I've been asked to help with our community's reopening

The Quarantine Zone
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I’ve been asked by our mayor to join his economic council on reopening our community. We are a top 20 metropolitan area in the US. Our company is a large employer in the community, and we operate in essential industries around the globe, and as such have continued to keep our operations running, albeit in new ways including social distancing, health screening, etc.

Many of our employees have expressed a variety of emotions and concerns over the past two months, which we’ve have listened to and responded to. Early on, we hired an emergency care physician, who is also a professor at one of the local medical schools, as our health advisor. She has been invaluable to us as we have navigated our company through these new waters.

What advise would you give to a mayor’s committee/council on re-opening the community? What should we not do? What should we make sure and do?

Thanks

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I think it’s important to be very deliberate about the language and terms you use. Using the word “reopening” is a potential minefield - it’s nonspecific, so people will immediately attach their own meaning to it before they look at the details. Whatever plan you come up with, it’s not going to be a true reopening. Maybe “less-stringent rules” is better, maybe just “new rules.” Make sure you are saying things like “safely” and “carefully” to recognize the valid fears people will have.

As for specific advice, if your area depends on mass transit, that needs to be a major focus. It’s important that workplaces address whatever distancing requirements are necessary, but if people can’t get to work safely, it doesn’t matter what individual companies do.

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You should demand that there is accountability from employers, and that there is oversight of working conditions. People need to get back working, of course, and they need to be PROVIDED a safe environment by the employer, who is making a buck thanks to the returning employees.

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I’m not presenting this as the correct solution but here is a pretty comprehensive reference the State of Texas used to justify partial reopening.
https://gov.texas.gov/uploads/files/organization/opentexas/OpenTexas-Report.pdf

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Copy what the successful (low infection rate) businesses that never closed do wherever practical. They have the customer interaction and employee safety stuff figured out. Partially opening a business may not allow enough income to make it financially prudent to open up. Almost has to be mostly open or not at all. Put the basketball hoops and soccer nets back up in the parks and let people smooch their spouse on the park bench. Restrict gatherings if needed by removing the picnic tables or spreading them out far apart. Block every other parking spot to reduce parking lot gathering.

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Hopefully you have time to look at a video by economist Richard Wolff on the need for worker protection:

“Prof. Wolff comments on the current rush of the government and employers to get Americans to return to work. Despite the failures of the system to prepare and plan adequately for the pandemic, workers are being asked to make the ultimate sacrifice (their health and safety) in the name of patriotism.”

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I guess, from the Australian experience, take baby steps - one concession / change at a time, then wait two weeks to see if its tolerable or creates a spike in numbers. If okay, then rinse and repeat.

Also, important, organise things to be immediately reversible if things go wrong or people abuse the privileges. Major Sydney beaches were shut, then cautiously re-opened for active swimming and running only. People flocked to sunbake, so they were shut down mid afternoon, there was a period of public shaming and lesson-sinking-in, and now they are being re-opened with more people conscious of what is expected, but also lessons learned on how to better encourage good behaviour.

Don’t be shy about being a dick and enforcing the prohibitions that remain. People take their prompts from those around them - if they see someone jumping the fence, then why shouldn’t they.

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I like the idea of having a hammer ready to swing as a threat to any business that reopens but doesnt take good precautions and let them know the city is ready and able to jump in and shut them down if they see a spike in infections there or they see violations on safety.

Heck even threaten heavy fines and jail time for managers.

The Smithfield meat plant in Sioux Falls SD did just about everything WRONG like pushing if not forcing sick employees to come in and work and not giving out PPE. The mayor and governor shut them down.

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  1. This is a volatile issue, and you have extremists on both sides of the fence. One side claims that the conservatives want to sacrifice human lives on the altars of the wealthy, while the other side claims the liberals want to free ride our nation into bankruptcy because they are gutless, lazy, or both. The key is to look past that nonsense and proceed with the knowledge that the large majority of people want to return to a normal society, but they want to do so safely. Your game plan should be centered on that.

  2. Because this is such a hot issue that affects virtually everyone, you are NOT going to please all of the people. Don’t even consider that for a second. Far from reaching a perfect solution, you may very well have to formulate a plan made out of the lesser of two evils.

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This is key. You should make it clear to businesses that want to reopen that providing sick leave and protective equipment is a major part of their side of the deal. They want to make money, fine, we understand that, but we want to limit spread of the disease, and they need to understand that.

If they’re not willing to uphold their end of the deal, shut them down, and explain to them exactly why it’s their fault they’re going broke.

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Even better. Walk in with the cops and put the managers in handcuffs. Have them spend overnight in county lockup and include full strip search and body cavity search. Have a tow truck haul off their cars to the impound lot so they have to pay a fee to get them out. Let them spend the night in a stinky, cold cell on a metal bed wearing orange. Warn them the next violation means a week.

That should change their attitude.

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I have been trying to develop an at-home test for determining risk status, with the aim of allowing people to make a determination of whether they should go out, when the doors are opened. And/or to give guidance to people to go get a better set of testing done by a real doctor to figure out how at-risk they are.

Personally, that would be my recommendation. Divide people into groups by risk factor and let them out in waves. Having a process like that will make people more willing to wait to go free, because people like order and process, so you can draw it out more. And, obviously, it allows you to protect the at-risk groups for longer, while holding out hope that a good treatment will become available.

For the most high-risk groups - well, probably many of them won’t be employed to begin with - but for any who are employed you would probably want to see to it that they can work from home or have financial aid if not. Employable or not, anyone at high-risk should stay isolated from society (and others at high-risk) until a treatment becomes available or so long as the percentage of people with anti-bodies continues to rise (once herd immunity is established, the level will plateau). So, there, the important thing is seeing to it that the people can get medicines, food, and other basic needs supplied. That means, also, that you will need delivery people and health workers who can be kept isolated from society, to aid those at risk while they are isolated.

And so, similarly, you will need to see to it that these delivery people and health workers are being supported and regularly tested. If they have children, you would want to help pay for daycare and anything else - though it would be better to select people who are childless.

You might also want to think about entertainment options. There are some online boardgame applications that you might suggest to people.

For the at-home test, the goal is simplicity and ease-of-completion rather than medical exactitude.

Basically, the risk factors seem to be (as I understand it):

  • Age
  • COPD
  • Diabetes
  • Auto-immune disorders

Obviously, a hard diagnosis of having one of these things would be sufficient to let you give a simple yes/no on whether you have it (among the latter three). But I also wanted to include a risk test, so people could know that - diagnosed or not - they might want to be careful or get better testing. (And, realistically, diagnoses are a hard boolean result where, it’s more likely, that actual illnesses are on a spectrum.)

I determined that there’s a 95% correlation between the amount of time that a person can hold their breath and whether they have COPD.

I’ve been trying to determine a halfway decent test for diabetes based on age and activity level, but combining those two seems to be about the limit of what I can do on that one.

And I’m still trying to find a decent test for autoimmune. Plus, I have been trying to determine the risk factor for immunodeficiency as well, but that’s less common.

Between those four, though, you should be able to identify the vast majority of people who are at-risk. It will miss some, and that is unfortunate, but it’s also unhealthy to keep people in an unemployed, prison-like state. On the balance, letting people go be free who are probably not at risk is, probably, better than trying to keep everyone in quarantine for too long of a period.

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Thanks everybody. These are all good thoughts. Keep 'em coming.

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Actually, you probably could and should add a fifth risk factor of asking people, just in general, “Or do you have any other health complications? How healthy do you feel, on a scale from 1-10?”

It’ll net you a bunch of hypochondriacs but it should also get a lot of people who don’t fit into one of the big buckets who are liable to be at risk. (And the hypochondriacs will simply be happy to be able to mark themselves up as being at deaths door, and not having to go to work.)

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Two things: testing and treatment.

How many people have been tested? How many are you capable of testing now and in the future? How reliable are the tests you’re using? Can everyone who wants a test get one quickly and are those tests accurate?

What is your current hospital capacity? What are the healthcare workers in your city telling you? Are they burnt out? Are they running out of ICU beds and beds in general? Are hospitals having to bring in more healthcare workers from outside to replace those who’ve gotten sick?

I wouldn’t even think of reopening until your city’s gotten good answers to these questions.

Once you’ve gotten answers to these questions, you have to have ways to credibly enforce public health behaviors: people have to wear masks and there must be ways to enforce them.

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I’d add that it’s probably more productive to work with businesses (grocery stores, restaurants, etc) as partners, rather than people who need to be governed and told what to do. It’s better to get buy in from them if possible.

Maybe you can talk to someone here has expertise in municipal government, municipal planning, community organizing, etc. I think they’d probably have some specific ideas on how to communicate with businesses so that they receive the message well and are willing to be part of the team.

As others have said, people need to wear masks and you need businesses to buy in to enforcing that behavior. If there’s a way to work with large high-volume businesses like supermarkets and wholesale stores (Home Depot, etc) to install thermometer cams, then maybe there’s a way they could segregate sick customers into curbside or outside service while allowing healthy people to enter stores with some restrictions, that might work.

When reopening, the biggest danger is probably going to be to the workers themselves, the blue collar people who need a paycheck. Keep them in mind.

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A comment I had made in another thread is that the people who are going to be in the greatest financial danger are often going to be in industries which need white collar workers to be going out and doing all the normal things. However, the white collar workers are the ones who can most easily work from home and who are going to be the most resistant to going out, even when the green light turns on again. That’s probably something that you will just have to live with. Certain parts of the economy simply won’t restart, no matter how much you tell people to go out.

Setting up programs like contact tracing, testing, protection of at-risk people, delivery of supplies, etc. are all good things to keep people employed who would, otherwise, be working at hotels and other places which will remain out of commission for some months.

I would suggest creating educational programs for how to perform all of these different services, as well as things like basic nursing and etc., and making it clear that the city will be hiring the people who complete these programs for the remainder of the year.

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Picking up on something said above, if you were on a construction site and there was a change of safety procedure, then everyone would have to attend a tool-box talk or induction and, often, sign a document to say that they had listened and understood. It drives home that you are personally responsible for doing what is required.

From that, perhaps a basic standardised 5 minute induction on hygiene basics and procedures that employers are required to give all employees when the business fires up again. You have been told, the lines have been clearly drawn and there are no excuses.

Officious but giving people agency to know what the rules are and to act within them.

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The city might also want to talk to local farms and food factories and see if there’s any aid that can be sent that way, in terms of extra manpower, as the current ones work around gaps due to illness.

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BTW: https://www.nber.org/papers/w27102