Kentucky released benchmarks for reopening during COVID-19. But what do they mean?
Gov. Andy Beshear unveiled seven benchmarks last Friday that he will use to guide his decisions about re-opening Kentucky’s economy during the COVID-19 pandemic, but figuring out how to measure the state’s progress has been difficult.
The Democratic governor and his administration have provided scant information about how it is defining and tracking each indicator.
At their core, the benchmarks for reopening really boil down to four things: how many people are getting sick from the coronavirus, how many people can be tested for the virus, how many people are available to trace the contacts of infected people, and how much personal protective equipment is available to those who need it.
Here’s what we know about each of those subjects.
Are fewer people getting sick?
Beshear has said he wants to see the coronavirus decline in Kentucky for 14 days before re-opening much of the economy. He appears to be using two key numbers to measure progress on this front: Kentucky’s three-day average of new confirmed COVID-19 cases and the percentage of people tested who have the virus.
It is difficult to tell whether the number of cases is trending downward in Kentucky by just looking at the number of new cases Beshear reports each day. Those numbers tend to jump around based on a variety of timing issues. To account for those variables, Beshear has said he focuses on a three-day average.
On Saturday, April 18, the three-day average was 166 new cases before it jumped to 204 on Sunday. It decreased to 158 on Wednesday before rising to 178 on Thursday and 226 on Friday. Those numbers do not indicate a downward trend over the last week.
Beshear has said he’s also looking at “the rate” of new positive cases. It’s unclear how exactly he is measuring this, but one simplistic method is to divide the number of confirmed cases in Kentucky by the total number of people who have been tested.
That number increased steadily from April 12 to April 21, from 7.59 percent to 9.58 percent, before dropping significantly to 8.12 percent on Thursday, when the number of people tested jumped by more than 6,700. It rose to 8.4 percent on Friday.
Of those tested over a recent six-day period (April 18 to April 23), 7.2 percent tested positive.
Can we test everyone who needs to be tested in a timely manner?
The Beshear Administration has quickly started to increase testing capacity and announced Wednesday that it will be able to test around 20,000 people next week (19,096 have been tested in the last 12 days).
Since April 13, the state has averaged 1,591 new tests a day, but that is well shy of the 9,000 to 13,000 people the state hopes to be able to test in a single day. It’s not known how quickly the state might be able to reach that goal, or if re-opening the economy would be halted if the state falls short.
Beshear has said a key problem is the lack of nasopharyngeal swabs, which are stuck up people’s noses in order to get a sample of the virus to test
As of Monday, only 0.73 percent of Kentuckians had been tested for COVID-19, which was one of the lowest rates in the nation, according to the Washington Post. By Friday, 1.01 percent of Kentuckians had been tested.
In Nashville, public health experts have said their goal is to have the ability to test one out of every 150 residents each week, with a 24-hour turnaround time on results. The ability to return test results quickly is critical to monitoring the status of the epidemic and to tracing contacts of those who test positive.
By that standard, Kentucky would need to be able to test 29,786 people a week. Most of the major labs in Kentucky currently have a 48-hour turnaround time.
Can we trace the contacts of those with COVID-19?
The Beshear Administraiton has not said how many people it now has available to trace the contacts of those with COVID-19, but on Friday, Beshear said he believes the state will need more than 700 people to trace contacts.
So far, contact tracing has been left up to local health departments and individual employers.
In Lexington, the health department stopped contact tracing when there were more than 20 new cases a day (if each of those people came in contact with 20 people, that’s 400 people they’d have to call) but Dr. Kraig Humbaugh, the public health director, has said the office is looking at resuming contact tracing now that the number of new cases has dropped significantly.
Shawn Crabtree, director of the Lake Cumberland District Health Department, said his health department has been able to complete the contact tracing necessary thus far. His department covers 10 counties in Southern Kentucky.
“We can deal with some increased cases per day, but might eventually need some support from the state, who is looking at embedding some folks locally at some point to assist,” Crabtree said.
At the Barren River Health Department, which covers seven counties in Southern Kentucky, officials said they are training more staff to help with contact tracing. Some of the health department’s nurses, environmental staff and health educators have already been trained and are helping with the effort.
In Nashville, the recommendation is that officials have the capacity to trace the contacts of a COVID-19 patient and contact those people within two days of a reported case.
Do we have enough PPE to keep front-line workers safe?
The amount of personal protective equipment for medical workers in Kentucky significantly increased between April 14 and April 21, but it’s not clear how long that supply is expected to last or how much state health officials think they should have on hand. Beshear said Friday that the state could probably help provide hospitals and nursing homes experiencing critical shortages of PPE for a month, maybe less.
Beshear has said hospitals need to be in charge of procuring their own PPE and that they should have a stockpile of at least a week. He said they can request PPE from the state during shortages to handle COVID-19 cases and other critical needs, but not for use on elective procedures.
From April 14 to 21, the state increased the number of surgical masks by 318 percent to 1.4 million and the number of respirator masks by 330 percent to 1.2 million, including 932,000 KN95 masks and 364,000 N95 masks. Face shields, which are being manufactured in-state, increased by 190 percent to 445,000.
It has been more difficult to obtain surgical gowns, which increased by 0.54 percent to 37,000, and gloves, which increased 7 percent to 4.5 million.
What will reopening look like?
The state appears to be using guidance from the White House as it plans for reopening. The federal plan has three phases, with a new phase implemented each time a state sees a 14-day decrease in the virus, with no resurgence. Here’s what would happen in each phase:
Phase 1
- Individuals: People who are particularly vulnerable to the virus, including those over 65, would have to continue to shelter in place. Others would have to maintain a social distance of at least six feet in public and avoid socializing in groups of more than 10 people. Non-essential travel would not be allowed.
- Work: Companies must continue to encourage people to work from home. If people come back to work, they’re supposed to come back in phases. All common areas would have to be closed and there should be special accommodations for vulnerable employees.
- Institutions: Schools would stay closed, nursing homes would stay closed to visitors and bars would stay closed. People would be allowed to have out-patient elective surgeries, venues could reopen with social distancing policies (think restaurants and movie theaters) and gyms would be allowed to reopen with proper social distancing.
Phase 2
- Individuals: Vulnerable people would still have to shelter in place. People would still have to maximize physical distance in public, but would be allowed to meet in groups of up to 50 people. Non-essential travel would be allowed again.
- Work: Employees who can work from home should continue to do so, common areas should remain closed and special accommodations for vulnerable employees would continue.
- Institutions: Schools and organized activities for kids would be allowed to reopen (think summer camps), large venues could operate under “moderate” social distancing policies, bars could reopen with “diminished standing room occupancy” and both in-patient and out-patient elective surgeries would be allowed.
Phase 3
- Individuals: People who are particularly vulnerable to the disease would finally be allowed to resume public interactions, but they’d have to keep practicing physical distancing. Low-risk people should minimize their time in crowded environments.
- Work: Companies can resume unrestricted staffing at worksites.
- Institutions: Nursing home visits would be allowed again, large venues can have minimal social distancing policies and bars would be allowed to increase their occupancy.
This story was originally published April 24, 2020 at 4:46 PM.
