AKRON — In 12 days, Ohioans are set to launch an extraordinary and precarious experiment to see if we can safely return to work, to our doctors’ offices and to other parts of ordinary life amid a pandemic that some say could stretch into 2022.
State leaders caution this will be a slow, science-guided journey into an altered reality of face masks, hand-washing stations, physical distancing and cleaning, cleaning, cleaning.
But not everything Ohio leaders have said they need to get the public moving again is in place, said Terrence O’Sullivan, who teaches at the University of Akron and is director for the Center for Emergency Management and Homeland Security Policy Research.
“Here’s the problem: We still are flying blind to some extent because of testing. We’re still way behind on the testing,” he said.
Testing, or a lack of it, has been an issue from the start of the coronavirus. But there’s an emerging scientific complication that makes testing even more important, he said. The virus is spreading through large numbers of infected people who never have a fever, cough or other symptoms, he said.
“Asymptomatic carriers may be the biggest transmitters of all,” he said.
The Centers for Disease Control and Prevention, which has suggested 25% of people infected by COVID-19 may never show symptoms, recently launched an investigation in Boston after officials there tested everyone in a single homeless shelter. Of 397 people tested, 146 were infected with COVID-19. None showed any signs of illness.
Closer to home, Ohio Gov. Mike DeWine on Friday revealed similar asymptomatic test results at Marion Correctional Institution, a prison that houses about 2,600 men 100 miles southwest of Akron.
After a coronavirus outbreak there, the state increased testing and discovered 365 inmates and 99 staff members are infected.
On Friday, 26 inmates were hospitalized.
In one of the prison’s dorms, DeWine said that all 152 men tested positive for COVID-19, yet 60 showed no virus symptoms.
It’s not yet clear why some people infected by COVID-19 are devastated by symptoms, while others never realize they have the disease. Underlying health issues explain only part of the phenomenon.
But without widespread testing, it’s impossible to know how far-reaching the infection is in Ohio and how many Ohioans may be unknowingly spreading the virus because they don’t feel sick, O’Sullivan said.
Additionally, a large number of asymptomatic carriers could mean some measures taken by essential businesses that have kept operating during the pandemic — like daily body temperature checks of nursing homes, factory and restaurant workers — may not be as effective at stopping the spread as once hoped, he said.
About six weeks into the pandemic, less than 80,000 of 11.7 million Ohioans had been tested. The vast majority of those were patients hospitalized with suspected coronavirus, health care workers, first responders and the medically fragile.
In the Akron region, testing is limited and mostly available at hospitals and some nursing homes.
Summit County Public Health Commissioner Donna Skoda said local officials were unable to set up community testing sites here because they lacked both the supplies and ability to test.
“We went through a lot of the planning process to find out there is not testing available at this time,” she said, adding that could change if testing becomes available.
The international supply chain of chemicals, swabs and equipment to perform the tests was broken by the pandemic months ago and is yet to be repaired, DeWine and others have said.
President Donald Trump, meanwhile, has so far declined to exercise his power to order U.S. manufacturers to produce COVID-19 testing supplies.
And Ohio leaders’ efforts to ramp up testing with state-manufactured supplies and innovations — as it has with personal protective equipment (PPE) — has not yet yielded anything close to widespread testing.
Tara C. Smith, a professor of epidemiology at Kent State University, said she’s waiting to hear details of Ohio’s plan to reopen, but is concerned it’s slated to begin so soon.
Citing a World Health Organization plan released last week, Smith said Ohio meets few of the conditions needed to open up.
Without large-scale testing, Ohio can’t do contact tracing, which involves notifying everyone an infected person has come into contact with so that they can self-isolate and stop the spread before a hot spot emerges.
“We don’t have enough PPE for first responders, much less for average individuals who may want to use surgical masks rather than homemade cloth masks,” Smith wrote in an email to the Beacon Journal. “Many still are lacking other basics that individuals need to protect themselves: disinfectants, hand sanitizer.”
Getting back to work
DeWine announced the May 1 target for the state to enter a new phase of its response to COVID-19 on Thursday as protesters in Columbus and a few other state capitals last week demanded stay-at-home orders be lifted.
Some said they believed the danger of the pandemic has been overblown; others just wanted to get back to work.
Ohio’s unemployment rate hit a five-year high in March as the state lost 39,700 jobs. But the worst damage from the coronavirus outbreak could come in the months ahead, when unemployment is expected to climb into the double digits.
Steve Millard, president and chief executive officer of the Greater Akron Chamber, said businesses want to reopen, but they’re also cautious about moving too fast.
Millard also put increased testing at the top of what businesses need to reopen.
“We must have the ability to reliably test and test in high enough quantities, so we know who has it,” he said.
Business also needs to understand the rules, restrictions and timing of Ohio’s gradual reopening.
“Our businesses will need to be able to plan … figuring how fast they can scale up,” Millard said. “There must be a framework of expectations.”
Some businesses may remain closed longer than they need to and wait for supply chains to get geared up again.
Many business owners have found a way to reopen once, Millard said. But they cannot survive repeatedly opening and closing if Ohio sees waves of coronavirus reappear.
O’Sullivan, too, said it’s grim for the economy.
Many businesses across the country have likely already gone bankrupt during the coronavirus crisis, he said, but have been unable to file paperwork because of the shutdown.
Making tough choices
Tough choices, even with a surge of new testing, are ahead.
Schools will almost certainly remain closed until fall, and it’s uncertain they will open even then, he said.
Sports arenas might reopen, but only if they are willing to seat people 6 feet apart and operate at about 20% capacity, he said.
And when businesses do begin to reopen, will employees with underlying health conditions be forced to choose between their job and their health?
“People are starting to think about that at the expert level, but not saying out loud because of the harsh implication,” O’Sullivan said.
DeWine last week said that older workers and those with asthma, diabetes or other conditions that put them at a higher risk of death from coronavirus will have to work with their employers and weigh the risk of their situations.
Those who can work from home, DeWine said, should continue to do so.
O’Sullivan said it’s clear that neither the nation nor Ohio can stay home until a vaccine is ready.
“At the moment, Ohio is ideally suited for an early experiment with reestablishing some normalcy because people rightly perceive leadership has been competent,” O’Sullivan said.
But, he warned, there is risk if Ohio moves too quickly and there’s a spike in new COVID-19 cases.
“If people lose trust in leadership,” O’Sullivan said, “they are in big trouble because then, even good advice is ignored.”