The state of Maryland has been in lockdown for over a month in an attempt to slow the spread of the COVID-19 pandemic — but last week, Gov. Larry Hogan provided Marylanders some sense of hope when he released his plan to “reopen” Maryland.
Hogan’s document states it is “a roadmap, not a calendar.” The administration does not intend to set dates or telegraph benchmarks for moving through this journey.
“Unfortunately, the virus dictates the speed with which the state can move.”
As the shutdown of the state was done in phases, so is the pace at which the state will reopen. “The administration intends to move rapidly, but not recklessly,” the document states. The hospitalization rate is considered the more accurate measure by which to determine where the state stands on the recovery roadmap.
“So long as hospitalizations remain steady, and ICU resources continue to be available, we can take a series of steps toward normalization,” the document said.
However, if there are signs that the easing of restrictions are triggering new outbreaks or increasing the strain on medical resources, it will slow plans to reopen Maryland. And if there is a major new outbreak or cluster, it could cause some of the reopening steps to be rolled back.
Governor Hogan described four “Building Blocks” to put in place for the state to move towards recovery:
Personal Protective equipment — the surgical masks, gloves, gowns and face shields used by hospitals, first responders and other frontline personnel to protect them from exposure to the virus. Maryland goes through roughly 287,000 surgical masks, 181,000 N95 masks, 715,000 gloves, 299,000 surgical gowns and 44,000 face shields per day; and that doesn’t count the PPE required each day by police and correctional personnel. While the state has acquired equipment which can sterilize masks to be reused, it needs to find reliable and consistent sources of enough PPE to meet its needs.
Surge Capacity - This is the number of acute and critical care beds available within the hospital system in the event the number of infected suddenly increases. It also considers the number and quality of ventilators and breathing-assistance devices in the state’s healthcare system. Last month Gov. Hogan ordered the state’s surge capacity to be increased by 6,000 beds. The state is on-track to reach that number.
Testing - The state has been working to acquire both tests and testing kits to check for the presence of the coronavirus. In addition to obtaining 500,000 test kits from the Republic of Korea, the state is pursuing domestic suppliers of testing kits and expanding its number of testing facilities for processing test samples.
“The ultimate goal for diagnostic testing should be that all patients with COVID-19 symptoms seeking outpatient or hospital care receive a reliable diagnostic test,” Hogan said in the roadmap document.
Contact Tracing - This is looking for all people a confirmed infected person had contact with prior to being diagnosed with the coronavirus. The state currently has 1,000 people working as contact tracers, as well as a contact tracing platform called “COVID Link” which will assist in the monitoring and collecting of information about COVID-19 patients and any community transmission.
Principles for Road Map
It won’t be quick. Maryland residents should be prepared to continue teleworking, wearing masks and practicing social distancing for the foreseeable future.
Industries will have to make sure they can reopen safely. To help with this, the state will have the business and industrial communities meet with public health experts to create ways for people to get back to work safely and efficiently. Employers will be required to consider the economic, medical and societal factors surrounding reopening. The state will then meet with them to create unified and detailed “Safe Reopening Plans,” which will be used by the Administration to determine the time frame for reopening businesses.
The Maryland Department of Commerce formed 13 Industry Recovery Advisory Groups: retail, accomodations, sports, restaurants and bars; attractions, destinations, tourism, trnasportation, manufacturing. professional and financial services, personal services and small business, and construction and development, and arts. Each advisory group is working closely with the Commerce Department to develop recommendations and best practices under which their industries could operate responsibly.
This is divided into three stages: Low Risk, Medium Risk and High Risk. Each of these stages could contain several phases, with these sub-phases being announced when the governor determines gating benchmarks exist for the rollout of additional openings.
Under Low/Medium/High Risk stages, activities and businesses are further divided into categories designated as having Medium or High “Modification Potential” to mitigate the risk of infection and protect individuals; and Low or Medium “Number of Contacts” or “Contact Intensity.”
Hogan will continue to consult with the State Superintendent of Schools, as well as area superintendents, to evaluate the safe use of school and child care facilities throughout the state.Again, the roadmap expects that people currently teleworking continue to do so for the duration of the State of Emergency, along with people continuing to practice social distancing and wearing masks.
Low Risk is first, beginning when Hogan feels the state has a sufficient foundation using the Building Blocks and other benchmark metrics. What activities will be permitted under “Low Risk” will not be announced in whole, but rather as a phased rollout. The initial steps will involve lifting the Governor’s “Stay at Home” order and switching to a voluntary “Safer-at-Home” guidance.
Other changes that could be implemented are: small shops and certain small businesses reopened; elective medical and dental procedures; limited attendance at outdoor religious gatherings; car washes; recreational boating, fishing, golf, tennis, hiking and hunting; and limited outdoor gym and fitness classes.
“Stop Signs” which could cause the reopenings to be slowed, stopped or even reversed, include: unexpected increase in hospitalizations or a increase in patients requiting intensive care; indications that Marylanders are disregarding social distancing; outbreaks of infection where contact tracing cannot find the route of the spread.
Within this stage, there could be: a raised cap on social gathering; indoor gyms and fitness classes and childcare centers reopened; restaurants and bars reopened; transit schedules returning to normal; and indoor religious gatherings.
There is no realistic timeline yet for when this stage may be reached. It will require either a widely available and FDA-approved vaccine, or safe and effective therapeutics that can revive people with significant disease or prevent serious illness in those most at-risk. During the High Risk phase, larger social gatherings could be allowed; high-capacity bars and restaurants reopened; entertainment venues reopened; and larger religious gatherings allowed.