Some governors blindside front-line staff with abrupt reopening plans

Governors preparing to roll back restrictions put in place to slow the spread of the novel coronavirus are in some cases acting without the input and against the wishes of their own medical and emergency management staff.

Georgia's Republican governor, Brian Kemp, announced he would let tattoo parlors, hair salons and bowling alleys reopen without receiving guidance from the panel of doctors tapped to advise him and without giving advance notice to regional health departments responsible for carrying out his orders, according to physicians and state officials.

In Utah, the governor lifted a statewide lockdown on elective procedures before his medical supply team had finished estimating how quickly hospitals would exhaust their supply of personal protective equipment, according to members of the state's response team.

And plans to ease restrictions on economic activity and public assembly in Tennessee have been met by dread among emergency management officials, who are in "complete disbelief that we are reopening the state," according to a person involved in the planning who, like others, spoke on the condition of anonymity for fear of professional retribution.

In these states, among those moving fastest to jump-start idle economies, plans are proceeding without the full approval of medical professionals and emergency response officials closest to the ground-level unfolding of the outbreak, which has claimed nearly 50,000 lives in the United States. The quest by certain governors to reopen by May 1 - the date favored by President Donald Trump - has blindsided some of the officials advising them.

Kemp, for example, did not seek consensus among the doctors on his task force before proceeding with his reopening plan, according to one of its members, Andrew Reisman, who is president of the Medical Association of Georgia.

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Kemp and other governors pursuing aggressive reopening plans say they are following data-driven strategies in line with White House guidelines that make a downward trajectory of new cases in a 14-day period a condition of a phased reopening.

"Our next measured step is driven by data and guided by state public health officials," Kemp said this week when Trump, after initially cheering efforts to end lockdowns before May 1, second-guessed Georgia's approach. The governor's office did not respond to a request for comment.

The apparent rush in Georgia and other states has alarmed some local leaders, who fear political considerations are overriding detailed assessments of the data.

"I have great concerns about federal and some state pressure to reopen the economy without the guidance of the public-health data," said Erin Mendenhall, the Democratic mayor of Salt Lake City. "No one doubts the gravity of this economic crisis, but the cost of human life is also grave."

She added: "I think politics permeates crisis. And this crisis we are in is not exempt from that."

Reisman said Kemp's physician task force had grown less active following an initial burst of activity about two weeks ago. Its chairman, Republican state Sen. Ben Watson, who is a physician, emphasized that the state's stay-at-home order continues through the end of the month and until May 13 for vulnerable populations.

Epidemiologists said the Trump administration's guidelines are so vague as to sanction potentially any strategy, no matter how hasty.

In Tennessee, Republican Gov. Bill Lee this week hailed a "steady decline in the growth rate" of new cases, explaining why he would begin a phased reopening May 1.

But arriving at the state's growth rate by dividing new cases by total cases is off the mark, said Joshua Epstein, an epidemiologist at New York University. And the calculation has also raised eyebrows internally, according to an official familiar with the state's planning.

Along with metrics such as hospitalizations, states should simply be tracking new cases per day, Epstein said, and looking to see whether they are rising or falling. In Tennessee, it is not yet consistently falling, even if the percentage growth is diminishing.

"The guidelines are tremendously vague in many respects, but in the cases they're not vague, they're certainly not being satisfied by these states," Epstein said.

A state medical officer in Tennessee, who spoke on the condition of anonymity because the official was not authorized to discuss internal deliberations, confirmed the virus growth rate was the figure informing the state's plans, while also saying discussions were ongoing about the most reliable measurements.

Tennessee's approach allows local authorities to maintain stricter orders even as statewide restrictions are rolled back. Health officials in Shelby County, which includes Memphis, said the areawould not be ready to reopen May 1. That view was shared by Memphis Mayor Jim Strickland, a Democrat, whose city is home to the state's largest African-American community, which has been disproportionately affected by covid-19, the disease caused by the coronavirus.

Some local orders will also still stand in Colorado, where the governor, Jared Polis, is among the Democrats moving fastest to end statewide orders, saying Thursday he was counting on "personal responsibility" when businesses gain permission to reopen at limited capacity Monday.

Polis also refuted his own covid-19 incident commander, Scott Bookman, who just days earlier had told reporters the state would not reopen "until we have the capacity to make everyone safe." By that metric, Polis said, "we would have to be closed forever."

Asked for input on the governor's plan last week, Colorado's association of local public health agencies drafted guidance that the reopening should not start until all symptomatic people can be tested and all cases monitored.

Denver Mayor Michael Hancock, a Democrat, said restrictions in his city could last longer, warning, "This will be a different summer for those of us here in Denver."

In Georgia and South Carolina, by contrast, statewide directives lifting restrictions on businesses preempt local orders, incensing mayors of some hard-hit cities. Atlanta Mayor Keisha Lance Bottoms, a Democrat, who has decried the governor's decision, on Wednesday posted a tweet of a text message she received referring to her by a racist epithet and telling her to "just shut up and reopen Atlanta!"

The Atlanta mayor's trepidation about allowing a range of businesses to reopen Friday - and others, including movie theaters and dine-in restaurants, on Monday - was shared by regional health departments.

Officials in two districts said they learned of the governor's plans when he announced them publicly at the start of the week.

"We found out from the announcement," said Dave Palmer, a spokesman for a regional department covering a northeastern expanse of the state. He said the district is committed to following the governor's directive, including to ramp up testing, which has lagged behind other states.

The breakdown in communication and planning runs deeper, according to officials in other Georgia health districts who spoke on the condition of anonymity because they feared losing funding from the state.

An official in one district said there wasn't proper infrastructure for the recent rollout of a testing hotline required by the state, forcing health workers to scramble and use their cellphones, missing a number of calls. Similarly, districts learned only the night before that they were being required to extend their weekday hours at testing sites and add a half day on Saturday.

Reisman, the medical association president, said he understood the governor's impulse to move quickly. He also said the sweeping stay-at-home orders were never taken especially seriously by the public. "Georgia was never closed for business, in my opinion," said the doctor, who recounted a recent visit to a Home Depot in Gainesville, Georgia, where "none of the employees were wearing a mask, and no one was social distancing."

"So when I hear the governor say, 'OK, you can get your hair cut or your nails done, you can go to the gym, and I have confidence owners of these places are going to do their utmost to sanitize,' I don't feel like it's hugely different," Reisman said.

In Utah, a spokesman for the state's covid-19 task force acknowledged that "analysts are still working on what the appropriate 90-day moving average burn rate for PPE should be."

"But because of current supplies and our close monitoring of demand, we feel that it is actually most helpful to relax standards on elective procedures so that flow can factor into our burn rate," task forcespokesman Paul Edwards said. "We can always dial this back down if necessary."

In South Carolina, reopening plans are being devised by the governor, Republican Henry McMaster, and "the team they've assembled with the private sector," said Derrec Becker, a spokesman for the state's emergency management division. At McMaster's news conference Monday announcing that he would let certain businesses reopen, the state's epidemiologist, Linda Bell, continued to ask that "people only participate in essential activities."

Bell noted that the state has not seen a “consistent decline,” only “a plateau for a few days.”