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Gov. Eric Holcomb announced that Indiana is now moving to Stage 5 of its opening amid the coronavirus pandemic. Here’s what happens now.
Two days after Gov. Eric Holcomb announced Indiana would move to Stage 5 — the final phase of reopening — the state logged 1,195 new cases of coronavirus, as public health experts said they feared cases could rise in the wake of his decision.
Giving restaurants and bars the green light to operate at full capacity — albeit while adhering to social distancing — puts even more of an onus on individuals to do their part to stem viral spread, many public health experts agree.
Even though Holcomb also announced he would continue the state’s mask mandate, a measure that has drawn its share of critics, some may interpret the reopening announcement as a statement that they no longer have to worry so much about the virus.
“The risk is that people will see…a change in state as an invitation to relax their own diligence and personal behavior,” said Joshua Vest, professor of health policy and management at the Fairbanks School of Public Health at IUPUI. “That’s a big risk.”
Governor Eric Holcomb, right, elbow bumps MonoSol President and CEO P. Scott Bening after speaking at the MonoSol Lebanon Facility ribbon cutting, Thursday, July 16, 2020. (Photo: Kelly Wilkinson/IndyStar)
The lack of a vaccine and limited therapies to COVID-19 means we all need to do what we can to control the spread of the virus, even though state has now entered the final stage of reopening, he added.
As a government official, Holcomb has to balance the desires of many different segments of the population in deciding how to respond to the pandemic, said Kim Irwin, administrator of the Indiana Public Health Association, a local affiliate of the American Public Health Association.
“There’s a lot of complexities and it’s hard to make a decision and pick an answer and reflect all of those complexities,” she said. “This is the reality of the situation that we’re in, given current politics and community appreciation for the science and data.”
Mixed messages on the virus’ dangers
But experts and states officials do not always send a clear message about the danger the virus poses, potentially confusing people, said Pamela Aaltonen, a professor emerita at Purdue University and the immediate past president of the American Public Health Association.
On the one hand, earlier this week the Centers for Disease Control and Prevention recommended against trick-or-treating. On the other, Indiana restaurants can open at full capacity.
Local and state health officials will have to work to clarify the message that wearing masks, watching one’s distance and washing hands are as important as ever to control a virus that has led to more than 3,300 deaths in Indiana and over 114,200 cases.
“I do think people will struggle to try to make sense of that…. We have been challenged to communicate well during this pandemic and not have mixed or muddled messages,” Aaltonen said. “My concern is does this open the door for people to think oh, I don’t need to be quite so vigilant.”
Even those in the medical field who approve of the move warn that Indiana residents should not be complacent when it comes to the virus.
Positivity rates one factor in the decision
Indiana State Medical Association president Dr. Roberto Darroca said in an emailed statement that the state positivity rate for cases has declined to less than 4%. It was at 6.4% when Holcomb first issued the mask mandate.
The positivity rate provides a window into how pervasive the virus is in a community, measuring the total number of tests divided by the number of people who test positivity. Higher positivity rates suggest greater virus circulation and or too little testing. The World Health Organization has said that governments not reopen until the positivity rate is lower than 5% for at least two weeks.
Given the current positivity rate, Darroca said, the medical association supports Holcomb’s decision to move ahead with the state’s Back on Track plan.
“But we’re not out of the woods yet,” he added. He urged people to follow all the now-standard precautions and get their flu shots as well to guard against that virus.
And, the Stage 5 that Holcomb announced earlier this week is not necessarily the same as what life was like before coronavirus entered our vocabulary, said Dr. Gabriel Bosslet, a pulmonologist at the Indiana University School of Medicine who runs the Hoosier COVID-19 Update, a Facebook page on which he tracks the virus.
What Stage 5 rules mean
Under the Stage 5 rules, people must social distance in bars and customers must be seated at tables or counters. Other establishments must also adhere to physical distancing regulations, raising the question whether that will impact their capacity.
“People think Stage 5 means we’re wide open. The fact is we’re not,” he said.
While Bosslet said he would have preferred the state stay at Stage 4.5, he added that things have gone better since the state started reopening in late spring than he would have expected. Cases have gone up but the number of hospitalizations has remained manageable across the state.
A lone bicyclist rides past the shuttered Hi Fi in Fountain Square, which shows music from indie artists, Indianapolis, Friday, March 20, 2020. The recent coronavirus threat has kept many locals indoors, with grocery stores and only a few local eateries and places to buy alcohol remaining open for carry out service. (Photo: Robert Scheer/IndyStar)
Going to Stage 5 could prove risky, public health experts agree. Bars and gyms are environments in which it’s harder to social distance and people are less likely to wear masks and more likely to mix with those from other households, Vest said.
“It sounds nice to say let’s say just try it out and see what happens. That could come with a cost – increased transmissions, increased infections,” Vest said. “There are many negative outcomes that could occur.”
In fact, moving to a new stage is likely to translate into an increase in cases, said Dr. Amesh Adalja, a senior scholar with the Johns Hopkins Center for Health Security.
Responding to uptick in cases, if necessary
That fact in and of itself does not necessarily mean that a state can’t move forward. Rather, state officials should insure they have the capacity to perform sufficient testing and contact tracing to handle any uptick in cases that follows rolling back restrictions, he added. In addition, the state must issue clear guidance for businesses as to how they should operate in this new stage.
“If you go to full occupancy, as close to normal as possible, you have to anticipate that you’re going to get cases, so it shouldn’t be surprising,” he said. “You can open these things, you can put in place precautions but you’re going to get cases.”
The lower the positivity rate, the easier it is to go to additional capacity, Adalja said.
State officials also need to be poised to act quickly should they see any key statistics trend in a negative direction, he added. Rather than completely backtrack, health officials may find ways to intervene to prevent whatever activities are driving the new infections, he said, a traditional harm reduction approach.
Still, others worry that reversing any of the reopening measures — even if the numbers support that move — could prove difficult.
No matter what happens, Bosslet said, it’s clear that Stage 5 is not the end of the road.
“In looking at what Stage 5 means, there’s going to have to be Stage 6 — normality,” he said.
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