AMA warns, ’Do not confuse re-opening with returning to normal’

The CDC issued two new guidance documents for Americans — “Considerations for Events and Gatherings” and “Considerations for Daily Life” — as the country begins to reopen during the ongoing Covid-19 pandemic.

Reporters attending the CDC telebriefing homed in on the timing of the new guidance on events and gatherings, coming just days after President Donald J. Trump announced that he will return to the campaign trail with a rally slated for June 19 in Tulsa, Oklahoma.

The document states that large gatherings and events, where it is difficult to maintain 6-feet between persons, carry the highest risk of people contracting SARS-CoV-2, the virus that causes Covid-19. It also emphasizes the importance of hand hygiene and wearing cloth face coverings along with social distancing.

The administration noted that attendees to the president’s rallies will not be required to wear masks, although they are required to sign a waiver agreeing not to sue the campaign or the venue if they contract Covid-19.

Jay Butler, MD, the CDC’s Covid-19 Incident Manager, said, “the guidelines speak for themselves and they are not regulations, they are not commands, but they are recommendations or even suggestions… to be able to tell how you can have a gathering to keep people as safe as possible.”

Some highlights of those safety suggestions are:

  • Attendees and employees should say home if they have tested positive for Covid-19, showing signs and symptoms or have had close contact with someone with Covid-19.
  • Along with hand hygiene, events should display signs that discourage handshakes, fist bumps, high fives, etc.
  • Cloth face coverings should be required for staff and encouraged for attendees.
  • Limit the number of people allowed in restrooms at one time to allow for social distancing.
  • Events should modify their layouts for seating to allow for social distancing, or host smaller events in larger rooms.
  • Physical guides, such as 6-feet apart indications on floors to ensure social distancing should be implemented and seating should be arranged so people can maintain 6-feet distance between themselves.

The guidance issued for daily life is similar. As people venture out, they should consider how many people they will be interacting with, as the more people, the higher the risk of contracting Covid-19. Also, of consideration is the ability to maintain social distancing, as well as the length of time people will be interacting. The CDC also noted in the document that people need to be aware of the spread of Covid-19 in their communities.

In fact, both Redfield and Butler noted that state and local officials are the ones to help guide decisions about how fast or slowly states are easing mitigation efforts, and if transmission starts to increase, then more mitigation efforts may need to be implemented.

Asked if states such as Arizona have opened up too soon, given their new cases of Covid-19 are beginning to spike again, Butler said, “Temporal association doesn’t prove causation, that’s one of the reasons why we don’t just sit back and look at the numbers… one of the measures is whether or not there is more severe illness, or whether we are diagnosing more asymptomatic people… the importance of surveillance to be able to understand the evolution of the pandemic is critical.”

AMA Urges Vigilance

And, while the CDC is offering guidance for reopening, the American Medical Association is continuing to urge caution.

“In far too many states — in rural and urban locations — we are seeing an increase in Covid-19 cases that could lead to further illness, deaths and other potentially dangerous impacts on health systems across the country. Physicians, scientists and public health experts are learning more every day about Covid-19, but we already know what stops the spread of the virus — wearing a face mask, maintaining physical distancing, and washing your hands regularly for 20 seconds. Adhering to these simple steps is the most effective way to prevent deaths and safely allow re-opening to continue. America’s physicians and the men and women on the front lines of this health care crisis urge you: do not confuse re-opening with returning to normal. Acting as though Covid-19 is behind us now will lead to another surge of Covid-19 cases. We appreciate that many people have been taking steps over the last several months to reduce the spread of Covid-19, but we urge the public to continue to be vigilant in taking steps to mitigate the spread of the virus,” Susan R. Bailey, MD, President of the AMA, wrote in a press statement. “Personal Protective Equipment (PPE) shortages remain an ongoing challenge and a significant hurdle that is preventing physician practices from re-opening. With PPE still in short supply, a second surge in Covid-19 cases not only risks additional lives – it jeopardizes routine medical care and procedures and endangers our health care workers. The AMA continues to urge the Administration to implement a national coordinated strategy on the production, acquisition, and distribution of PPE supplies to both ensure that the extreme shortages faced by front-line providers during the initial Covid-19 surges will not recur and help non-hospital health care practices to re-open safely for routine patient care.”

American Public OK with Mitigation Strategies

But while the country appears to be chomping at the bit to get back to business as usual, it also appears that the American public, for the most part, supported and adhered to the mitigation strategies put in place for Covid-19, according to a new Morbidity and Mortality Weekly Report.

The CDC surveyed adults in New York City, Los Angeles, and elsewhere across the U.S. about stay-at-home orders and closings of nonessential businesses, as well as adherence to the CDC mitigation guidelines. From May 5 to 12, 4,042 adults age 18 or older were invited to complete an online survey.

“Most respondents in the three cohorts supported stay-at-home orders and nonessential business closures (United States, 79.5%; New York City, 86.7%; and Los Angeles, 81.5%), reported always or often wearing cloth face coverings in public areas (United States, 74.1%, New York City, 89.6%; and Los Angeles 89.8%), and believed that their state’s restrictions were the right balance or not restrictive enough (United States, 84.3%; New York City, 89.7%; and Los Angeles, 79.7%),” Michael A. Tynan, with the CDC Covid Response Team, and colleagues reported.

They also found:

  • 88% of respondents agreed that people should maintain social distancing of 6-feet apart.
  • 82% agreed that groups of 10 or more people should not be allowed.
  • 80% supported stat-at-home orders and nonessential business closures.

Notably: “Among respondents in the U.S. cohort (1,676), 16.8% knew someone who had positive test results for COVID-19, compared with 42.0% of respondents in NYC and 10.8% in Los Angeles; 5.9% of respondents in the U.S. survey cohort knew someone who had died from COVID-19, compared with 23.1% in NYC and 7.3% in Los Angeles,” Tynan and colleagues reported.

When they polled those who were employed, more nonessential workers (63.1%) than essential workers (80.6%) reported self-isolating. And, more essential workers than nonessential workers said they felt safe if mitigation strategies were lifted (37.7% versus 23.7%).

Also of note, “There was a significant association between age and feeling safe without community mitigation strategies, with younger adults feeling safer than those aged ≥65 years, which might relate to perceived risk for infection and severe disease. As of May 16, adults aged ≥65 years accounted for approximately 80% of reported Covid-19–associated deaths, compared with those aged 15–24 years, who accounted for 0.1% of such deaths,” Tynan and colleagues reported. “Identifying variations in public attitudes, behaviors, and beliefs by respondent characteristics can inform tailored messaging and targeted nonpharmacological interventions that might help to reduce the spread of Covid-19.”

At the beginning of the CDC’s telebriefing, CDC Director Robert Redfield, MD, said that there is still a lot of work to be done as the country begins to reopen, and noted that social distancing, hand washing, and wearing a face covering are still “key defenses” in ensuring a safe return to public spaces.

“I wanted to take a moment to really say thank you to the American people for basically being selfless in taking on the precautions of that we’ve requested… I know that people are eager to return to normal activities and ways of life, however it’s important to remember that the situation is unprecedented and that the pandemic has not ended… this is why today we’re releasing these common-sense suggestions as communities open up,” Redfield said.

At the end of the telebriefing, Redfield called the media critical partners and thanked the media for “what you do.”

  1. The CDC has issued two new guidance documents — one for people venturing out after self-isolation and another one on best practices for social gatherings and large events.
  2. A new MMWR report finds that a majority of the American public supported stay-at-home orders, social distancing, and closures of nonessential businesses.

Candace Hoffmann, Managing Editor, BreakingMED™

None of the sources cited disclosed any relevant relationships.

 

Cat ID: 190

Topic ID: 79,190,254,930,791,932,570,190,926,192,927,151,928,925,934