As you are likely already aware, tomorrow Friday May 8th, the County of Los Angeles will begin Stage 2 of their reopening plan. Trails, golf courses, florists, car dealerships and stores that sell toys, books, clothing, sporting goods and music will be permitted to resume operations. The businesses will only be allowed to offer curb-side pickup while in-store shopping will remain on hold during this phase.

Generally, these steps are in line with what is known about COVID-19 infection patterns, namely that the main route of transmission appears to be sustained indoor contact. In fact, a recent study from China looking at more than 300 outbreak clusters found that transmission occurred outside in only one, involving just 2 cases Most occurred in home or public transport. Outdoor recreational spaces make important contributions to out physical, social and mental health. Therefore, prolonged restriction of access to such may no longer balance the needs of the population against the potential risks of community spread.. Link: https://www.medrxiv.org/con…/10.1101/2020.04.04.20053058v1).

At Wednesday’s briefing, Dr. Barbara Ferrer, the head of the Los Angeles County Health Department, also discussed safeguards that will be in place as other non-essential businesses and services plan to reopen. Unfortunately, as we have come to expect from public health officials, these safeguards are incorrectly prioritized.

Dr. Ferrer outlined that the the first safeguard will be to make sure the county has enough hospital capacity. The second is to ensure protection of vulnerable populations by having adequate personal protective equipment. And the third and final safeguard is the county’s capacity to test, trace and isolate.

We should know after 6 weeks of Safer at Home whether or not we have adequate hospital capacity. We should have also taken steps to secure adequate PPE across the County. But there has been no articulated or tested plan to trace and isolate individuals who are COVID-19 positive, and to have their close contacts quarantined.

Test, trace and isolate is a core function of a Public Health Department, yet it continues to be ignored, relegated further and further down the list of priorities. New cases and mortality rates in Los Angeles County have ‘flattened’ but there is not a clear downtrend. Re-opening businesses without the Health Department performing its most basic function is a recipe for disaster.

As we watch our national leadership and local governance pat themselves on the back for ‘re-opening’, a little perspective is in order. Below is a link for a fascinating article comparing the response to COVID-19 in the UK as compared to Germany. Germany has kept its case fatality rate low without closing offices, non-essential factories or shelter-in-place orders. The article points out that Germany does not share many structural similarities with other countries that have also responded effectively to COVID-19 (such as South Korea, Singapore, New Zealand). But the commonality is that all marshaled “energy towards the maxim of test and trace.”

The article notes that for those countries that employed test and trace, “their reward was precious life for their citizens. In the UK, […] our politicians have been clueless, a step late or a step off-course. The penalty, for citizens, is nearly too terrible to imagine. For those of us glued to the charts, it is etched above the grim British curves that could soon resemble the horror of the United States.”

The horror of the United States. Let that sink in. That’s the international perspective, and the one that our own public health infrastructure refuses to acknowledge.

(Link: https://www.prospectmagazine.co.uk/…/germany-covid-19…)