The START Guide for re-opening San Luis Obispo County could accelerate Santa Barbara County’s transition into the next phase of the COVID-19 pandemic.
In California, the curtain is coming down on the statewide stay at home order issued in response to COVID-19. Counties are charting their own course. Businesses are re-opening. Law enforcement is showing little enthusiasm for enforcing certain provisions. After withdrawing his ill-conceived threat to close all beaches in the State, Governor Newsom has belatedly relaxed portions of the order and created a mechanism for returning public health to local control.
With Counties poised to exercise increasing authority over public health, the key question is: What set of local policies should replace the stay at home order? Working with economic development experts at REACH, San Luis Obispo County has published a thoughtful and comprehensive framework for re-opening society while protecting public health. The framework is particularly relevant for Santa Barbara County because REACH is performing similar work for our Board of Supervisors.
The good news for our County is that the START Guide is good starting point for our re-opening as well. But we are weeks behind San Luis Obispo County, and we need to catch up quickly by adapting the Guide to address circumstances in Santa Barbara County.
The START Guide is Data-Driven
The START Guide is premised on the view that society should re-open in a phased manner that protects the most vulnerable while enabling a careful return to public life for everyone else with certain safeguards in place. This premise is fully supported by the latest scientific data related to actual risks posed by COVID-19.
To begin with, COVID-19 poses little or no risk to most of those infected. Roughly half of those infected with COVID-19 will have no symptoms whatsoever. Indeed, the vast majority of the population infected with COVID-19 will suffer no more than moderate symptoms and will not require hospitalization. The risk of dying from COVID-19 is also incredibly small for those under the age of 65 with no serious underlying health conditions. In one study, people fitting this description accounted for only 0.3%, 0.7%, and 1.8% of all COVID-19 deaths in Netherlands, Italy, and New York City, respectively.
According to the CDC, the most vulnerable population includes: (1) People 65 or older; (2) People who live in a nursing home or long-term care facility; or (3) People of any age with (a) chronic lung disease or moderate to severe asthma, (b) serious heart conditions, (c) compromised immune systems, (d) severe obesity, (e) diabetes, (f) chronic kidney disease, and (g) liver disease.
Given the data, the current stay at home order should be replaced with local measures that protect the vulnerable without forcing everyone else to remain at home, as the START Guide recognizes. The explicit public health goals of this policy should be to minimize hospitalizations and fatalities among the most vulnerable and ensure that sensible social distancing and hygiene measures are followed by everyone else until we acquire herd immunity or a vaccine is developed. These goals should be clearly and consistently communicated to the public.
The START Guide does a very good job of explaining many of these points. It makes it clear that it is intended to “protect public health and our most vulnerable populations, while also providing residents, organizations, and businesses with a path to reopening our communities and economy with COVID-19.” Based on this philosophy, it correctly rejects the essential vs. non-essential business distinction and instead focuses on risk. It recognizes that a great deal of activity should resume during Phase 1 for low-risk populations, especially our children (who have suffered greatly under the stay at home order). It also recognizes that the most vulnerable will need to continue to stay at home. Thus, on the critical issues, the START Guide is analytically sound, well-supported by the latest data, and deserving of public support in Santa Barbara County.
Adapting the START Guide to Santa Barbara County
The START Guide should, however, be modified in certain respects before it is adopted as a framework for Santa Barbara County. The most important changes are discussed below.
First, confirmed cases should not be used as a metric for loosening or tightening public health measures. The overwhelming majority of people who test positive for COVID-19 will not require hospital care, and it is difficult to compare the number of confirmed positives from different time periods if testing protocols and/or volume have changed. Rather than confirmed cases, the most important metric for determining whether to adjust public health measures should be hospitalizations.
Second, although the START Guide correctly included modified re-openings for K-12 schools (and presumably school-related summer programs), gyms, parks, and playgrounds in Phase 1, Santa Barbara County should provide more explicit guidance to school districts, athletic directors, youth sports leagues, and summer camp operators regarding a wider range of permissible activities. Healthy, school-aged children are unlikely to become symptomatic or to suffer more than mild symptoms of COVID-19. Moreover, research suggests that children who catch COVID-19 are not silent spreaders. But they are suffering in silence. The time away from school has negatively impacted their learning, socialization, and health. It is also difficult to foresee a return to economic health in our County if working parents cannot have their children attend school, after school programs, summer school and related programs, outdoor camps, and sports programs. In light of the data, science, and social considerations, Santa Barbara County should explicitly permit various after school, summer school, outdoor camps, and summer sports programs for children, subject to sensible hygiene and public health measures.
Third, although the most vulnerable should stay at home as much as possible, this is a serious burden that carries its own social and emotional costs. Santa Barbara County should, therefore, establish a program whereby the most vulnerable are given dedicated shopping hours each day (some stores have adopted such policies already). If successful, the County could expand this policy to include dedicated hours for dining and other activities in later phases.
Lastly, the START Guide calls for at least 30 days between the start of each Phase. This is unnecessarily long. Hospitalization data reveals the impact of policy changes on the trajectory of the virus within 14-21 days of those policy changes being implemented. Given the enormous collateral costs of our public health measures, we should not wait 30 days to transition to a new phase if the data tell us we can do so in less than 21.
Let’s Get STARTed ASAP
Santa Barbara County has the healthcare capacity and public health tools required to re-open society while protecting the most vulnerable. We must do so as soon as possible given the enormous costs of the status quo. The START Guide for San Luis Obispo County is an excellent starting point. We should use it to jump-start the economic engine for Santa Barbara County.
Editor’s Note: I’d like to thank Cori Hayman for her substantial contributions to this Post, which is adapted from comments that we submitted to the Board of Supervisors on Monday, May 4th.