DALE JENKINS, DAVID KING & MARK MCCLELLAN: Reopening North Carolina, together step by step

Thursday, April 16, 2020 -- Even as we continue to work to reduce COVID-19 cases and deaths, we must take steps toward reopening North Carolina. To make this happen, we all need to work together to reopen our state prudently and safely, recognizing that regional differences exist and that some activities should come back faster than others. With the threat of the virus continuing, simply setting an arbitrary date is not a wise basis for successful reopening. Instead, the focus should be on achieving some key milestones for protecting North Carolina.

Posted 2:20 p.m. Apr 16, 2020 — Updated 4:48 p.m. Apr 16, 2020

EDITOR’S NOTE: Dale Jenkins, former chair of the N.C. Chamber of Commerce, is CEO of Curi, a provider of products, services, and experiences for physicians and those who support them. Dave King is executive chairman of the board and former CEO of LabCorp. Dr. Mark McClellan is the director of the Duke-Margolis Center for Health Policy and former Commissioner of the U.S. Food and Drug Administration.

It’s been a very tough spring unlike any ever before in our nation. Despite the huge toll in illness and death, we are seeing real progress in fighting the COVID-19 pandemic.

Thanks to the aggressive actions of doctors, nurses and hospitals to address the surge of cases in the state, and the efforts people, leaders, and businesses to slow the virus spread, North Carolina is leading the way to mitigate the impact of this unprecedented pandemic.

These extreme steps have been difficult and all agree it will be tough to sustain. Our state is experiencing its worst-ever increases in unemployment. Our health care organizations are having trouble sustaining their practices – even though we need their help to contain this epidemic going forward, especially our primary care providers and our frontline workers and first responders.

Even as we continue to work to reduce COVID-19 cases and deaths, we must take steps toward reopening North Carolina – and begin to return to our lives. To make this happen, we all need to work together to reopen our state prudently and safely, recognizing that regional differences exist and that some activities should come back faster than others.

With the threat of the virus continuing, simply setting an arbitrary date is not a wise basis for successful reopening. Instead, the focus should be on achieving some key milestones for protecting North Carolina as quickly as possible. Meeting these milestones will give our citizens confidence that they can get together with family, shop at stores, send their children back to daycare or school, visit the park or the beach, and do many other things that make life here so special. The same milestones will give North Carolina businesses confidence that they can hire back and invest, without risking the emergence of another major outbreak that could bury them. Gov. Roy Cooper has recently described such a path forward. Leaders of both parties in North Carolina at the state and local levels are working toward a reopening that will last, and collaboration with business, health care and citizens will be essential for success.

First, our health care needs to be ready. Our medical professionals have been heroic in getting through this tough first wave of the pandemic. Going forward, they must be confident that cases are declining and they have the beds and protective supplies in place to treat any outbreaks that occur, along with starting to resume important non-COVID services that we need for our best health. In addition to our hospitals, our primary care providers will need to be confident, too.

Second, and critical: We need to grow our test and trace capacity. The Duke-Margolis report on how to do this highlights several key elements, starting with large-scale availability of testing.

Our state’s testing capacity continues to grow. State, hospital and commercial labs continue to increase the availability of laboratory tests; we are bringing in new rapid tests that can be done in the community; and, possibly soon, we will see tests that people can collect themselves. We need to establish a comprehensive ability to test across North Carolina, supported from across the healthcare spectrum, combining the work of companies like LabCorp, hospitals and health care providers, and public health agencies.

We also need collaboration among state leaders and providers to get testing to all people who need it. In each N.C. community, people with symptoms should have rapid access to safe collection sites. People who could transmit in high-risk environments like nursing homes or prisons should have routine testing. Businesses are starting to think about their role in testing to protect workers and customers, and should get support in doing so.

Next, those who test positive should have quick support for isolation, monitoring and access to treatments that prevent COVID-19 complications, as those treatments become available. Also critical is rapid tracing of contacts, with support for quarantine, rapid testing and isolation as needed.

Like some other early-acting states, North Carolina will need to build a special corps of COVID-19 outbreak fighters by training a short-term work force to do the critical work of finding those who may have been exposed to the virus, and helping them get tested and quarantined as appropriate. Many people will be able to quarantine at home, but some will need a convenient local place to stay like a converted hotel.

We also need to understand immunity to the virus in our communities. This will help protect from future infections. But with a highly contagious virus like this one, most people need to be immune to slow it down. That probably won’t happen until we have a vaccine. Still, we need to know how many people have been exposed to the virus, and there are methods available using standard blood samples that can be used quickly to estimate this exposure.

These studies will likely show that the vast majority of N.C. residents are not immune. That’s why test and trace steps will be a critical part of successful reopening. Better, more accurate tests for immunity among people who have recovered are coming, and they could help people work safely in jobs where virus transmission is a concern, further reducing risk. But that’s a ways off, and those tests would supplement -- not replace -- the other milestones.

As North Carolina stands up these capabilities, it will need further help from the federal government. Shortages of protective equipment and some key test supplies continue. Without further steps to increase supply, states will continue to be stretched in containing COVID-19. The next federal stimulus package should include more financial and technical support to put in place the people and health care capabilities needed for COVID-19 containment – an important economic stimulus that also will speed recovery.

And perhaps most important, success in this coming phase will depend on the people and the businesses of North Carolina. Self-monitoring for symptoms and fever, following guidelines to reduce transmission, and maintaining reasonable distances, especially in communities where we know the virus is still present, will be more critical than ever.

Accomplishing these milestones --and reopening--won’t happen overnight. But by working together quickly, a prudent, thoughtful, step-by-step reopening can take us toward a new normal of respecting physical distance and avoiding crowding in public, of modified ways to shop and go to school, of hand waves and face coverings.

We’ll see new business practices, with workplace modifications, expectations of testing and monitoring for COVID-19, and support for workers to stay home when screening tests come back positive. We will see further outbreaks and probably some temporary additional restrictions in specific communities as a result. But we’ll be in much better shape to contain these outbreaks. Taking these steps forward together will give North Carolinians and businesses confidence in this new environment, and we can all get going on recovering our lives and our economy.