Why the White House guidelines for Opening Up America Again are so wimpy

The Trump Administration published a set of guidelines for restarting economic activity after the global pandemic. They’re so squishy that they’re meaningless.

This set of guidelines follows a dizzying set of stances from the President, starting with Trump’s statement Tuesday that he had the absolute authority to order states to “reopen.” That flew in the face of the Tenth Amendment, which says that any power not explicitly reserved to the president belongs to the states — and local regulation of public health is included. After likening states banding together to make their own decisions to a mutiny, Trump has now done a complete about-face and now says it is up to the states to decide when and how to open.

Next came the guidelines, announced yesterday. Let’s take a look.

What are the criteria?

The guidelines begin with “Gating Criteria” that indicate when it will be safe to relax restrictions. They provide almost unlimited leeway. Here they are, with my comments.

SYMPTOMS

Downward trajectory of influenza-like illnesses (ILI) reported within a 14-day period
AND
Downward trajectory of covid-like syndromic cases reported within a 14-day period

CASES

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)

HOSPITALS

Treat all patients without crisis care
AND
Robust testing program in place for at-risk healthcare workers, including emerging antibody testing

State and local officials may need to tailor the application of these criteria to local circumstances . . .

Do states even aggregate reports of influenza-like illnesses? And what is a “downward trajectory?” For example, is a 1% decrease in 10 of 14 days with increases on the other days a downward trajectory? “Robust” is a classic weasel word — it’s not measurable and means nothing. And at the current time, there is no dependable antibody testing.

Just in case this isn’t squishy enough for you, the final clause says that states can do whatever they want.

These guidelines are a combination of ill-defined criteria and hoped-for tests that do not exist yet. Far from “absolute authority,” these loose criteria reflect abdication of authority.

The guidelines also tell states what they need to do. Those guidelines are slightly less vague, but imply that states are on their own to get the resources they need. For example [my comments in brackets]:

Ability to quickly set up safe and efficient screening and testing sites for symptomatic individuals and trace contacts of COVID+ results

Ensure sentinel surveillance sites are screening for asymptomatic cases and contacts for COVID+ results are traced [This is passive voice — who and how should states trace contacts?]

Protect the health and safety of workers in critical industries [How?]

Protect employees and users of mass transit [How?]

What are the guidelines?

The document continues with guidelines in “Phase One” for states and regions that satisfy the vague criteria. These are, at best, aspirational. For example:

INDIVIDUALS

Members of households with vulnerable residents should be aware that by returning to work or other environments where distancing is not practical, they could carry the virus back home. [Is “awareness” a guideline?]

Precautions should be taken to isolate from vulnerable residents. [What precautions? This is passive.]

EMPLOYERS

Continue to ENCOURAGE TELEWORK, whenever possible and feasible with business operations. [What does “encourage” mean? And is it up to businesses to determine if telework is “feasible”?]

Strongly consider SPECIAL ACCOMMODATIONS for personnel who are members of a VULNERABLE POPULATION. [This is so vague as to be meaningless. Any employer could easily say they “strongly considered” special accommodations, and then decided to do nothing.]

SPECIFIC TYPES OF EMPLOYERS

LARGE VENUES (e.g., sit-down dining, movie theaters, sporting venues, places of worship) can operate under strict physical distancing protocols. [What are those protocols?]

GYMS can open if they adhere to strict physical distancing and sanitation protocols. [Have you ever been to a gym? It’s a breeding ground for pathogens. Sweat is everywhere. Will someone wipe down each machine as soon as someone uses it? What does a yoga class with strict physical distancing protocols look like?]

The document continues with descriptions of protocols in Phase Two and Phase Three, which are defined as follows:

Phase Two

For States and Regions with no evidence of a rebound and that satisfy the gating criteria a second time

Phase Three

For States and Regions with no evidence of a rebound and that satisfy the gating criteria a third time

There are going to be rebounds. Even if there are not, what does it mean to satisfy the criteria “a second time?” Does that mean for a second 14-day period? A second month? Should the criteria become more stringent in the second and third phase, rather than remaining the same?

Trump can’t decide whether to be king or a figurehead

Why publish these empty guidelines? It all has to do with the difference between leadership and “leadership,” the role of the federal government, and blame.

We are at this moment caught in a deadly trap between Trump’s desire to be seen as an authoritative, masterful, powerful leader, and to avoid responsibility for the devastation caused by a virus, an enemy that cannot be reasoned with or demonized. If you’re in charge, you get both credit and blame. If you’re not, you look weak. There’s no easy out.

In my imaginary scenario of leadership in this situation, the president would federalize the acquisition and distribution of supplies and support the activities of federal public health agencies like the CDC. This would prevent states bidding against each other for equipment, and would establish a source for accredited testing supplies and would put the full force of the federal government behind acquiring and distributing them.

However, all implementation would be local, because each state and locality would be responsible for decisions based on what is happening on the ground — rates of transmission, capacity of hospitals, and contact tracing.

Despite the self-aggrandizing daily fights with reporters, these vague guidelines reflect a different perspective on leadership. States are free to interpret them any way they want. States are on their own for acquisition of supplies and testing equipment. They are on their own for decisions on how to open up the economy. The guidelines, as written, allow plenty of room for states to make whatever decisions they want — and for Trump to blame them for any waves of death that result. “We told them what to do, and they didn’t listen,” he can say.

Should the guidelines be firmer? Wrong question. I think these decisions should be up to the states, with intelligence and modeling provided by economic and health professionals. What we need is not better guidelines. What we need is a plan that states can actually follow, based on science, and the supplies to implement it.

I’m not holding my breath. And if we continue on this reckless path, far too many of us may not have any breath left to hold.

4 responses to “Why the White House guidelines for Opening Up America Again are so wimpy

  1. Did you investigate the meaning of “robust” in statistics (aka testing)? I bet you will find a specialized meaning, rather than a weasel word.

    The guidelines suck, but they are the best we have. They are high-level and lack triggers (when we ought to take action), but nothing I have seen has include triggers. I include my guidance in the “missing triggers” pile and that is the only pile.

    It is interesting to see the interplay between states and the feds. Both sides are acting ridiculous (see NY governor and President as the leaders of the insanity). It is not clear who is running the show, who can (Constitutionally), and who ought to (to be effective).

    This is a good start: ” I think these decisions should be up to the states, with intelligence and modeling provided by economic and health professionals. What we need is not better guidelines. What we need is a plan that states can actually follow, based on science, and the supplies to implement it.’ It is to note that neither economic nor health professionals nor any other expert makes policies. The science can inform policy, but cannot make it. That’s basic Policy 101.

    It’s time to stop with conflicting, confusing, and contradictory “guidance” from experts (real ones, like the CDC and the WHO). A lot of what is being reported is incorrect in the reporting (that is on the journalists) and the content (that is on we the “experts”). A lot is unknown (the lack of widespread antibody testing is not concerning, by the way), we need to be honest and say when we are guessing. And everything needs to target triggers, if you know X, you will do Y.

    Serving the world from Kingman, AZ USA.

    Be well and wise,
    Norman

  2. A better read of the Tenth Amendment is put it in a process flow.

    Limited powers specifically listed in the Constitution are given by the people and divided between the federal government (the three branches, not the President, by the way, which is merely a part of a branch) as specified in the Constitution and the remainder (read almost everything) is retained by the people. If it is not specified, it is the people’s and was not given up.

    It really is that simple.

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