, health experts and Wyoming Governor Mark Gordon warn it’s too soon to start letting up on social distancing protocols and Gordon’s ordered business closures and restrictions.

“It is critical that we continue to stay the course and adhere to the public health orders that are currently in place,” said Gordon during a press conference on Wednesday. “It still remains too early to see if we are near the peak of these illnesses yet. We must follow all recommendations in place to reduce the likelihood of large clusters of new cases.”

The nation’s top infectious disease expert, Dr. Anthony Fauci, praised Gordon’s response to the pandemic during a press conference last Friday, when Fauci said states like Wyoming and governors like Gordon don’t get the recognition of other high-profile states and individuals despite their success in slowing the rates of infection.

Gordon has, however, begun working with other state officials on what it will look like when orders do begin to be lifted and life may begin to return to some semblance of normal, although experts caution “normal” is not likely to return for months, if not years.

“We are going to emerge into a new reality, a new economy,” said Gordon. “Social distancing is not going to go away. We need to start thinking about what our schools will look like next year. … We are all talking about what our new reality is going to look like.”

The federal government and governors in all 50 states have begun to have those same discussions, especially in light of growing discontent with stay-at-home orders, as evidenced by protests around the country, and the economic turmoil that continues due to the COVID-19 pandemic. Another 5.5 million Americans filed for unemployment last week, the U.S. Department of Labor announced on Thursday, bringing the total to more than 22 million in the past four weeks, with the unemployment rate now reaching levels not seen since the Great Depression.

Small businesses continue to struggle, and the Small Business Administration announced on Thursday that the $349 billion dollars the federal government allocated for the Paycheck Protection Program has all been spent “until such time Congress appropriates additional funding.” Proposals to increase the level of funding have been discussed by Congress in recent days; however, Democratic lawmakers have reportedly held up those increases with insistence that any new relief package also include emergency dollars for local and state governments, which are also reeling from lost revenues.

As a sign of the impact on Wyoming’s revenues, on Wednesday Gordon instructed all state agencies to prepare for budget impacts by identifying “opportunities to immediately reduce spending” through the current budget year and the next two-year budget. Gordon issued immediate position freezes, halted general fund contracts greater than $100,000 and ordered “rigorous review” of major maintenance spending.

A dire economic report from the state’s Legislative Service Office (LSO) released last week looked at the impact of COVID-19 on Wyoming’s finances which, in addition to a global oil price war, has significantly altered the state’s budget outlook since the most recent Consensus Revenue Estimating Group (CREG) Report. The LSO report utilized three revenue scenarios — optimistic, intermediate and pessimistic — based on factors like the length of the downturn and the time of recovery, as well as possible second waves of infection and a longer-term impact on oil supplies. Those three scenarios estimated anywhere from a $555 million to a $2.8 billion total decline in state revenues for fiscal years 2020, 2021 and 2022.

President Donald Trump has put together a task force to develop plans to re-open the economy and lift stay-at-home orders, and all three Wyoming members of Congress — Sens. John Barrasso and Mike Enzi and Rep. Liz Cheney — have been appointed to the group. However, public health experts say the country is several weeks from having appropriate systems in place to meet what they say are necessary benchmarks for any kind of easing of restrictions.

The primary factor behind the closures is to reduce the impact on healthcare systems to prevent them from being overwhelmed and unable to care for the numbers of patients, both those sick with COVID-19 and those needing non-COVID-related care. In order to do that, several things need to be in place, according to a late March report by the American Enterprise Institute, whose findings are echoed by health experts across the country.

Before there can even be consideration of lifting restrictions, experts say there needs to be a sustained decrease in confirmed cases for at least 14 days and healthcare facilities in a given area must be able to safely treat and care for all patients without resorting to crisis standards of care, including having access to adequate supplies of personal protective equipment (PPE) for healthcare workers. If those criteria are met, other measures need to be in place to prevent another case surge, which would result in new closure orders and increased fatalities, thereby negating all the gains made by the current closures.

First, widespread testing capabilities are necessary, both to determine who is currently infected and those who have antibodies to the virus because they’ve already been infected and recovered. Some experts have said this would require the ability to test up to 750,000 Americans each week; currently, less than 100,000 tests are being conducted weekly.

Systems would also need to be in place to allow extensive and timely contact tracing of those who have tested positive, to place people into quarantine to prevent community spread of illness. The country currently does not have the resources or manpower to implement such rigorous contact tracing, which requires intensive interviewing and the ability to track down each and every person who may be infected.

These requirements are not likely to be met in every state or city at the same time, as surges and peaks will likely hit at different times throughout the country. In addition, even after some restrictions are limited, other measures are likely to remain in place for months, including bans on large gatherings, limits on the numbers of patrons that can be in a business at any one time and recommendations to avoid shaking hands, maintain distance from others and possibly continue to wear face masks in public.

States will need to have systems in place for careful monitoring and rapid response and be ready to return to more restrictive measures if case counts begin to increase, especially if cases cannot be traced to a specific and traceable exposure.

During the weeks and months of continued limitations, scientists hope to be able to develop proven treatments for the disease, as well as a vaccine. Until a vaccine is available, it is likely that outbreaks of the novel coronavirus will continue to occur, possibly necessitating repeated episodes of social restrictions and lockdowns.

Experts caution that to even begin taking these steps, the country will need to invest the necessary resources to immediately ramp up the production of both testing materials and PPE to have adequate supplies of both. They further recommend increased production levels continue to replenish the depleted National Strategic Stockpile and prepare for any future outbreaks of COVID-19 and any new viruses that may emerge in the future, a likelihood that increases with both population growth and increased global travel.

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