A Kentucky School Nurse Faces The Pandemic As Her ‘Hotspot’ District Reopens  Thursday, Aug 27 2020 


Tina Ryan knows the hallways of East Calloway Elementary better than most. Besides working as a school nurse here for 20 years, Ryan, who is 55, was also a student here herself. 

“I’m probably one of the older ones here as far as staff and things. Or maybe the oldest one here,” she said with a laugh. “I was happy to know I was coming to East Elementary when I got the job. Because I was an alumni here.”

A pencil-shaped sign that reads “Nurse’s Office” hangs in the hallway next to her door, with all the classic supplies of a veteran nurse inside: tongue depressors, a blood pressure cuff, itch cream “bug bites all the time” and loads of bandages and band-aids. 


Questions And Anxiety Mount Over COVID-19 Workplace Safety As More Businesses Reopen Friday, May 29 2020 

Gail Fleck is a school cafeteria worker in the greater Cincinnati area and lives with her 90-year-old father. She loves her job because she gets to work with kids. But she is worried she won’t be able to keep her dad safe if her work exposes her to the coronavirus and she unknowingly brings it home. 

“I’m scared, I’m worried. I feel like, we’re talking about life and death here and this is my father,” she said. 

Fleck, who didn’t want to name her workplace, said she hasn’t been back to work since before the schools went on spring break. When she ran out of sick days, she stopped receiving a paycheck. 

“I’ve just worked very hard at keeping myself and my father at home and not going out,” she said. 

Workers like Fleck across the Ohio Valley face difficult choices now that states are gradually reopening workplaces. Many don’t feel safe going back to work, and adding to the anxiety is the uncertainty about the enforcement of safety standards for businesses that are reopening. During pointed questioning at a Congressional hearing Thursday a top official with the Occupational Safety and Health Administration was not able to say how many workplaces are seeing cases of COVID-19.  

Who Keeps Workers Safe?

OSHA is the main federal agency responsible for enforcing workplace safety standards. Ohio and West Virginia are among roughly half the states where OSHA has direct oversight of most work safety regulations. Kentucky is among the states with a federally approved work safety program administered by the state. The Kentucky Labor Cabinet said it is working with businesses to ensure they are complying with Kentucky’s minimum requirements.

“Notes of Deficiency, and if necessary, orders to cease operations will be issued to businesses that demonstrate they are not making substantive efforts to comply with the reopening requirements,” Kentucky Labor Cabinet Chief of Staff Marjorie Arnold said in an email.

Some work safety advocates have criticized the federal OSHA’s lack of involvement in workplaces during the coronavirus pandemic.

Safety and Health Program Director at the left-leaning nonprofit National Employment Law Project, Deborah Berkowitz, said OSHA should be taking more action to help keep workers safe. 

“The sad reality is that OSHA is failing here,” Berkowitz said. “They’ve actually just walked away from this whole pandemic and decided that though they could, they’re not going to do any enforcement. They’re not going to issue any mandates that are requirements, and instead, they’ll issue a poster or publication.”

Berkowitz was previously chief of staff and senior policy adviser for OSHA under the Obama administration. She advises if employers are not following the Centers for Disease Control guidance, the employee should file a complaint with OSHA. 

“Even though they’re not going to go out and do an inspection, I think they will call the employer and say a complaint has been filed,” Berkowitz said.  

She also said local health departments should be notified, in order for community spread to be prevented. Ultimately, Berkowitz said localities need to be smart about reopening and not sacrifice the safety of workers for the health of the economy. 

“But if you cut corners, and say that employers can do whatever they want at work, then most likely, you will see what’s happening in meatpacking plants and poultry plants right now around the country, and that is the spread of this disease will whip like wildfires around the workplace and back into the community,” she said. 

Heated Hearing

In an Education and Labor Committee House hearing Thursday witnesses with OSHA and the National Institute for Occupational Safety and Health were questioned about their role in keeping workers safe in the era of COVID-19. 

Principal Deputy Secretary of OSHA Loren Sweatt defended her agency’s decision against a new regulatory standard on coronavirus safety.

In questions from Democrats on the panel Sweatt was not able to say how many workplaces have reported cases of coronavirus. She also told the committee that a lawsuit against the agency, filed by the AFL-CIO, prevented her from answering some questions about OSHA’s actions. 

Sweatt said there have been at least 1,374 whistleblower COVID-19 complaints as of May 26. However, none of those businesses have been sanctioned for retaliation against employees. She said there’s no statute of limitations on investigations of those complaints. 

“While investigations are ongoing I can tell you in certain circumstances, we have seen resolution almost immediately when the whistleblower calls to initiate the investigation,” Sweatt said. 

Sweatt clarified that a resolution means a worker getting their job back as well as back pay after allegedly being punished by their employer for making a complaint to OSHA. 

NIOSH Director John Howard said his organization has just started tracking coronavirus cases in the workplace, about two months after the virus was declared a pandemic. 

“We have been getting better at tracking occupation and industry for COVID-19 cases,” he said. “We have a new case report form that we are hoping that the states will start using.”

Howard said NIOSH is now beginning to track coronavirus cases in meatpacking plants. Kentucky, Ohio and West Virginia have all seen large outbreaks in meat processing facilities as workers try to keep up with soaring demand from consumers. 

Back To Work

Ohio Valley workers are left to navigate a lot of uncertainty as many of them return to work amid health and safety concerns. And some state actions appear to limit an employees’ options. For example, in Ohio, the state’s Department of Job and Family Services now has a form online where employers can report employees who quit or refuse to work due to concerns about COVID-19. Officials in Ohio say the form has always been available online but has only changed focus so employers can report workers who use the fear of contracting the virus as a reason for not wanting to return to work. 

Kentucky, Ohio, and West Virginia have been working to reopen their economies a few sectors at a time. The first sector to reopen was healthcare. Now restaurants are opening to in-person dining, as well as recreational activities, fitness centers, and cosmetology services. Many of the facilities aren’t the same as they were pre-pandemic, with limited occupancy and increased personal protective equipment for customers and workers. 

Tom Tsai is an assistant professor in Health Policy and Management at the Harvard Chan School of Public Health and the Harvard Global Health Institute. 

“The overall message, though is more important than the thresholds for reopening, is that this is not an on-off switch, but really a dial,” he said. “The states need to really consider having very clear metrics on what success or failure looks like.”

Tsai said there is already some “social distancing fatigue” people are feeling and that’s why it’s important to get the policy correct now.

“Because in some ways, once the floodgates open, in terms of trying to return to normal, it’s going to be very hard to reinstitute social distancing measures,” he said.

Kentucky’s Reopening Brings Health Fears, Hope For Economy Wednesday, May 20 2020 

Last month, protesters stood outside the window of the room where Gov. Andy Beshear gives his daily press briefing. As Beshear calmly read out the number of Kentuckians newly infected with coronavirus, and those who had succumbed to the disease, the protesters chanted about getting back to work. 

Eventually, unable to ignore their loud chants to reopen the economy, Beshear weighed in. 

“Folks,” he said, “that would kill people. It would absolutely kill people. We know we’re not at that point.”

Two days later, Beshear announced the benchmarks the state would have to meet before allowing businesses, restaurants and stores to reopen — including 14 days of declining cases.

The state still has not met that benchmark, but the phased reopening is well underway.

Beshear has since changed the way he talks about those benchmarks, including saying the number of available hospital beds is a good metric or that he’d be satisfied with a 14-day decline in the percent of positive tests

After seven days of steady decline, that number increased on Saturday. 

Beshear has attributed recent spikes in case numbers to outbreaks at a state and a federal prison and nursing homes, and to increased testing. But some areas of the state are still in the midst of an outbreak in the wider community, including Warren County, home to the state’s third-largest city. 

Manufacturing, car dealerships, offices and pet groomers are open, with some restrictions. Today, retail and funeral services will resume at 33% capacity. By Friday, restaurants will reopen under the same restrictions.

Social gatherings of 10 people or fewer are also allowed as of Friday, a date Beshear said he moved up by a few days because he knows people want to socialize over Memorial Day weekend. 

“I trust that we can do this right, that we can do this safely,” he said. “And I’d much rather get out there with some good guidance and rules, if a number of people are going to do this anyways.”

For many workers, reopening is a cause for concern. 

“I feel like we’re caving,” said Sarah Williams, who lives in Lexington and works at a local gym. “It’s just not making sense in my head.”

Williams, 43, tunes in almost daily to hear Beshear’s updates about the COVID-19 pandemic, and for the most part, she has liked what she’s heard. He’s been pretty open, consistent and seemed to really care about people, she said. She even changed her Facebook banner image to show her support for Beshear’s “Team Kentucky.”

But now, as she listens to Beshear talk about reopening the state’s businesses, she’s worried. 

Two of her three children are immunocompromised, putting them at higher risk of infection, and she dreads the thought of reporting to work in a few weeks to a crowded, sweaty building as the number of coronavirus infections continues to rise. 

To her, the state’s reopening feels like an about-face.

“I can’t get my head around it,” Williams said.

Beshear’s office declined to make him or Department for Public Health Commissioner Dr. Steven Stack available for an interview. 

The Kentucky Center for Investigative Reporting spoke to business leaders and elected officials who helped shape Beshear’s reopening policies, and economic and public health experts about how they’re likely to play out. And we interviewed workers and business owners from across the state that are most affected by these plans. 

Regardless of what ultimately influenced Beshear to begin a phased reopening, the decision took place amid a confluence of economic worry, social distancing exhaustion and political pressure.

Business advocates and local government officials who support the reopening say it’s time to stop the economic free fall and put people back to work. 

But public health officials, and some workers worry the decision may have come too soon — and the worry may be warranted. The virus is still spreading and a vaccine is nowhere in sight. Health officials warn that cases will spike again if reopenings come too quick.

“The restrictions to keep Kentucky on the low side of people with the disease are now going to be going away,” said Christopher Johnson, a public health researcher at the University of Louisville. “Most experts would agree that a second surge is probable, inevitable, more than likely to occur.”

Shutdown Saved Lives, Hurt Economy

Kentucky issued its “healthy at home” order on March 25, and most non-essential businesses have been closed to in-person traffic since then. Restaurants closed even earlier, on March 16.

The data shows that these measures saved lives. 

A study from the right-leaning University of Kentucky’s Institute for the Study of Free Enterprise found that, without instituting these measures, the U.S. would have had 35 times as many cases of coronavirus by April 27. Government-issued stay-at-home orders alone decreased the spread 10 times over. 

In Louisville specifically, researchers with the University of Louisville and the city public health department looked at the impact of social distancing rules on mobility and case numbers. The study found that the rules the city put into place in early March prevented a surge in cases that could have overwhelmed the healthcare system. 

The study also cautioned that reopening too soon, and without a robust testing and contact tracing infrastructure already in place, will inevitably lead to a second spike in cases. 

Louisville public health director Dr. Sarah Moyer was one of the authors of the study, and Mayor Greg Fischer reviewed the findings. His office did not respond to a request for comment about how this study influenced the city’s reopening plans. 

But for as much good as these measures did, they also hurt.

With the stroke of a governor’s pen, Moonlite Bar-B-Q Inn was forced to close its dining room on March 16, along with the rest of the restaurants in the state. That announcement came as a shock to owner Patrick Bosley, and right out of the gate, the restaurant took a huge financial hit. 

Moonlite Bar-B-Q Inn has been an Owensboro tradition for 57 years, and Bosley likes to think they’ll be there for another 57, too. They’ve stayed open through floods and ice storms and worse, and the sudden shutdown hit them hard.

“We purchase food for several days or a week,” he said. “You had a lot of restaurants that had tens of thousands of dollars worth of food in their facility, and there’s nothing you could do with it.”

For the next three weeks, the restaurant was hemorrhaging money, Bosley said. He furloughed 70 employees, and has only recently started breaking even on his carryout business. 

This was the story at restaurants, stores, gyms, salons and businesses all over the state, all of which were shut down suddenly in an effort to stem the spread of the virus. 

This pain is almost certainly influencing the rush to reopen as public officials balance public health with the health of the economy. 

Between mid-March and May 14, 743,000 Kentucky workers filed unemployment insurance claims — 33.6% of the workforce. No other state saw a larger share of the workforce claim unemployment.

The Unemployment Insurance Trust Fund started the year with a balance of $618 million and was down to $426 million by April 16, according to the most recent Treasury reports. It’s already one of the worst funded in the country, and still struggling to make up ground lost after the previous recession.

With so many Kentuckians out of work, sales and income tax revenue took a significant hit.  Together, the taxes make up about two-thirds of Kentucky’s revenue. 

Kentucky’s budget office last month began warning state agencies of an impending “severe economic downturn resulting in a revenue shortfall.” 

In an April 29 letter, the budget office asked cabinet and agency leaders to plan for a restriction on hiring and an immediate stop on non-coronavirus discretionary spending. They were told to make expense cuts that, if extended for an entire fiscal year, would amount to 12.5% of the budget. 

The governor has said at his daily briefings that concerns about the state budget were not pushing him to reopen. “We just believe that we are at the point in time where we have got to reopen, but in a slow and gradual way,” Beshear said on May 5. 

But it’s clear that stopping the economic free fall has been on the mind of local government officials, many of whom say they have shared those thoughts with the governor’s office. 

The Kentucky League of Cities surveyed Kentucky cities about the pandemic’s impact on their budgets and found that cities in its membership estimate a total shortfall of up to $85 million for fiscal year 2020. Michele Hill, a governmental affairs communications specialist at the Kentucky League of Cities said the organization has been in contact with the governor about the financial crisis facing Kentucky’s cities: the cities of Ashland, Berea, Bowling Green and Georgetown have each reported budget shortfalls of more than $2 million this fiscal year. 

The impact has been felt by individuals, too. Somerset Mayor Alan Keck said though Pulaski County has had only two deaths and 50 cases, he’s constantly fielding calls from residents with another set of concerns — losing their business, missing a bill payment, still waiting on unemployment checks. 

“I have a sworn duty, just like any other executive, to protect the folks who live and work in my community,” he said. “Part of that protection is advocating for their economic well-being, not just their health and safety.” 

That’s why Keck has informally rallied a group of mayors to push the state forward on reopening.

“I refuse to make this about lives versus livelihoods,” he said. “There’s a path forward for us to do both. And, you know, I hope we’re finally seeing someone’s end of the tunnel there.”

Reopening ‘Has To Be A Positive Thing’

Keck said he met with business owners to develop proposals to send to the governor about how to safely allow child care facilities to open May 11 and restaurants to open May 20 at 50% occupancy. 

Keck never heard back, but felt that the governor’s restaurant reopening plan reflected some of his advocacy. He’s disappointed that child care remains closed, and said that creates a serious problem for many of the people being sent back to work in his community. 

A prominent restaurant industry lobbyist said her group also submitted reopening plans, but didn’t get everything they wanted.

Stacy Roof, the president and chief executive officer of the Kentucky Restaurant Association, said her reopening proposal closely mirrored the plan released by the governor’s office — encouraging restaurants to use technology to help limit face-to-face interactions when possible, keeping patrons from waiting for tables inside and requiring staff to wear face masks.  

But it had one crucial difference: Roof asked for a 50% capacity limit. She said she doesn’t know where the governor got the idea to limit capacity at 33%, and that limitation is a heavy fiscal burden. It could lead some businesses to close, Roof said.

“Opening up at a limited capacity won’t really get them anywhere,” she said. “Until they’re at full capacity, they won’t be able to even start digging out of that hole.”

Still, she’s pleased restaurants will now get the chance to open back up. She said the state’s restaurant industry has lost more than $550 million since the pandemic hit and more than 80% of employees have been furloughed.

“Putting people back to work has to be a positive thing,” she said. “This is what the governor has to do, put your toe in the water.”

Beshear’s spokesperson declined to provide details about the data and science Beshear is using in his decision making process for reopening. The governor’s office also declined to provide copies of reopening proposals submitted to his office by businesses and business associations, claiming the records are “preliminary documents not subject to public inspection.” 

But representatives of industries and chambers of commerce that submitted the plans felt their input was influential in helping craft the requirements businesses must now follow.

“The governor’s office has listened to our concerns and adjusted policy based on those concerns,” said Brent Cooper, the president and chief executive officer of the Northern Kentucky Chamber of Commerce.

Cooper said they successfully lobbied to allow employees to self-report their temperatures, instead of requiring employers to conduct the temperature screen.

Also, Cooper said the governor dropped a requirement for employees in the shipping and handling sectors to wear gloves after the chamber argued that grocers, and food delivery workers aren’t required to wear gloves.

“The state said, ‘you know what, you’re right,’” Cooper said. 

The governor’s office also changed face mask requirements after input from industry leaders, said Lee Lingo, executive director of the Kentucky Association of Manufacturers. Wearing face masks at all times just wasn’t practical for welders and other workers who already are required to wear face coverings, Lingo said. The state amended its policy for manufacturers to encourage social distancing when possible, and require face masks only when more than one person is in a vehicle.

“We were able to provide a considerable amount of input and it was all taken into consideration,” Lingo said.

But despite that input on health and safety, these groups say they’re not responsible for the public health considerations of this pandemic.

“When it comes to infections, we’re sort of hands off,” said Iris Wilbur Glick, the vice president of government affairs and public policy for Greater Louisville Inc.

Glick said business owners should understand that if they cannot follow the guidelines, then they shouldn’t reopen.

“Just because you can reopen, doesn’t mean you should,” she said.

No 14-Day Decline Yet

Beshear has developed a few catchphrases during his daily 5 p.m. briefings, and one is about beating coronavirus on the first try. That’s what he discussed when he laid out his benchmarks for reopening, based on the benchmarks laid out by the White House. 

“Let’s make sure we’re not focusing on the next game before we win this game,” he said. “Lives are depending on it.” 

Kentucky has increased testing capacity and the availability of personal protective equipment. The state has tested nearly 3% of the population, a number that has doubled since just May 6. 

But on other benchmarks, progress is slow or merely theoretical at this point. The state has said it plans to hire 700 contact tracers, but has only just awarded the contracts to begin hiring. One benchmark is the status of vaccine and treatment; while that’s not something Kentucky has much control over, there’s no vaccine and treatment options are still limited.

The benchmark that can be measured most clearly is also the one Kentucky has most clearly not met: 14 days where cases are decreasing. There was a huge spike in new cases when more testing became available, and since then, Kentucky has reported between 100 and 250 new cases a day. Most days are on the higher end of that scale.

Even the three-day average of new cases climbed steadily for a week before it started declining on Sunday. 

The percentage of people tested who were COVID-19 positive has been declining as more testing has become available, which public health experts say is a very good sign. Before the increase in testing, more than 8% of tests came back positive. For the last week, it’s been closer to 6%. 

But that also has not been consistently declining for 14 days. Even before a minor increase reported Saturday, Kentucky had seen a declining percentage of positive tests for only eight days. 

As of Tuesday, Kentucky has recorded 8,069 cases and 366 deaths. And during his regular evening briefing, Beshear also announced the state’s highest single daily death count yet — 20 people. 

“This thing is still deadly,” he said. “It’s still taking people we love and care about.”

Peer Pressure And Public Opinion

Kentucky would not be the first state to reopen despite not meeting the White House’s benchmarks. Indiana, Ohio and Tennessee all opened restaurants to limited-capacity dining, weeks earlier than Kentucky. 

That likely plays a role in Beshear’s thinking, said Adam Enders, a political science professor at the University of Louisville. 

“That’s going to supply some additional political pressure from people who are already sort of mad about this, or are just sort of bored and want to get back to life as normal,” said Enders. 

Usually, Enders said, we want politicians to be responsive to the will of the people, but when public health is at stake, they may have to make unpopular decisions. Beshear has proven that he’s willing to make those difficult choices, but at this point, Ender said, public opinion may be winning out. 

And social distancing measures rely on community support and buy-in more than government action. 

“The supportive infrastructure of, ‘we’re all in this together and we don’t really know what’s going on, so let’s just band together and do what we think is best,’ that’s starting to crumble now,” he said. 

Pam McMichael of the Kentucky Poor People’s Campaign says the public health question has not been sufficiently answered to justify reopening the economy. The organization has been very impressed with Beshear’s work as a governor, but the rush to reopen Kentucky before a significant decline in cases “speaks to the values of putting profits over people,” she said.

“Opening businesses back up into unhealthy situations is not the only thing that we can do as a society or as a government or as a community,” McMichael said. “It’s a false narrative to say the only way to save the economy is to send people back to work in unsafe situations. Having a pandemic, and having people die, that also affects the economy.”

Kentucky is in a region with the lowest prevalence of workers offered paid sick leave in the country, and the commonwealth also ranks high for coronavirus risk factors, like obesity, diabetes and smoking. And economists are unsure of what the impact of reopening the economy at this point will even be.

It’s unclear if consumers will return to their old spending habits once restrictions are lifted, for example, and many of the industries most impacted by the coronavirus, such as travel and the airline industry, will be struggling long after Kentucky’s orders are lifted.

Jason Bailey, the executive director of the Kentucky Center for Economic Policy, said any economic gains to be had from reopening now won’t be enough to fix Kentucky’s budget problems. 

“We’re still going to have high unemployment. We’re still going to have businesses that can’t reopen or won’t reopen,” Bailey said. “The budget is going to be in terrible shape no matter what we do, for now, and it’s really about the issue of federal relief.”

Kentucky will need a loan from the federal government sometime this summer to keep paying unemployment benefits. Bailey and Beshear are part of a chorus of voices calling on Congress to provide financial assistance to states. The bipartisan National Governors Association has asked Congress for $500 billion in fiscal relief for states budgetary shortfalls.

The state’s business representatives also don’t know what reopening the economy will actually mean for the economy. 

“There are a lot of unknowns,” said Glick of Greater Louisville Inc. She said her agency is working with analysts to try and gauge the impact, but “there are lots of question marks.”

“The only way to support businesses is to give them a chance to open up,” she said.

Ashli Watts, the president and chief executive officer of the Kentucky Chamber of Commerce, said reopening now doesn’t guarantee a full economic recovery.

“We’ve never seen anything like this before,” she said. “I think most people are pretty realistic that we’re not just going to open up and things will be fine.”

In the long run, Kentucky’s economic health is tied to the health of the rest of the nation. Take Somerset, where Mayor Keck is champing at the bit to reopen. 

He said one of the county’s biggest employers is a factory that provides parts for Toyota. He worries that reopening Kentucky won’t be enough to save all those jobs — at least, not until the rest of the country is reopened and supply chains pick up again. Then, they still might have to wait until more Americans have enough disposable income to buy new cars. 

Beshear has said that the continuation of a phased reopening is dependent on how quickly the coronavirus spreads. Mayors and economists and workers and business owners are all waiting to see what comes of that decision. 

Williams, the Lexington gym staffer, is unsure whether she will return to work when fitness centers can open on June 1.

“I don’t want to bring it home,” she said. 

At Moonlite Bar-B-Q Inn, they’re cautiously preparing to reopen and are in wait-and-see mode about what this will mean for business.

It’s going to be expensive to get back up and running, even before you factor in the new costs: disposable menus, masks, gloves, cleaning supplies. Bosley’s not sure they’ll be profitable anytime soon. 

“All your bills you had before COVID-19, you still have,” said Bosley. “But you can only feed a third of the people that you were feeding before.” 

He’s eager to get their dining room reopened, but he’s not rushing it. He’s going to see how the reopening goes for other restaurants first. He’s worried that they could invest a lot of money in getting up and running again, only to learn that they’re being shut down again, or regulations are being rolled back. 

Moonlite is aiming to reopen on June 1, with the goal of avoiding the initial crush of people eager to get back to restaurants and celebrate Memorial Day weekend. 

“There’s a lot of money to be made” on a holiday weekend, Bosley said. “But it can’t all be about money.”

The post Kentucky’s Reopening Brings Health Fears, Hope For Economy appeared first on Kentucky Center for Investigative Reporting.

Are Ohio Valley States Ready To Reopen? Analysis Finds More Coronavirus Testing Needed Friday, May 8 2020 

An analysis by Harvard scientists and NPR finds that most states —  including Kentucky and Ohio — are not testing enough residents for coronavirus in order to meet recommended benchmarks to safely begin to reopen their economies. 

That analysis by Harvard’s Global Health Institute found that West Virginia is roughly meeting the minimum targets for coronavirus testing, while Kentucky and Ohio lag behind the recommended testing levels. Data on Kentucky and Ohio also show other indications that more testing is needed.

For example, the Harvard/NPR analysis of a week’s worth of Kentucky’s testing found that Kentucky averaged 1,229 tests per day — far lower than the estimated minimum needed by May 15 in order to begin to safely relax some of the business closures and social distancing safeguards in place. 

The Harvard scientists also recommend that the ratio of coronavirus tests that return a positive result be 10% or lower, something the World Health Organization also recommends. For the testing done during the week of April 29 through May 5, the ratio of positive tests in Kentucky was nearly 17%, far exceeding the recommended limit. 

From NPR and the HGHI

Similarly, Ohio averaged 5,717 tests per day, again far lower than the minimum the Harvard team estimated would be required by May 15.

From NPR and the HGHI.

However, both those states are ramping up testing capacity rapidly as they approach a phased-in reopening of some businesses and services. An analysis by member station WFPL of more recent testing data from Kentucky shows a far lower ratio of positive results, an indicator that the state is making progress.  

Dr. Tom Tsai is an assistant professor at the Harvard Chan School of Public Health and the Global Health Institute. He’s also a surgeon at Brigham and Women’s Hospital in Boston. 

In an interview with the ReSource’s Becca Schimmel, Tsai explained some of the public health benchmarks for safely reopening state economies, and talked about how an increase in testing and contact tracing can help overcome some of the challenges of resuming work life during the pandemic. 

Dr. Tom Tsai: The thresholds we look at in terms of whether a state is ready to reopen are several-fold. One is to make sure their test positive rate is below 10%. That’s a useful premise, because we know that in South Korea, their test positive rate was 2 to 3%, Germany was 6 to 8%. And anything above 10% suggests that you’re under-testing the population. So the test positive rate is a helpful metric to consider. 

The second is the number of tests that you’re doing as a per capita basis for the country. And that’s largely driven through a complex relation of issues, but including the burden of cases in your state, but also the strategy of why you’re testing. Then the most important thing is whether the actual number of cases is decreasing with time and the number of hospitalizations is decreasing with time.

Courtesy of HGHI

Dr. Thomas Tsai of the Harvard Global Health Institute.

Just looking quickly at some of the numbers for Kentucky and Ohio, I think they’re, you know, in a position where they are past the peak of where the cases are, and are in a plateau stage and even starting to see some of the cases decline, which is good news. 

The overall message, though, is more important than the thresholds for reopening, that this is not an on-off switch, but really a dial. And that the states need to really consider having very clear metrics on what success or failure looks like, and understanding that in the next weeks to months, based on the testing data, if the number of positive cases is actually increasing, then we may have to dial-up social distancing, again, in order to make sure that we’re not inadvertently creating a resurgence of cases by lifting social distancing too early.”

Schimmel: Do you think that if social distancing policies end and then need to be put back in place, that people will want to follow those guidelines again after they’ve had them dialed back?

Dr. Tsai: There’s definitely a social distancing fatigue that we’re already seeing in lots of space, especially as the weather is getting nicer and people are more likely to leave their homes. That’s why it’s so crucial to get the policy right now, because in some ways, once the floodgates open, in terms of trying to return to normal, it’s gonna be very hard to reinstitute social distancing measures that have been placed over the last several weeks, to months.

Schimmel: What are the risks to the states if they open without meeting those benchmarks?

Dr. Tsai: Well, we’re in a lockdown now, nationally, because we didn’t have the right testing capacity over the last several months, and we want to make sure as we consider reopening that we can stay open. And that means having enough information on testing. But testing is only one piece of the puzzle. Moving forward will likely involve really thoughtful and aggressive contact tracing to make sure we’re testing everybody who’s been exposed to a contact. It also may mean that we need to do workplace surveillance.

Schimmel: Aren’t there concerns about violating HIPAA and personal privacy when taking employee temperatures that some have been implementing in workplaces?

Dr. Tsai: I think it’s important to frame it in the right way, that this isn’t meant to be an obtrusive way of monitoring. This is really to help people have the right and best information for their own safety. And, you know, we think about you know, when you’re driving a car, right, everybody wears a seatbelt. We follow the rules of the road, we follow traffic lights, we stop at stop signs. And those aren’t invasions of your autonomy or privacy, but that’s basically following the rules of the road and making sure that it’s safe for everybody on the road, safe for society. I think some of these strategies — wearing masks and public being screened for temperatures —  can be viewed in the same way. They’re not affronts to your personal liberty. It’s making sure that everybody including yourself is safe from COVID-19.

This interview was edited for length and clarity.