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Economic reopening is a delicate balance of satisfying competing interests. It’s not a matter if to reopen but how and when. The economy is in shambles. People and businesses are hurting and protracted shutdown is unfeasible. Our country is determined to reopen.
Federal guidelines, now largely ignored, outline a staged approach for relaxing shutdowns given the attainment of certain criteria, including 14-day decrease in virus activity, hospital upsurge capacity, and adequate testing and contact tracing. Unfortunately, our nation reopened too early with some states having rising coronavirus cases and no states meeting all criteria. States lost their mitigation resolve, bending to political and economic pressures.
Gov. Eric Holcomb boldly issued lockdown orders and now has boldly delivered a staged-reopening plan. He’s in a tough, risky position and must thread the needle rescuing the economy, satisfying conservative Hoosier ideology, respecting personal liberties, and preserving public health. Although Indiana now has decreasing daily COVID-19 hospitalizations, the most important coronavirus activity measure, I fear his thoughtfully designed plan was initiated too early without fully attaining the federal criteria. It also progresses too rapidly.
Indianapolis Mayor Hogsett was prudent in moving more slowly.
Indiana’s plan lacks a critical element: mandatory mask-wearing in public. Reopening after a more dramatic decrease in disease activity would have greatly facilitated case tracing. With 400-500 new cases daily, effective case tracing will be difficult.
Indiana’s testing should be multiple-times greater than the state’s goal. Full reopening by July 4 is much too ambitious and progressive stage advancements push against the 3-4-week lag time for each stage’s downstream effects. I am particularly concerned with the allowance of large social and cultural gatherings and unrestricted religious assembly rules.
As Dr. Anthony Fauci warns, if we move too quickly, we risk exponentially increasing coronavirus cases and deaths and even greater financial losses. With 97.2% of Hoosiers still coronavirus susceptible, many lives can be saved until a vaccine is developed.
Although increased deaths are inevitable with any reopening, the University of Washington predicts a 154% mortality increase for Indiana by early August. Holcomb has been silent on acceptable case and mortality increases. They may well be measured by the limits of ICU and ventilator capacity. A tragic, but stark reality.
The federal response has been chaotic, insufficient and delayed. That prevented controlling the pandemic early through individual containment, necessitating mass mitigation and costing tens of thousands of lives. President Trump continues his shell game of disinformation, creating his own reality. Denial, projection, distraction.
Nothing has more exposed Trump’s lack of leadership and empathy, and his ignorance, self-absorption and narcissism than this little virus. His administration fails in leading a unified national pandemic strategy. Trump has diminished Dr. Fauci’s public visibility and has either removed or disregarded other scientific experts. One advisor, Dr. Debrah Birx, sounds more like a politician than a physician-scientist. The CDC is muzzled and its recommendations marginalized. Politics over science.
It will be difficult to lock down again after reopening; people should proceed guardedly. Those at-risk must not assume reopening applies equally to them. Remember that children, although generally less affected, serve as vectors to adults. Wear masks and social distance. The future depends on individuals maintaining responsible mitigation efforts.
With luck, a temporary natural moderation of coronavirus will occur. Within a month, we will know the effects of reopening. Meanwhile, don’t listen to the man behind the curtain. Listen to Dr. Fauci.•
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Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon. Send comments to ibjedit@ibj.com.
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Thank you Dr. Feldman. Every doctor I hav discussed the with (personal physicians as well as several relatives) agree with you.
Thank you for a very important succinct letter, Dr. Feldman. My husband and I, both physicians, agree with you completely. As do physician friends….. Much as I, personally, would love to get back to a “normal” situation, I am willing to delay gratification and proceed with much thought and discussion on activities we would love to resume. I encourage all readers to pay attention to physician/scientists vs. political advice.