April 2020 Although we are currently and squarely in Phase 1 of our region’s COVID-19 response, we should be constantly looking to take steps to emerge from the crisis and resume normal life—while preventing steps backward in the fight against COVID-19. As a community, the response of not only our jurisdiction, but that of the region, will determine the course of the disease. As such, the document will address both Polk County and well as the response occurring in our region. This planning document will focus on the current state of our community as well as look forward to providing guidance and framework on how we move into Phase 2 – Recovery.

Triggers for Moving to Recovery Phase

As the community has responded to COVID-19, focusing on embracing changes that have created improvements and efficiencies. As the community prepares to reopen, it must have confidence that it is prepared to do so. Following the response plan, the community should not proceed into the Recovery Phase until the following four elements are achieved:

Sustained reduction in cases for at least 14 days
Hospitals are able to treat all patients with COVID-19 without crisis standards of care – including monitoring available beds and COVID cases in the hospital.
All symptomatic people can be tested – utilization of CMH drive thru clinic and health department testing.
Public health can maintain active case and contact isolation and monitoring including the number of residents in quarantine.

Sustained reduction in cases for at least 14 days

As the community has passed the first month of disease, data is becoming available to inform our understanding of the spread and progress of the disease. Through the first month of our community’s response, there has been cautious optimism that we have been able to avoid the explosive growth of the disease that some communities have experienced. During March, the progress of the spread of disease has been low. Polk County Health Center will continue to closely monitor and report relevant metrics on this progress on an ongoing basis.

Hospitals are able to treat all patients with COVID-19 without crisis standard of care

If there is growth of total and active cases within the community, there will be increasing pressure on the healthcare system. This is a primary concern and focus on the community’s response to COVID-19. Exceeding this capacity has a detrimental effect on the community. Currently, hospitals have been able to treat all patients with COVID-19. Polk County Health Center will work with CMH to determine bed capacity as well as total number of COVID patients hospitalized and when threshold limits are reached.

All symptomatic people can be tested

Testing has significantly improved since the start of the outbreak. During the first few weeks, testing was extremely limited and the turnaround time for results was exceedingly long (with some test results taking greater than two weeks). More recently, testing capacity has significantly increased and the turnaround time for results has significantly decreased. Using a combination of government and private laboratories, test results are provided between 1 and 3 days. Currently, there is sufficient testing availability to meet the need for all symptomatic people to be tested. As the community is reopened, more testing and quicker test results is likely needed. Polk County Health Center will work with regional partners including the Springfield/Greene County Health Department as tests become available that produce results in less than 24 hours

Public health can maintain active case and contact isolation and monitoring

Currently, public health can maintain active case and contact isolation and monitoring. As was previously discussed, our department has taken steps to dramatically increase the capacity to conduct epidemiology activities in response to COVID-19. For the foreseeable future, case investigation, isolation, and quarantine can be maintained.

Regional Considerations

As Polk County moves towards reopening the community, the spread of and response to COVID-19 throughout the region must be taken into consideration. There are differing capacities and capabilities throughout the region to effectively respond to the testing, public health, healthcare, and community needs to combat COVID-19. As such, community leaders and policy makers will need to review information beyond Polk County. Data on the spread of disease and other key measures will also be presented regularly to community partners.

Phase 2: Recovery

During Phase 2, the community will take steps to reopen and recover, while still implementing multiple measures to check the spread of disease. When reopening the community, it is vital that it occurs with ultimate regard for maintaining life and reducing morbidity while balancing the vital need to restart the economy. If a community is reopened too aggressively, the virus can spread quickly, overwhelming the healthcare and public health systems, nullifying much of the work and community sacrifice that has been made. If reopened too slowly and conservatively, it will become increasingly more challenging for the economy to recover, making the long-term impact of the virus even more devastating. It is also important that individual communities and counties in our region take these steps in a coordinated manner, adjusting as needed. Throughout the duration of Recovery, vigilant surveillance of available data is required. Using data to drive decision-making in reopening the community will allow for a balanced, responsive approach. Within implementation of the Recovery Phase there are three key elements:

Adjust physical distancing strategies
Maintain focus on testing, isolation strategies and healthcare
Identifying individual and corporate responsibility

Adjust Physical Distancing Strategies

Prior to the current statewide stay-at-home order, there were multiple phased-in actions taken by Polk County to increase physical distancing. A similar, stepwise approach is required as communities are reopened. The following outlines several recommended steps in this continuum. Movement through each step will be determined by the spread or containment of disease. Each step within Recovery should be a minimum of two weeks and may be as long as several months. If the spread of COVID-19 increases to unacceptable levels, the recommendation is to move backwards through the steps up to and including resuming a stay-at-home order. Throughout the steps, physical distancing standards must be applied, which includes remaining physically separated by 6 feet at all times and frequent disinfecting of surfaces of common areas and in between groups’ use of a space. During Recovery, travel outside of the community and region should only occur for essential activities.

Step 1: Reopen business and organizations with occupancy limitations, no mass gatherings
Step 1 begins to relax the community mitigation strategies to cautiously resume some normal community activities while keeping many measures in place to limit physical interactions and the spread of disease. Individuals at high risk should continue to stay at home and not interact with others except for vital activities. Business/Organization: Current essential, non-retail businesses and organizations will continue operations. Most businesses and organizations that were not essential, as well as all retail, can be reopened but are restricted in that they must maintain 6 feet from all customers. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Business activities that bring people together are not permitted or allowed as it increases risk to spread disease. Specific guidance is available for the various business types. Mass gatherings: Mass gatherings of less than 50 individuals may resume. The limitation of 50 individuals pertains to all individuals at an event or location. The total number individuals may not be divided among different portions of a location- e.g. different rooms or fields. All mass gatherings are required to apply physical distancing standards, and if physical distancing standards cannot be met, the gathering must be postponed or cancelled. Churches: Churches may hold in-person services as long as the social distancing requirements are followed. However, common practices that may occur with worship services, such as hand shaking and shared communion cups, should be avoided. Places of worship are also encouraged to continue use of alternative means of services through streaming services and other opportunities. Mass gathering limitations do not apply to churches. All vulnerable individuals should continue to shelter in place. 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. Precautions should be taken to isolate from vulnerable residents. Visits to senior living facilities and hospitals should be prohibited. Those who do interact with residents and patients must adhere to strict protocols regarding hygiene. Minimize non-essential travel and adhere to CDC guidelines regarding isolation following travel. If travel is required internationally or to areas where there are outbreaks of the virus, a 14-day isolation is recommended for anyone traveling from those areas.

Step 2: Reduce limitations for businesses and organizations, reintroduce limited mass gatherings
Step 2 continues the reopening of communities by relaxing the occupancy limitations and begins to resume mass gatherings on a limited basis. All interactions within the community are required to maintain physical distancing strategies. High risk individuals should continue to limit interactions to those that are considered vital. Business/Organizations: Current essential, non-retail, businesses and organizations will continue operations. For all other business and organizations, occupancy restrictions are relaxed more while maintaining 6 foot spacing in all areas possible. All businesses and organizations must continue to apply physical distancing standards in all facilities. When possible, operations should be conducted remotely. Mass gatherings: Mass gatherings of less than 150 individuals may resume. The limitation of 150 individuals pertains to all individuals at an event or location. The total number individuals may not be divided among different portions of a location- e.g. different rooms or fields. All mass gatherings are required to apply physical distancing standards, and if physical distancing standards cannot be met, the gathering must be postponed or cancelled. Churches: Churches may hold in-person services as long as the social distancing requirements are followed. However, common practices that may occur with worship services, such as hand shaking and shared communion cups, should be avoided. Places of worship are also encouraged to continue use of alternative means of services through streaming services and other opportunities. Mass gathering limitations do not apply to churches. All vulnerable individuals should continue to shelter in place. 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. Precautions should be taken to isolate from vulnerable residents. Visits to senior living facilities and hospitals should be prohibited. Those who do interact with residents and patients must adhere to strict protocols regarding hygiene. Schools: All schools are permitted to reopen. Physical distancing and personal protection strategies should be applied to full capability. Protocols implemented regarding regular hand hygiene of students, teachers and staff as well as routine cleaning procedures. Minimize travel to essential travel only and adhere to CDC Guidelines regarding isolation following travel. If travel is required internationally or to areas where there are outbreaks of the virus, a 14-day isolation may be recommended.

Step 3: Remove limitations for business, maintain limited mass gatherings, reopen schools
Step 3 allows for further reopening of the community, while still limiting mass gatherings, which are a risk for rapid community spread of the virus. Interactions throughout the community need to continue to maintain physical distancing strategies. With the increase in physical interactions, individuals and organizations must increase the focus on personal protection through hand hygiene, respiratory etiquette, and self-isolation with symptom onset. High risk individuals should continue to limit interactions to those that are considered vital. Business: Businesses must continue to apply physical distancing strategies in all facilities. All occupancy restrictions for businesses are removed. When possible, business operations should be conducted remotely. Mass gatherings: Mass gatherings of less than 250 individuals may resume. The limitation of 250 individuals pertains to all individuals at an event or location. The total number individuals may not be divided among different portions of a location- e.g. different rooms or fields. All mass gatherings are required to apply physical distancing standards. Churches: Churches may hold in-person services as long as the social distancing requirements are followed. Places of worship are also encouraged to continue use of alternative means of services through streaming services and other opportunities. Protocols implemented regarding routine cleaning procedures. Mass gathering limitations do not apply to churches. All vulnerable individuals should continue to limit outings to those that are essential. Utilizing face coverings and other protective measures when in public places. 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. Precautions should be taken to isolate from vulnerable residents. Visits to senior living facilities and hospitals should be limited and follow strict guidelines. Those who do interact with residents and patients must adhere to strict protocols regarding hygiene, including the wearing of face coverings. Schools: All schools are permitted to remain open. Physical distancing and personal protection strategies should be applied to full capability. Protocols implemented regarding regular hand hygiene of students, teachers and staff as well as routine cleaning procedures. Continue to minimize travel to essential travel only and adhere to CDC Guidelines regarding isolation following travel. If travel is required internationally or to areas where there are outbreaks of the virus, a 14-day isolation may be recommended.

Step 4: Expand mass gathers
Step 4 takes a final step in reopening the community with restrictions, relaxing the maximum allowable attendance at mass gatherings. Step 4 will be maintained until a transition to Phase 3 is achievable. High risk individuals should continue to limit interactions to those that are considered vital. Business: Businesses must continue to apply physical distancing strategies in all facilities. All occupancy restrictions for businesses are removed. When possible, business operations should be conducted remotely. Mass gatherings: Mass gatherings may resume allowing for physical distancing standards. Churches: Churches may hold in-person services allowing for physical distancing standards All vulnerable individuals should continue to limit outings to those that are essential. Utilizing face coverings and other protective measures when in public places. 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. Precautions should be taken to isolate from vulnerable residents. Visits to senior living facilities and hospitals should be limited and follow strict guidelines. Those who do interact with residents and patients must adhere to strict protocols regarding hygiene, including the wearing of face coverings. Schools: All schools have reopened. Physical distancing and personal protection strategies should be applied to full capability. Travel may resume. If travel is required internationally or to areas where there are outbreaks of the virus, a 14-day isolation may be recommended.

Maintain Focus on Testing, Isolation Strategies and Healthcare

As the community engages in Step 1 – Step 4 of Recovery to reopen the community, there is an ongoing need to maintain focus on the following:

Testing is available to everyone who is symptomatic
Individuals with COVID-19 and their contacts are isolated
Healthcare has adequate capacity to treat individuals needing care.

Testing supplies and laboratory services must be able to maintain turnaround time of testing of less than 72 hours, with a goal of less than 24-hour turnaround. This will provide public health and healthcare with information needed to respond to the disease and provide community leaders with accurate and timely information for decision making. Public health must maintain the increased capacity to conduct epidemiological processes. As efficiency and effectiveness permits, public health and healthcare should implement initiatives to provide targeted and rapid testing and containment strategies with newly identified cases. These approaches may prove beneficial to limit the spread of disease. During Recovery, healthcare will continue to treat the symptoms and secondary effects of the disease. Therapeutic modalities will be introduced as they become available. Significant progress in treatment may also encourage the reopening of the community.

Individual and Corporate

During Phase 2’s implementation of reopening the community, individual and corporate responsibility is the most important component, and the most challenging to ensure. The major assumption throughout Recovery is that the success and continued reopening depends on large-scale compliance with the guidance that will be issued. While community leaders are responsible for determining the timing and implementation of reopening, the full adoption of the spirit behind the steps is incumbent of everyone. Businesses, associations, churches, and organizations must take responsibility for taking appropriate measures for their employees, members, and patrons. Applying physical distancing strategies including the limitations of occupancy, maintain a 6 foot distance, providing remote accessibility, and not allowing anyone with symptoms to be present will greatly affect the community’s wellbeing. It is each of our own individual decisions and actions that will ultimately determine the spread of COVID-19. Diseases are fueled by sick people in contact with healthy people and insufficient hygienic practices. We also know that people can spread disease up to 48 hours before becoming symptomatic. Choosing to abide by requirements and recommendations at each step of community reopening will allow communities to more quickly emerge from the impacts of COVID-19. When we focus on the community’s response and recovery, not just ourselves, we all benefit.

Adjusting the Response and Trigger for Phase 3

How quickly and effectively the community can reopen is directly related to the spread of COVID-19, which depends on the community’s response. When all rules and guidance in each step are followed, the likelihood for a more rapid reopening occurs. When rules or guidance are not followed, the reopening process is likely to take significantly longer. The progression of COVID-19 will be monitored by public health officials and community leaders. When the spread of disease is slow or reduced progression into and through Recovery will occur. If the spread of disease is rapid or hits elevated levels that exceed hospital capacity, it is likely that the community will have to regress with reopening the community and may include an additional stay-at-home order. When the community has sustained a low level of COVID-19, allowing it to progress through the steps of Recovery, there are three triggers that could prompt movement into Phase 3:

Availability of a vaccine
Widespread availability of effective treatment
Minimal active cases

Phase 3 will introduce long-term solutions to mitigate the spread of disease and lift all restrictions associated with COVID-19. More detailed plans for transitioning into Phase 3 will be developed as the time nears.

Polk County Response and Recovery Plan