As park and recreation professionals work towards a path to recovery from the coronavirus disease 2019 (COVID-19) pandemic, it is essential to take a thoughtful and methodical approach to reinstating operations that protects public health and safety. This section of the Path to Recovery Framework includes guidance on the core indicators that must be met prior to transitioning to reopening.
The World Health Organization as well as the White House Coronavirus Task Force and Centers for Disease Control and Prevention (CDC) have identified core indicators that communities impacted by the COVID-19 pandemic should meet as they begin to lift mitigation measures in a phased approach. Progress in meeting these indicators should be tracked and monitored to inform and guide the timeline of lifting mitigation and control measures that have been put in place. Communication from state and local public health and government officials is critical for sharing progress on meeting indicators as well as the status of mitigation measures. While state and local public health officials will assume the main responsibility of monitoring these indicators and directing decisions related to reopening, local park and recreation professionals should be aware of the conditions that should be present in communities prior to implementing a phased reopening plan.
Below we present the current guidance from the World Health Organization as well as the White House Coronavirus Task Force and CDC. Your state and local government may decide to follow variations of either or both of these. Knowing what measures need to be in place, can help you determine the safest way to phase your reopening plans (details to be provided in Part 5 of the Path to Recovery Framework).
According to the World Health Organization, communities should meet six indicators including:
- Confirming that transmission of the virus has been controlled.
- Ensuring the health systems are capable of testing, isolating and treating every case of COVID-19 and tracing every contact.
- Making sure that outbreak risks are minimized in health facilities and places that serve vulnerable populations.
- Putting preventative measures in workplaces, schools and other essential places.
- Managing risk of imported cases from travelers.
- Fully educating, engaging and empowering communities to adjust to these critical measures as part of everyday life.
According to the White House Coronavirus Task Force and CDC, communities should meet the following gating criteria prior to lifting mitigation measures, recognizing that state and local governments may need to tailor the application of these to local circumstances:
- Downward trajectory in influenza-like illnesses and COVID-like symptoms within a 14-day period.
- Downward trajectory of documented cases or positive tests within a 14-day period.
- Ability of hospitals to treat all patients and have a robust testing program in place for at-risk essential healthcare workers.
- While not specified as official gating criteria, the plan also calls on state and local officials to be prepared to provide comprehensive testing and contact tracing, have capacity in the health system and personal protective equipment for health workers, and plans in place to protect public health.
Specific measures identified by WHO and the White House/CDC include:
World Health Organization Core Indicators
1. COVID-19 transmission is controlled to a level of sporadic cases and clusters of cases, all from known contacts or travelers and the incidence of new cases should be maintained at a level that the health system can manage with substantial clinical care capacity in reserve.
2. Sufficient health system and public health capacities are in place to enable the major shift from detecting and treating mainly serious cases to detecting and isolating all cases, irrespective of severity and origin:
- Detection: suspect cases should be detected quickly after symptom onset through active case finding, self-reporting, entry screening, and other approaches.
- Testing: all suspected cases should have test results within 24 hours of identification and sampling, and there would be sufficient capacity to verify the virus-free status of patients who have recovered.
- Isolation: all confirmed cases could be effectively isolated immediately (in hospitals, and/or designated housing for mild and moderate cases, or at home with sufficient support if designated housing is not available) and until they are no longer infectious.
- Quarantine: all close contacts could be traced, quarantined and monitored for 14 days, whether in specialized accommodation or self-quarantine. Monitoring and support can be done through a combination of visits by community volunteers, phone calls or messaging.
3. Outbreak risks in high-vulnerability settings are minimized, which requires all major drivers and/or amplifiers of COVID-19 transmission to have been identified, with appropriate measures in place to minimize the risk of new outbreaks and transmission (e.g. appropriate infection prevention and control, and provision of personal protective equipment in health care facilities and residential care settings).
4. Workplace preventative measures are established to reduce risk, including the appropriate directives and capacities to promote and enable standard COVID-19 prevention measures in terms of physical distancing, hand washing, respiratory etiquette and potentially, temperature monitoring.
5. Risk of cases from travelers managed through an analysis of the likely origin and routes of importations, and measures would be in place to rapidly detect and manage suspected cases among travelers (including the capacity to quarantine individuals arriving from areas with high community transmission).
6. Communities are fully engaged and understand that the transition entails a major shift, from detecting and treating only serious cases to detecting and isolating all cases, that behavioral prevention measures must be maintained, and that all individuals have key roles in enabling and in some cases implementing new control measures.
White House Coronavirus Task Force & CDC State or Regional Gating Criteria
Downward trajectory of influenza-like illnesses (ILI) reported within a 14-day period, and downward trajectory of COVID-like symptomatic cases reported within a 14-day period.
Downward trajectory of documented cases within a 14-day period, or downward trajectory of positive tests as a percent of total tests within a 14-day period (flat or increasing volume of tests).
Treat all patients without crisis care, and robust testing program in place for at-risk healthcare workers, including emerging antibody testing.
Core State Preparedness Responsibilities:
- Testing and Contact Tracing
- Ability to quickly set up safe and efficient screening and testing sites for symptomatic individuals and tract contacts of COVID positive results.
- Ability to test Symptomatic/ILI-indicated persons for COVID and trace contacts of COVID positive results.
- Ensure surveillance sites are screening for asymptomatic cases and contacts for COVID positive results are traced (sites operate at locations that serve older individuals, people living in lower-income neighborhoods, people of color, and indigenous people).
- Healthcare System Capacity
- Ability to quickly and independently supply sufficient Personal Protective Equipment and critical medical equipment to handle dramatic surge in need.
- Ability to surge ICU capacity.
- Protect the health and safety of workers in critical industries.
- Protect the health and safety of those living and working in high-risk facilities (e.g., senior center facilities).
- Protect employees and users of mass transit.
- Advise citizens regarding protocols for social distancing and face coverings.
- Monitor conditions and immediately take steps to limit and mitigate any rebounds or outbreaks by restarting a phase or returning to an earlier phase, depending on severity.
Guidelines for Individuals
Continue to adhere to state and local guidance as well as complimentary CDC guidance, particularly with respect to face coverings.
- Continue to practice good hygiene.
- Wash your hands with soap and water or use hand sanitizer, especially after touching frequently used items or surfaces.
- Avoid touching your face.
- Sneeze or cough into a tissue, or the inside of your elbow.
- Disinfect frequently used items and surfaces as much as possible.
- Strongly consider using face coverings while in public, and particularly when using mass transit
- People who feel sick should stay home.
- Do not go to work or school.
- Contact and follow the advice of your medical provider.
Decisions about when to transition must be evidence-based, data-driven and implemented incrementally. It is essential to have real-time, accurate data on the testing of suspected cases, the nature and isolation of all confirmed cases, the number of contacts per case and completeness of tracing, and the dynamic capacity of health systems to deal with COVID-19 cases. To reduce the risk of new outbreaks, measures should be lifted in a phased, stepwise manner based on an assessment of the epidemiological risks and socioeconomic benefits of lifting restrictions on different workplaces, educational institutions and social activities.