By ROB LAMBERTS, MD

Things have changed.

The governor has eased restrictions and now we can go to restaurants, go bowling, get tattoos, and visit many of the stores that were previously closed. Churches are now planning to meet again.

This leaves many of my patients wondering what to do. Is it OK to go to these stores, to get your hair done, to join the neighborhood pool, to go out to eat, to go to church? Is it safe to do now?

No. It’s not safe yet. You are at the same risk of catching coronavirus now that you were 2 weeks, or 1 month ago. The change in the policies in both Georgia and South Carolina were not due to a lessening of the risk of the infection; it is an economic decision. It was very reasonable to shut everything down when we didn’t know how full our hospitals, ICU’s, and ER’s would get with a surge in cases. It was important to “flatten the curve,” and that seems to have worked. We do have enough capacity right now to handle the number of critically ill people in our hospitals. But that could change.

So what will happen now that “stay at home” restrictions are going away? It’s very likely that the number of infected people will go up, as will the number of deaths. So why open things back up? Because we cannot keep everything shut down while we wait for 1-2 years for a vaccine to come out. The economy simply can’t sustain that, and people would suffer because of it (economically, emotionally, and physically). We need people working again, and we need to avoid a total collapse of our economy.

But again, do not think it’s now safer than it was before the governor’s decision. Do not think it’s not still important for high-risk people to remain isolated, for people to stop wearing masks, or to stop washing their hands. This virus has killed nearly 75,000 people in the U.S., and the rise in deaths is not seeming to slow at all. A vaccine is unlikely to come out in 2020, so we will have to adjust to the new normal of living in the shadow of this pandemic. It will take a very long time for things to resemble the way things were before this all started.

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By ANISH KOKA, MD (7)

Our strategy with nursing homes in the midst of the current pandemic is bad.  No, make that terrible. Nursing homes and other long term care facilities house some of our sickest patients in and it is apparent we have no cogent strategy to protect them. 

I attempted to reassure an anxious nursing home resident a few weeks ago. I told him that it appeared for now that the community level transmission in Philadelphia was low, and that I was optimistic we could keep residents safe with simple maneuvers like better hand hygiene, restricting visitors, as well as stricter policies with regards to keeping caregivers with symptoms home.  I was worried too, but optimistic.

I figured the larger medical community would be on the same page if someone did get COVID.  It made sense to me to be aggressive about testing staff and residents and quickly getting COVID-positive patients out of the nursing home.  So when I heard of the first patient that was positive in the nursing home, my heart sank, but it fell even further when I found out the COVID-positive patient was sent back from the hospital because they weren’t “sick enough” to be admitted.

This is exactly what we do with the general public when they arrive in the ER.  If you’re not sick enough, the best place for you to recover from COVID is at home, not the hospital.  But treating nursing home patients like everyone else is really not smart.  Long term care facilities are not designed with pandemics in mind.  They are basically converted dormitories with care staff ratios of 1:10.  Isolating patients in these facilities is close to impossible.  There are usually no flexible spaces in which to isolate residents, and the staff at these facilities are relatively lower-paid, poorly trained and ill-equipped to suddenly handle a patient with COVID that requires a significantly higher level of care than usual.

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By ADRIAN GROPPER, MD (9)

Until scientists discover a vaccine or treatment for COVID-19, our economy and our privacy will be at the mercy of imperfect technology used to manage the pandemic response.

Contact tracing, symptom capture and immunity assessment are essential tools for pandemic response, which can benefit from appropriate technology. However, the effectiveness of these tools is constrained by the privacy concerns inherent in mass surveillance. Lack of trust diminishes voluntary participation. Coerced surveillance can lead to hiding and to the injection of false information.

But it’s not a zero-sum game. The introduction of local community organizations as trusted intermediaries can improve participation, promote trust, and reduce the privacy impact of health and social surveillance.

Building Trust with Transparency

Privacy technology can complement surveillance technology when it drives adoption through trust borne of transparency and meaningful choice.

We can try to understand privacy technology from the perspective of decentralization. Decentralization keeps all personally identifiable information under the user’s control, therefore offering total transparency over its use and total choice over how it is used.

Ideally, managing contact tracing, testing, test interpretation, symptom reporting, health records, relationships, and location history should be decentralized. This information should be entirely under the control of the individual, and contribute only aggregated learning to the collective — using differential privacy, homomorphic encryption, and split learning.

While these technologies are still too immature and expensive to be useful for the present pandemic, current technology does not force a binary choice between absolute decentralization and coerced government surveillance. Partial decentralization of technology and technology policy at the level of a cooperative, community, or town can leverage the trust many have in their local relationships and the peace of mind that comes from the ability to choose what information to share with whom.

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