States Are Ending Social Distancing Measures, But Experts Say 'Normal' Routines Won't Return

From Good Housekeeping

• Despite new guidelines issued by the White House that set clear circumstances for ending social distancing, governors across the nation have reopened non-essential businesses. Some medical authorities are concerned that the nation may experience what's being called the "second wave" of COVID-19 outbreaks.

• CDC guidelines continue to limit group meetings indefinitely, and many states have extended stringent social distancing initiatives into June.

• Some experts believe our routines won't return to "normal" this year.

After states like California and New York first established stay-at-home orders in March, all but five states have asked residents to stay at home until further notice — and yet, federal officials in the White House were among the first to discuss a timeline of when social distancing would end. After multiple timelines were suggested throughout the month of April, it seems that state leaders have final say over when residents can have more access to public spaces and visit non-essential businesses, even if their state healthcare system hasn't met conditions laid out in a set of guidelines released by White House leadership in April.

Many health experts have expressed concerns that a "second wave" of the novel coronavirus will impact Americans sooner than the end of the summer if states aren't able to meet these federal guidelines. The White House's coronavirus task force outlined a new plan called "Opening Up America Again" that contains three different stages, staggering the end of social distancing based on a two-week period of "downward trajectory" of COVID-19 cases, USA Today reports. "We are not opening all at once, but one careful step at a time," President Trump first said during a press briefing in mid April. State leaders worked to extend social distancing guidelines into late April and May based on these guidelines.

But many have since adapted their restrictions and relaxed them, in some cases: According to a CNN report, more than 40 states will have eased their restrictions in some way by the end of the first week of May. Some have allowed non-essential businesses to reopen while others have simply reopened public parks. Some of the states that have eased their restrictions are showing a decline in new COVID-19 cases, but none of them currently meet all four of the criteria established by the White House to resume normal routines, Caitlin Rivers, a senior scholar at Johns Hopkins University (the same body currently tracking up-to-date COVID-19 outbreak statistics), tells CNN.

While your home state or city may soon ease social distancing rules, there's a strong possibility that a resurgence of COVID-19 cases later this year may require us to social distance again.

When will the coronavirus pandemic end? It depends on vaccines and immunity.

Current recommendations from the Centers for Disease Control and Prevention mandate that large gatherings involving more than 50 people should be canceled seemingly indefinitely, but experts say these precautions may apply elsewhere for months to come (Case in point: Facebook officials have canceled large events through 2021). Tedros Adhanom Ghebreyesus, M.D., the director-general of the World Health Organization, has previously shared he expects that guidelines will continue to fluidly update as COVID-19 continues to spread, which is why many school districts have already closed for the remainder of the academic year. "The last thing any country needs is to open schools and businesses, only to be forced to close them again because of a resurgence," Dr. Ghebreyesus said in a press conference on March 25.

Ezekiel Emanuel, the vice provost of the University of Pennsylvania and a special adviser to the director general of the World Health Organization, published a piece in The New York Times in late March explaining why he believes shelter-in-place orders won't be entirely lifted until mid-June. But evolving information led him to extend his own timeline. In early April, Emanuel told ABC News that he doesn't believe we'll return to normal routines until a vaccine is developed, or for another 18 months. "The kind of normal where we go traveling, we go to restaurants, we go to concerts, we go to religious services, we go on cruises, until we have a vaccine that protects everyone. That's 18 months, it's not going to be sooner," he said.

But the difficult reality is that expert's guesses are just that — there isn't a concrete answer at the moment, says Bojana Berić-Stojšić, MD, PhD, CHES, an ambassador for the United Nations' Society for Public Health Education and director of the master of public health program at Fairleigh Dickinson University. She tells Good Housekeeping that regardless of when states decide to lift their stay-at-home guidelines, the end of social distancing won't look like an immediate return to everyday life. "Each part of the country is going through their own 'mini-epidemic' at their own different pace… Americans cannot expect to resume normal routine as soon as the month of May," says Berić-Stojšić, who also previously served as the president of the New Jersey Society of Public Health Education.

How do health officials determine when we can stop social distancing?

The timeline for social distancing for Americans all depends on when cases of COVID-19 have peaked — which, in reality, could be very different for people living in various communities in states across the country. Alongside Berić-Stojšić, many experts (cited in publications like The Atlantic and Vox) suggest there are a few more factors that will determine just how long Americans will spend social distancing over the next few months.

• One aspect is the reproductive rate of the virus and how immune others can be to the disease, which largely requires someone to overcome COVID-19 first. The reproductive rate is largely being influenced by social distancing measures, and currently, a lack of available testing means experts aren't sure how strong the reproductive rate is currently. According to projections from the University of Washington's Institute for Health Metrics and Evaluation, 97% of Americans will still be vulnerable to COVID-19 after a first wave of infections subsides, which means that the reproductive rate could remain quite high throughout the year.

• Another factor that'll influence timelines is whether or not scientists across the globe will be able to develop a vaccine, or identify stronger treatments. Multiple teams of researchers in the United States are working on preliminary safety tests on experimental COVID-19 vaccines. One of the nation's largest drug companies, Pfizer, began human trials of its in-development vaccine in early May. Internationally, scientists at Oxford University are touting a possible vaccine that may be available as early as September, despite limited findings. Only one drug has shown promise as an effective treatment against COVID-19: Remdesivir, an antiviral drug that may shorten the time spent recovering due to a COVID-19 diagnosis, according to early research from Stanford University. The Food and Drug Administration only approved it on an emergency basis in May, but researchers say they're hunting for more treatments as well.

• The last factor has to do with seasonal changes, and unfortunately, experts currently believe that rising temperatures won't have a strong effect on slowing the spread of COVID-19. CDC officials say "it is not yet known" whether the virus that causes COVID-19 will begin to slow due to higher temperatures. In a letter to the White House's coronavirus task force, experts from the National Academy of Sciences say that summer weather won't make a difference since most of the country isn't immune to the disease in the first place. While available research may suggest that SARS-CoV-2 doesn't live as long as it normally would in warmer temperatures, experts add that countries with warmer climates are still seeing major infection rates. “Given that countries currently in ‘summer’ climates, such as Australia and Iran, are experiencing rapid virus spread, a decrease in cases with increases in humidity and temperature elsewhere should not be assumed,” they wrote in the letter.

Why are some states lifting social distancing orders before others?

In March, Scott Gottlieb, the former commissioner of the Food and Drug Administration, published a "road map" to full recovery in conjunction with the American Enterprise Institute. That plan called for three different phases, based on declining cases over a 14-day period and slowly reopening schools and businesses, as well as areas being able to provide more testing to properly sequester sick individuals. Gottlieb's report did not indicate any timeline for these phases, but it did note that a state or city can revert back to "Phase 1" at any time if new outbreaks occurred, which suggested that certain states or regions may be able to relax social distancing precautions sooner than others.

White House officials on the coronavirus task force have introduced a new set of guidelines that are similar to Gottlieb's plan, known as "Opening Up America Again." Issued to governors this week, the guidelines outlined three different phrases to ease social distancing in states across the nation in staggered stages. These guidelines do not have dates set against them currently, and CNN reports that White House officials may leave final discretion in the hands of state governors and other local leadership.

1. The first phase of the plan requires states or regions continue to shelter in place, practicing social distancing in public and avoiding socializing in groups in more than 10 people. The guidelines maintains that non-essential businesses remain closed, but suggests that gyms may be able to reopen using physical distancing and sanitation guidelines established within.

2. The second phase of the plan suggests that states or regions that have seen no evidence of resurgence in new cases can ease more social restrictions. Schools will reopen, non-essential travel can resume, non-essential businesses including restaurants and bars can re-open with "diminished standing-room occupancy." but vulnerable people will continue to be asked to remain home. Importantly, this phase of the federal plan suggests elective surgeries can resume based on outpatients and an in-patients case basis.

3. Finally, the third phase suggests that states and regions with no evidence of any resurgence in COVID-19 cases and other monitoring criteria may lift most restrictions. Vulnerable individuals can return to social settings with physical distancing tips in mind, and normal visits to hospitals and nursing homes can resume.

Despite the timeline laid out in guidelines, the power to reopen states currently lies with state leaders rather than federal officials. Many states are easing business closings in the hopes of jumpstarting their economies, but asking shoppers to observe new rules and regulations aimed at keeping physical distance between customers. Journalists at CNN have created a live, up-to-date glossary of social distancing rules for each and every state in America — you can read more here.

How long could we potentially be social distancing?

Until states and major cities and metropolitan regions have days where no new cases are being reported by medical professionals, Berić-Stojšić says that she wouldn't anticipate social distancing precautions to end. "It really depends on the effectiveness of preventive measures, the time needed to have enough people who recovered from the disease to build resistance, the time to produce an effective treatment, and the time for an effective vaccine," she explains. "It's difficult to predict the exact time right now, but it will end."

We won't know if states that have already reopened will reinstate social distancing and stay-at-home orders until medical experts relay how many COVID-19 case counts are diagnosed within the next few weeks. But some states are not taking the opportunity to resume any semblance of a routine just yet. Here's a snapshot of how orders are evolving in states that are committed to maintaining social distancing through May:

1. Virginia: The Governor of Virginia, Ralph Northam, issued an order in March that asks residents to stay home until June 10, Newsweek reports. Another order that restricts crowds of 10 and businesses in recreation, entertainment, and personal care is set to expire in mid-May.

2. New York: Governor Andrew Cuomo has again extended a stay-at-home order, including dates for schools and non-essential businesses to remain closed, through May 15, per Politico. Governor Cuomo has led the state into a coalition with the states of New Jersey, Connecticut, Pennsylvania, Delaware, Rhode Island, and Massachusetts to tackle reopening their states and ease social-distancing orders in the future, according to a press release from Cuomo's office. In late April, the governor said that he's considering opening non-essential businesses in various phases based on needs and demands of residents, according to the New York Times.

3. California: One of the first states to implement an indefinite stay-at-home order, local mayors and other leaders in California are setting social distancing deadlines for their own cities and municipalities. Health officials in six counties in the Bay Area have extended timelines into May, according to the Los Angeles Times. And Governor Newsom announced a "Western States Pact" with Oregon Governor Kate Brown and Washington Governor Jay Inslee earlier this month.

4. Maine: Governor Janet Mills released a statement that acknowledged that the northern state had seen a dip in new COVID-19 cases, but has extended the state's stay-at-home order through May 31. Some non-essential businesses, including hair salons and auto dealerships, were allowed to resume service on May 1, and it seems that certain categories of businesses may be staggered in their reopening.

5. Louisiana: With New Orleans having faced a shortage of hospital beds for patients, Governor John Bel Edwards extended stay-at-home guidelines for all of Louisiana's parishes through May 15. Many non-essential businesses remain closed to the public, but many have been allowed to offer curbside delivery, and outdoor dining spaces at restaurants are available to people who wish to dine away from their homes.

CNN has published a list of up-to-date extensions of all states' stay-at-home orders.

Berić-Stojšić says that more extensions could occur in the future; in fact, in a perfect world, she says that Americans wouldn't get back to the way things were for almost a full year.

"I think it will take us another year to be able to breathe freely and return to a well-known routine," she says. "Until then, gradually we will return to our familiar circles of people; initially smaller gatherings, then larger… carefully considering information that is generated by scientists and researchers, and following guidelines and policies provided by the local, state, and federal public health practitioners."

As more information about the coronavirus pandemic develops, some of the information in this story may have changed since it was last updated. For the most up-to-date information on COVID-19, please visit the online resources provided by the CDC, WHO, and your local public health department. You can work to better protect yourself from COVID-19 by washing your hands, avoiding contact with sick individuals, and sanitizing your home, among other actions.

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