City Paper is not for tourists
D.C. will begin a phased reopening starting Friday, May 29. Under “Phase 1,” residents can once again get their hair cut and visit restaurants with outdoor seating. People are no longer ordered to stay at home, but life isn’t returning to pre-pandemic days yet. When leaving their homes, everyone must maintain social distance and wear a mask in most cases. A mayoral order that takes effect Friday continues to ban gatherings of 10 or more individuals.
Mayor Muriel Bowser decided to slowly reopen the District’s economy because she says the city met the metrics needed for Phase 1 on Wednesday. By now, some may have committed these metrics set by DC Health to memory: a sustained decrease in COVID-19 cases, the ability to test four priority groups, a health care system that’s below 80 percent occupancy for more than seven days, and enough contact tracers that new cases can be investigated within one day and their close contacts within two.
Some people continue to doubt whether D.C. has met the metrics or questioned the metrics themselves. They see the daily reports of new COVID-19 cases and do not understand why Bowser would lift her stay-at-home order. The mayor’s announcement came the same day the COVID-19 death toll nationwide surpassed 100,000. D.C. also failed to meet three criteria relating to testing and ICU beds on Wednesday that are set by the federal government or public health experts nationwide, according to ProPublica’s tracker.
“Not only is the positive rate above 10%—among the highest in the nation—it is rising. You can cook the books to try to fool the public, but you can’t fool the virus,” tweeted Topher Spiro, the vice president for health policy at the Center for American Progress, a Democratic think tank, in response to the news that the city is reopening.
Bowser had said during a press conference on Tuesday that she has “no interest in cooking the books” and acknowledged during Wednesday’s that one metric for Phase 1 had changed over time: how D.C. measures a decline in COVID-19 cases. Officials were measuring this based on when patients get their test results back but, after taking the advice of DC Health, decided to base it on when patients first experience symptoms. This metric became known as a 14-day decline in community spread, which officials say the District finally met on Wednesday. (The District was also measuring transmission rates to determine a sustained decrease in cases.)
On Wednesday, DC Health Director Dr. LaQuandra Nesbitt defended how her team measures a sustained decline in community spread, including the fact that the metric excludes cases in congregate settings such as nursing homes and homeless shelters. Even though workers can leave these facilities—as can homeless shelter residents—“it doesn’t diminish our ability to put in place infection control practices,” said Nesbitt. “We still have the ability to go in, do a comprehensive assessment, and then make recommendations for infection-control practices.” The D.C. government could prevent and quickly respond to an outbreak in these confined facilities, Nesbitt went on to say, unlike with the general public.
Bowser, however, has repeatedly denied that her administration ever considered the city’s positivity rate—determined by dividing the number of total tests by the number of positive cases—as a metric needed for Phase 1. Instead, her administration says it monitors the positivity rate. Nesbitt says her team calculates this rate on a daily basis “looking at the number of people sampled on a day versus the number of people who are positive on that day.” The city’s positivity rate hovers around 20 percent (17. 2 percent as of May 21) and Nesbitt suggested on Sunday a “goal” for Phase 1 is below 20 percent. (The goals for positivity rate vary by reopening phase.)
But in late April, the Bowser administration released 11 metrics required to begin a phased reopening, which included a positivity rate below 5 percent for 14 days. “We outlined 11 metrics that we are going to be following in order to be able to make some decisions about reopening,” said Nesbitt during April 29 town hall on phased reopening. D.C. is not unique in this way. Kentucky Gov. Andy Beshear, for example, has also changed the way he talks about his state’s benchmarks for a phased reopening. When asked how much of her decision to move to Phase 1 was influenced by the desire to reopen the economy on Wednesday, Bowser did not directly respond.
D.C. is clearly forging ahead with a phased reopening, a decision which Bowser has repeatedly said during various press conferences is informed by science. But what do the public health experts who don’t work for her think about this decision?
Joshua Sharfstein, the vice dean at the Johns Hopkins Bloomberg School of Public Health who is advising mayors across the country on the coronavirus, says it is a “judgement call” when local leaders decide to begin gradually reopening their cities’ economies. When making that call, he says, D.C. needs to look at a lot more than, say, D.C.’s positivity rate. Even when pressed to comment on whether D.C.’s case count should make us hesitant to move forward with Phase 1, Sharfstein emphasizes that it is important to look beyond that.
“I would try to get the overall picture,” Sharfstein says. “The overall picture in the cases seems like maybe they are bouncing around a little, but kind of heading down. They are slowly reducing the number of people in the hospital. They are slowly reducing the people on ventilators. So it’s overall getting a little better.”
“Because there’s still a lot of circulating virus, it’s important for the District to reopen slowly and for people to be very careful,” Sharfstein added.
Looking at the metrics used to move to Phase 1 on Friday, Sharfstein did not note any red flags. (He says they are comparable to Maryland’s, a state for which he used to serve as health secretary.) Neither did Dr. Anne Monroe, an associate professor in George Washington University’s department of epidemiology and biostatistics. Depending on the epidemiologists you speak to, the answer to that may change. The Post spoke with epidemiology professors at Harvard and University of California, Los Angeles who questioned why DC Health used symptom onset to determine a decrease in community spread if not everyone is symptomatic.
Monroe ultimately believes that the D.C. government has been acting prudently. She could understand why, for example, D.C.’s positivity rate is no longer a metric for Phase 1, as testing doesn’t reflect what’s actually happening in the community because it hasn’t been broad enough.
“Looking at the information that’s available, it is acceptable to begin a limited Phase One reopening as has been laid out,” Monroe says. “If there’s a reversal of the trends that have been seen in the past 14 days, I think that could be quickly addressed and restrictions could be reimposed.”
These are just two experts’ opinion. Ask another and they could easily disagree and believe Bowser should continue her stay-at-home order. A point to keep in mind is how the city enters Phase 1 is just as critical as the metrics that got us there.
“The lifting of these restrictions doesn’t guarantee anything. People have to continue to be willing to be tested. They have to be willing to continue social distancing. They have to be willing to continue hand-washing,” says Monroe. “It represents progress, but it doesn’t mean that we’re out of the woods and that people can just relax.”
This post has been updated to clarify the definition of positivity rate.