Various social distancing orders across the USA helped slow the spread of the coronavirus, but states are feeling increasing pressure from protesters and at times the White House to relax restrictions. Some are outlining their plans to do so.

President Donald Trump, who announced guidelines Thursday for states to start opening their economies, cited a handful of states taking steps toward a “safe, gradual and phased opening,” including Texas, Vermont and Ohio. He is pushing to relax the U.S. lockdown by May 1, a plan that hinges partly on more coronavirus testing.

Several states announced plans to coordinate their response with neighbors: California is moving forward in coordination with Washington and Oregon; governors from New York, New Jersey, Connecticut, Delaware and Rhode Island announced plans to form a joint task force.

Before beginning the three-phase process, Trump recommends that the states must meet the following criteria:

• A downward trajectory of influenza-like illnesses and COVID-19 syndromic cases reported within a 14-day period.
• A downward trajectory of documented cases or positive tests as a percent of total tests, within a 14-day period.
• Hospitals are treating patients without crisis care and have a robust testing program in place for at-risk healthcare workers, including emerging antibody testing.

Some restrictions have already been lifted. On Friday, Florida Gov. Ron DeSantis gave some municipalities the green light to reopen beaches with restricted hours for walking, biking, hiking, fishing, running, swimming, taking care of pets and surfing. In Jacksonville, people enthusiastically flocked to beaches when they reopened, drawing criticism on social media. On Saturday, DeSantis said schools would remain closed through the end of the academic year.

PHASE ONE

Vulnerable individuals should continue to stay at home and members of their households should be aware that returning to work where distancing isn’t practical risks passing on the coronavirus to the vulnerable person.

The guidelines define vulnerable people as “elderly individuals, individuals with serious underlying health conditions, including high blood pressure, chronic lung disease, diabetes, obesity, asthma, and those whose immune system is compromised such as by chemotherapy for cancer and other conditions requiring such therapy.”

Employers should continue to encourage their employees to work remotely, when possible, and return to work in phases. Additionally, employers should close common areas, minimize non-essential travel, and consider special accommodations for vulnerable employees.

During phase one, schools, daycare centers, and camps should remain closed, and visits to senior living homes and hospitals should be prohibited. Large venues, like dine-in restaurants, movie theaters, sports venues can reopen under strict physical distancing protocols.

Gyms can reopen if they adhere to strict physical distancing and sanitation protocols, but bars should remain closed.

Additionally, elective surgeries can resume on an outpatient basis at facilities that adhere to Centers for Medicare and Medicaid Services (CMS) guidelines.

PHASE TWO

During phase two, vulnerable individuals should continue to stay at home. Individuals should continue to social distance, but social settings of more than 50 should be avoided. Non-essential travel can resume.

Employers should continue to encourage their employees to work remotely, should keep common areas closed, and should continue to consider special accommodations for the vulnerable population.

In phase two, schools, daycare centers, and camps can reopen, and bars can open with reduced standing-room occupancy.

PHASE THREE

Vulnerable individuals no longer have to stay at home but should practice social distancing and minimize their exposure to social settings where distancing may not be practical. Low-risk populations should minimize their time spent in crowded environments.

Employers can allow their workers to return to work in phase three.

Visits to senior care facilities and hospitals can resume, but those who interact with residents and patients must maintain high standards of hygiene. Large venues, like movie theaters and sports venues, can operate under limited physical distancing protocols. Bars can operate with increased standing room occupancy.

Miscellany

Federal health officials warned leaders on the White House’s coronavirus task force this week that reopening the nation will require a massive capacity to test, track and treat people for the ongoing threat of the new coronavirus.

Recommendations under development by the Centers for Disease Control and Prevention, copies of which were obtained by USA TODAY, largely follow a playbook that public health experts have been advocating for weeks. In conversations with a dozen scientists, USA TODAY found that states are falling short of the measures laid out by the CDC, high among them access to testing.

“I don’t see a path to reopening unless the testing issue is fixed,” said Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security. “We have been complaining about testing for at least a month and nothing happened.”  Michigan and Illinois are among states reporting the most confirmed coronavirus cases.

Penn State Launches COVID-19 Convalescent Plasma Study

Convalescent plasma therapy for COVID-19 patients — an experimental approach of giving a transfusion of plasma collected from a donor who has recovered from COVID-19 to a patient with an active infection — is the focus of a new two-part research initiative at Penn Medicine. Researchers will first collect plasma from people who have recovered from their infection under a donor research protocol. The second part involves conducting clinical trials to test the safety and efficacy of giving that plasma to moderately and severely ill hospitalized patients.

“People who have recovered from COVID-19 rapidly develop antibody responses. Early reports suggest that these plasma antibodies can boost the immune response in severely-ill patients,” said Katharine Bar, MD, an assistant professor of Infectious Diseases in Penn’s Perelman School of Medicine. “By developing and implementing these research protocols in tandem, we will be able to use scientific and evidence-based methods to learn if, and how, convalescent plasma therapy helps patients. We’re working to start our clinical trial as soon as we possibly can, because we urgently need to determine if this approach works and if it is safe.”

Drinking Alcohol May Heighten Risk of Getting Coronavirus (WHO)

Alcohol sales have risen drastically nationwide during the nation’s stay-at-home experience, but booze may put individuals at increased risk for the coronavirus, the World Health Organization warns. Alcohol can weaken the body’s immune system and put drinkers at risk for other behaviors that could increase the likelihood of contracting the coronavirus. Upside: Alcohol does work as a disinfectant on surfaces.  “Alcohol compromises the body’s immune system and increases the risk of adverse health outcomes,” the WHO’s regional office for Europe reported.

Additional $300 Billion Relief Very Close

The White House and Congress were “very close” to a deal on Sunday for a $300 billion relief package for small businesses, Treasury Secretary Steven Mnuchin said. The money would replenish a loan program for small businesses, which already depleted an initial $350 billion in less than two weeks.

Too Soon?

Too much, too soon. Most Americans are worried about lifting stay-at-home orders too quickly, a WSJ/NBC News poll showed. Almost six in 10 people were concerned about moving too fast to loosen restrictions. About 3 in 10 said waiting too long was the greater worry. Additionally, 49% said they’d support Joe Biden head-to-head with Trump.

Expert Opinions Reported in N Y Times

• The lockdowns will end haltingly. Putting safety first could mean reopening only after coronavirus cases declined for 14 days, 90 percent of contacts of infected people could be traced, infections of health care workers were eradicated, recuperation sites existed for mild cases — and many other hard-to-reach goals.
• It is not clear whether recovery from the virus and antibodies confer immunity. If they do, or are believed to, America could be split into two classes: those protected (or thought to be) and those still vulnerable.
• The virus can be kept in check, but only with expanded resources like widespread testing. And treatments are likely to arrive before a vaccine.