How Washington state, a model for public health, plans to relax social distancing

How Washington state, a model for public health, plans to relax social distancing
People practice social distancing at a park in Seattle, Washington, on March 20. Karen Ducey/Getty Images

The state will probably reopen its economy more slowly than the White House suggests

Seattle was the first place in the US to go into lockdown over the coronavirus, after an outbreak at a local nursing home woke Americans up to the threat the virus presented. Now, the city and Washington state are starting to plan for an eventual, gradual reopening.

Public health experts credit Gov. Jay Inslee and local leaders for taking the dramatic steps necessary to get the Covid-19 outbreak in the state under control. And the curve there is flattening, with new cases and deaths down from their earlier peak. But the economy has endured the same shock felt across the country. Officials have begun to discuss how to restart the economy, without risking a sudden resurgence in infections and deaths. With global giants like Microsoft and Starbucks headquartered in the state, Washington could be a model for the rest of the country on the best way to climb out of the coronavirus hole.

The hard truth is no matter how cautiously reopening happens, Covid-19 is going to continue to spread. “I don’t think it’s possible to prevent all transmission. We need to keep the number of cases manageable,” Jeffrey Duchin, who leads the epidemiology division of the King County health department, told me. “We want to see something like a slow burn, where it doesn’t evolve into an uncontrollable raging fire.”

The goal will be to relax some of the social distancing restrictions without overwhelming the health care system. The first small step came late last week, when Inslee announced that ongoing construction projects could resume, so long as they follow certain safety protocols. The next step may not come for some time; Inslee has already said the state’s stay-at-home order will extend beyond its current May 4 expiration date.

Local public health experts expect the state will wait to see weeks of declining cases and deaths before taking more significant steps to restart its economy. Duchin told me that he wants to see “way more” progress before social distancing policies are changed. And once they are, just a few restrictions may be lifted.

“It’s essential that we go carefully slowly and in a stepwise fashion. After each step, we’ll evaluate the impact,” Duchin said. “That will take two or three weeks. We need to stop and observe. Unfortunately we can’t figure this out in a few days. It will take a few weeks.”

Washington state’s reopening plan is likely to share many features of the White House’s reopening guidance, which suggests a phased approach, local experts told me — except the state is likely to adopt a more cautious timeline than the Trump administration’s guidelines, which are more like a bare minimum.

“There’s a continuum, from people who really just care about making sure people don’t get sick and then to the other side, who don’t want the economy to be tanked,” Hilary Godwin, dean of the University of Washington’s school of public health, told me. “I would put the White House more on the end of caring more about the economy, though obviously they care about the people. What we’ve seen so far in Washington state is obviously Inslee cares deeply about the economy, but he has been a conscientious actor.”

Overt caution worked for Washington in clamping down on the coronavirus. Now, the state sees it as the safest path to resuming normal life.

Washington acted quickly and has seen its coronavirus curve start to bend

The first known case of Covid-19 showed up in a Seattle suburb in mid-January; a man walked into a clinic complaining of fever and a cough. His doctors quickly learned he had recently returned from Wuhan, China, the original epicenter of the coronavirus outbreak.

A month later, on February 29, the first reported death from coronavirus occurred at a Washington nursing home — a man whom, as the New Yorker reported, had had many family members come in to visit him shortly before his death. Local health officials soon petitioned Microsoft to ask its employees to work from home, which the company did on March 4, hoping it would set an example for other firms capable of remote work. One week later, on March 11, Seattle’s schools were closed. They have not reopened.

Though Inslee did not issue a stay-at-home order until March 23, much of the state had already started to shut down before then. As Dow Constantine, the King County executive, told the New Yorker, local leaders believe the preliminary steps — closing schools, having Microsoft and Amazon employees working from home — had communicated the severity of the situation to most people:

Constantine thought that announcing school closings was a potent communication strategy for reaching even people who weren’t parents, because it forced the community to see the coronavirus crisis in a different light. “We’re accustomed to schools closing when something really serious happens,” Constantine told me. “It was a way to speed up people’s perceptions—to send a message they could understand.”

A month later, the results speak for themselves. Washington has tallied about 13,700 coronavirus cases and 760 deaths as of April 28. Adjusting for population, the state ranks 19th in cases per capita and 15th in deaths — despite being the first place to suffer a known outbreak and having to deal with uncontrolled spreading from the Kirkland nursing home. The daily highs for new cases and deaths came in late March. The state has seen several weeks of halting but evident decline.

“When people ask me why things are going so great, I say, ‘We were on the front end, we reacted quickly, and we got lucky,’” Godwin said. “We are the public health model for doing things right.”

But that success has come at a cost, Godwin added. “If I cared a lot about economics, I wouldn’t be as thrilled.”

Seattle businesses, hit hard by Covid-19, are taking cues from Microsoft and Starbucks about how to reopen

Like the rest of the country, Washington’s economy has ground to a halt because of the lockdowns put in place to limit the spread of the coronavirus.

Nearly one-quarter of Washington households said somebody in their home had lost a job because of the economic downturn, according to data provided by the Downtown Seattle Association. About 650,000 jobless claims had been filed as of mid-April. Daily restaurant sales in Seattle were down nearly 80 percent; hotel revenues in the city have dropped by more than 90 percent. The expected cancellations of conventions in Seattle are projected to lead to economic losses exceeding $170 million.

“I think realistically it’s a few years before we have something approaching the economic activity we had pre-pandemic,” Markham McIntyre, executive vice president of the Seattle Chamber of Commerce, told me. “That’s how we’re thinking of this, a multi-year campaign.”

That toll is why these reopening conversations have begun to pick up. Government leaders are holding routine phone calls with businesses and their representatives to communicate their thinking and discuss the gestating plans to start easing social distancing. Officially, there is no plan yet for reopening. Inslee tweeted last week that discussions are ongoing, and Washington joined California and Oregon to formulate a roadmap for the entire West Coast.“…WE NEED TO KEEP THE NUMBER OF CASES MANAGEABLE. WE WANT TO SEE SOMETHING LIKE A SLOW BURN, WHERE IT DOESN’T EVOLVE INTO AN UNCONTROLLABLE RAGING FIRE”

The Seattle area has one advantage over some other parts of the country: the presence of Microsoft and Starbucks headquarters, companies that have already undergone a partial reopening process in their locations in China. Microsoft is representative of a white-collar office setting and Starbucks has experience in retail. They’ve been sharing their lessons with the people and businesses working on a reopening plan, according to McIntyre and Jon Scholes, president and CEO of the Downtown Seattle Association.

Microsoft, for example, has been suggesting some ideas about how to strengthen office culture, to set expectations for managers and workers about their productivity in an unusual environment. They’ve also covered basic sanitation, how to set up socially distant protocols for using elevators, and how to best arrange people’s desks to decrease the chances of airborne spread.

Seattle businesses have also been working with software developers to come up with a “personal protective equipment wizard.” It would be a program into which companies could enter their industry, number of employees, operating square footage, and other key criteria. An algorithm would tell them how many masks and other protective equipment they should keep on hand at all times.

Business leaders I spoke with emphasized the need for flexibility on the part of the government. New safety protocols will look different for a coffee shop than a factory or an office building. They floated the idea of setting “performance goals” — certain standards businesses should strive to meet — and then allowing businesses to figure out the best way to achieve them.

“It will be very hard for the government to have a highly regulated response to this,” McIntyre said. “They don’t have the bandwidth or the interest in trying to manage a massive regulatory framework to check and enforce how businesses are reopening.”

But businesses are also realistic about the pace of reopening — and the possibility social distancing restrictions would need to be put back into place if there is a surge in Covid-19 cases and deaths. As McIntyre said: “Any reopening is gonna be a dial, not a switch.”

Washington’s reopening will be gradual and it will depend on good public health practices

The uncomfortable truth is there’s no way to know when the right time to reopen an economy is. There is no evidence right now that the summer months will lead to a sudden decline in Covid-19 spread, and federal health officials are already warning of a second wave in the fall. No proven treatments for people who get infected exist nor do any vaccines to prevent people from becoming infected in the first place.

If public health were the only consideration, the solution to the coronavirus would be to keep everything shut down. It has been the only proven intervention. But it is also a blunt instrument, and there are other considerations.

A doctor and a nurse converse before testing patients for the coronavirus at the University of Washington Medical Center in Seattle, Washington, on March 13.

“The other side of the equation is the economic and personal financial costs of shutting things down,” Joel Kaufman, a UW professor who studies environmental and occupational health sciences and epidemiology, told me. “I think were it not for that, the answer would be to continue to stay at home. But that appears not to be a realistic option for the other parts of our country which are influenced by economic activity.”

That being said, public health experts in Washington told me they expected the state to broadly follow the guidelines recently released by the White House — but with a few important exceptions and a higher threshold for when it’s safe to relax more restrictions.

The Trump administration has said states should wait until they see 14 consecutive days of declines in flu-like and Covid-like symptoms. Washington is likely to wait longer than that before taking any more significant steps to relax social distancing.

“We have already passed that for the state of Washington, and I don’t think any public health experts would say today is the day,” Godwin told me. “I expect to be more protective of public health under our government.”

It’s also unlikely Washington will fully embrace every bullet point in the White House plan. Godwin scoffed at the idea of large gatherings, which would be permitted with some restrictions in Phase 2 (out of 3) in the Trump administration outline. Washington has put a ban on gatherings of more than 250 people and experts expect that to be among the very last of the restrictions lifted, a sharp contrast to the federal guidance.

“The thing that makes me say what was the large venues. I wouldn’t expect us to do that,” Godwin said. “The reason they were the first thing put into place is statistically if you have a large group of people and you have Covid-19 circulating, the chances you have somebody who is asymptomatic and they’ll pass it along are high.”

But opening restaurants, with social distancing guidelines, and some retail locations might make sense, Godwin said. Factories and offices need to take certain precautions, but they could also probably start to resume activities soon. Inslee has already announced that schools would not reopen before the end of the academic year, though Trump recently suggested that might be possible. But the belief now is they will start back up in the fall.

The success of social distancing depends not only on sound government policies but on individuals behaving responsibly. Since it appears the coronavirus may be more transmissible by air than by touch, Kaufman said he hopes that mask-wearing will remain commonplace when people go back to work.

“When you’re out of your own house and have any opportunity to interact with other people, you are wearing a mask to prevent you from spreading the virus to other people,” he said, adding that it should be communicated that not wearing a mask is “an act of incredible selfishness.”

Maybe most critical to the reopening plan will be the government’s ability to conduct contact tracing: the tedious work of identifying people who have the coronavirus and then getting in touch with everybody they’ve recently had contact with and either testing them or making sure they self-quarantining.

It will require a massive ramp-up: Johns Hopkins researchers estimate that, nationwide, the US has only a fraction of the trained staff necessary to do this work. Phone apps could automate some of the work “disease detectives” do, but a major expansion of the public health workforce will be necessary.

“Even a few cases if unrecognized will spark an outbreak that will spiral out of control. You have to be able to identify almost all the cases. If you miss a few, those little sparks can set off a forest fire,” Duchin said. “We’re not absolutely sure that we’re gonna be able to do it.”

The coronavirus is a particularly challenging pathogen to track because symptoms don’t appear for several days after a person has been infected. “The rapidity with which this work has to be done is really unprecedented.”

But everybody, even Duchin, is anxious for some degree of normalcy to resume. He’s looking forward to getting back out with his cycling friends (he’s feeling out of shape these days). He also has a daughter, a senior in college, hoping to visit with friends before the summer comes and goes. The public health experts who are urging caution feel the same kind of pressure as the rest of us.

But this process will require patience. That will be the first, second, and third principle of Washington’s reopening plans.

“This disease isn’t gone. One of the misperceptions is it’s going to go away if we suppress it and we can go back to normal. But it’s lurking. We’re just as susceptible,” Duchin said. “The potential for this to spiral out of control will be with us for many months.”

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