Policymakers around the world are in a triangular tug of war between fighting COVID-19, economic rehabilitation, and ensuring societal normalcy, wellbeing, and health. There are no easy answers or cookbook recipes and each question among the how, why, and when to open the economy is more daunting to answer than the other one. However, it is becoming increasingly evident that we cannot make decisions based on social, cultural, religious, or economic preferences alone. Also, decision making cannot be an absolute top-down approach, but a regionally driven strategy with citizen engagement.A few suggestions for our leaders and the public:
- Analyzing regional data on COVID-19 such as number of cases and deaths, racial/ethnic distribution of the disease, age and gender groups most affected, and social and medical history of those who are affected will help define the unique nature and extent of disease spread among communities and to strategize for customized prevention priorities. We need more testing based on population density so that the maximum number of infected people can be quarantined to break the chain of spread (the 3 T model= trace, test, treat).
- The key data points to consider in making a decision on opening the economy should be: number of COVID-19 cases, deaths, and recoveries mapped by the smallest geographic unit; the total population of the region with sociodemographic distribution; the number of primary care and emergency services; the number of hospitals and healthcare facilities, COVID-19 testing capacity, and healthcare-related assets available (i.e. materials, devices, and human resources).
- The rates of increase or decrease in COVID-19 cases play a major role in estimating regional transmission patterns. If a geographic region does not witness a case for more than a week, that's positive news. Once the 2-week mark is crossed without a positive case, plans to allow many essential human activities should be formulated and implemented. Additionally, regions should be classified as high risk, moderate risk, and low risk. Those regions that should qualify as high risk should exhibit high numbers and rates of cases or deaths that remain the same or increase over time (call them “hotspots”).
- We should categorize and redefine services as: highly essential, needed, and wanted. Based on relative importance, we should use a staggered time-phased opening approach. These classifications should keep in view, for each service, the amount of human to human contact, needs and capacities, the potential for large gatherings, demand versus supply of the service, the cost versus benefit of these services, and preparedness at service facilities as it relates to practicing aggressive hygiene and sanitation measures and social distancing for the clientele served. There should be ways to enforce the use of temperature screening devices, masks, sanitizers, and social distancing for all clients.
- Increasing the base of health prepared and health trained people in the communities would be another asset. Rapid and swift measures to educate and train lay health workers, non-physician professionals, and accelerating volunteer health services could be a priority. Academic-community partnerships and the use of professional organizations to provide data and scientific services should be done as soon as possible. All of this can be done remotely by data transfer and coordination between regional healthcare facilities, health departments, and stateor federal agencies. Existing data are assets that must be utilized.
- The last strategy is to remain prepared for shutting services again based on real-time regional evidence on COVID-19. We must also estimate, how long after we open the economy will business and industries flourish and how much time it will take to bring normalcy to life (that would create another lag in reaching our full potential). Despite phased openings, we will still see fewer workers, fewer service demands, and lesser clientele.
- It is time to utilize these strategies and aggressively prepare for the next phase- opening the economy and looking into the future. We have saved millions of lives by avoiding the disease and cannot lose our gains. However, we also have to be mindful not to lose lives due to other diseases, poverty, and psychological upheaval. Based on regional data and the unique nature of COVID-19 in a community, decisions should be left to counties and local governments on opening the economy. Such decisions should also engage regional healthcare providers, scientists, business owners, and representatives of the general public. We need to reappraise the values of our democracy- of the people, for the people, and by the people. Finally, it is high time, we think global and act local.