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How do we know when to stop social distancing and reopen the world? It's complicated. But there are four major goalposts we should meet before we start getting back to normal.

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Everyone wants to know when we're going to be able to leave our homes and open up the United States again.  It's a hot topic.  It's also the topic of this week's Healthcare Triage.

(intro music)

So when will we reopen the country? That's unfortunately the wrong way to phrase it.  What we should be asking is "how will we know when we should reopen the country?"

Any date that's currently being thrown around is just being pulled out of the air - it's just a guess! Americans have been reactive - often without data, and often too late.

A lot of what we're doing is because we saw bad things happening in Europe or even in New York City, and everyone's trying to prevent that from happening where they live.

That's why we're all sheltering in place.  We want to avoid getting there, and we don't have the tests to know where the hotspots really are, so therefore all of us have to act as one, and all of us do the same thing.

We're not gonna all reopen at the same time either.  Some cities or states will be able to reopen sooner than others.  A recent report from the American Enterprise Institute, written by Scott Gottleib(?~1:01) and colleagues offers up some helpful guideposts to help us figure out when it might be that some places can open up.

The first goalpost is that hospitals in any area have to be able to take care of all the cases of coronavirus that might show up without any fear of being overwhelmed.  Other cities and states worry they could be headed towards where New York is, and they need to make sure that they have enough doctors and nurses and respiratory therapists and ventilators and beds to make sure that they can take care of all the cases of COVID-19 that might show up without fear they might not have capacity and have to turn people away.

That's the most immediate bar we have to clear to even talk about reopeing.  And it's the one that most of us have been focused on for a while.  It's all we talk about when we mean "flattening the curve".  Almost nowhere in the United States has gotten over that peak yet - even by the time you see this video - and if some have, they're JUST doing it.  So, we're just getting there, barely.

The second goalpost is that an area needs to be able to test ANYONE who has symptoms at all.  So, Doctor Gottleib and colleagues estimate that in order to do this, by modeling and looking at past flu symptoms, they think that we'd need capacity at peak to be able to test about 750,000 people in a week.  There are times, of course, that we might need to test even more.

I talked to Doctor Mark McClellan(?~2:15), who's a professor at Duke University, and also one of the authors of that study.  Here's what he said:

"The 750,000 number should be viewed as a reasonable expectation for when we haven't been having any major pockets or regional outbreaks to manage...

...If more testing to help contain outbreaks and potential outbreaks is needed, which seems very plausible, especially early on, the number would need to be significantly larger...