Lifting the COVID-19 Restrictions

Nearly half of the United States is in lockdown. Private practices are severely limiting services or closing their doors altogether. Some predict this could go on for months. But comments from President Donald Trump in recent briefings leave us wondering, will restrictions be eased sooner than later?

The reality is, we don’t know.

In a private online forum created by Aesthetic Authority and moderated by Medical Advisor Randolph Waldman, M.D., physicians shared their opinions Monday after President Trump’s briefing that suggest the shutdowns could end in a couple of weeks whether the virus has peaked or not.

“Others have previously suggested limiting the quarantine to the most vulnerable and to let this illness run through society to increase ‘collective immunity,’ Dr. Waldman writes. “This might mean that we will be able to open up with precautions in three to four weeks? Anyone else see the briefing and come away with a different feeling?”

Responses within the 85-member group ranged from hopeful to skeptical.

One member of our online group who asked to remain anonymous writes, “In my opinion, this virus is not containable in the United States until an immunization is available or herd immunity has occurred. Its transmission is far too efficient, and our society isn’t compliant in the same way as Korea or China. It will be like trying to outrun bad weather on a boat.”

Richard Gentile, M.D., a facial plastic surgeon in Northeast Ohio, says he is following the mortality rate, as the virus has affected populations across the world differently, but he is optimistic. “[The U.S.] may support a less isolating method of response if we know ICUs and morgues won’t be filling up.”

In yesterday’s Presidential Press Briefing, Deborah Birx, M.D., response coordinator for the White House Coronavirus Taskforce, said that following mortality data is critical.

“…when you’re in the midst of this level of fight — that many of the European countries are — following mortality data will give you the best insight right now on how the epidemic is proceeding in those countries.”

Dr. Birx made a point that nation-wide restrictions were a necessary starting point for efforts to control and understand the virus before being able to address need on a regional level.

“We went out with a very blunt force. I mean, we have to all be honest — we had to do that because we weren’t sure where the virus was and where it is going,” Dr. Birx said from the podium yesterday. “I think, over this week, we’re concentrated on figuring out exactly where the virus is and making projections about where it’s going and the impact of our mitigation pieces.”

Notably, when the time is up next week on the national “15 Days To Slow the Spread” initiative, various parts of the U.S. may begin lifting restrictions based on regional data. By all accounts, New York metro area will not be one of them.

“The New York metro area of New Jersey, New York City, and parts of Long Island have an attack rate close to 1 in a 1,000. This is five times what the other areas are seeing,” Dr. Birx said. “This is the group that needs to absolutely social distance and self-isolate at this time. Clearly the virus had been circulating there for a number of weeks to have this level of penetrance into the general community.”

As Dr. Waldman points out in our online forum, “The shelter in place was to give the defense systems time to ramp up. NYC [is] obviously overwhelmed but other areas seem to be getting time to ramp up.”

Case-in-point, while NYC is moving dermatology residents (including Dr. Waldman’s daughter) to medical floors in an all-hands-on-deck effort, “The rest of the country isn’t seeing the same thing. ICU beds are available in Kentucky,” Dr. Waldman tells Aesthetic Authority.

But we also know that New Yorkers who may be infected have left the region for other parts of the country. Will we experience the same as New York?

“We have different types of environments,” says Dr. Waldman.

In New York, life everywhere exists in close quarters. It’s public transportation and apartment buildings vs. driving and living separately in most other parts of the country, he says.

According to Dr. Birx, we may be able to systematically determine how to handle other areas in the U.S. on a geographical basis.

“…if we geographically get specific data by zip codes and counties, we’ll be able to approach this in a very laser-focused way, making sure that what we’re doing in each of those areas is absolutely appropriate for where they are in their own little bell-shaped curve.”

Dr. Gentile uses the .3% mortality rate in Germany to emphasize virus variability.

“…It is clear this virus does different things to different populations. We need to continue to examine data and decide on its lethality to our people. If we are consistently under 1% that suggests state-by-state evaluations can be made.”

Ultimately, says President Trump, the federal government will allow governors to make decisions for their individual states: “We’re giving the governors a lot of leeway.”

Even if and when restrictions are lifted, another anonymous plastic surgeon in our online group remains a proponent of continued social distancing efforts.

“…all of the data I have seen points to recommendations for increased, not decreased, social distancing efforts…. I also have no reason to doubt the professionalism of the head of public health at Hopkins.”

This physician’s comment refers to a recent Tweet made by Tom Inglesby, director of Hopkins Public Health: “To drop all these measures now would be to accept that COVID pts will get sick in extraordinary numbers all over the country, far beyond what the US health system could bear.”

Despite the desire and near future possibility to return to business as usual, one group member encourages surgeons not to rush it.

“Wait. Hold the line. Strict social distancing,” he advises. “Scenario plan now for gradually opening back up. Don’t start doing so, however, until we are clearly on the downward slope of the curve. This will happen.”