Lifting Social Distancing Measures in America: State Actions & Metrics

We recently wrote about the scattershot approach states and communities took toward implementing social distancing measures, particularly stay-at-home orders.  While some moved relatively early – and there are indications that this is paying off– others only implemented stay-at-home orders after the White House announced federal social distancing guidelines would extend through April. However, with those guidelines now expired, and the release of the White House’s “Guidelines for Opening Up America Again”, a growing number of states have begun to ease social distancing requirements, even without clear indications that they are successfully controlling their outbreaks. Here we review which states have done so, the approaches taken, and look at several key metrics for assessing their readiness for reopening.

A Range of Approaches

As of May 4, more than half of the states (27) had loosened social distancing restrictions in some way (See Table 1), and others have announced changes that will take effect in the coming weeks. In some cases, these restrictions were only in place for a relatively short period of time, such as in South Carolina (13 days) and Georgia (21 days), whereas in others, they were in place for much longer, such as in Indiana (41 days). As of this writing, the longest across all states, including those that have not begun lifting restrictions, is 48 (California).

In addition, states have taken very different approaches to easing social distancing measures. Some are making small and incremental changes, phasing them in over a period of time, while others are adopting broad changes all at once (see Table 2). For example:

• On one end of the spectrum, Vermont is keeping its stay at home order in place, but relaxing rules for outdoor and construction work as well as services provided by single workers, such as realtors, attorneys, etc. as long as these businesses can meet strict social distancing standards. In two weeks, the Governor will evaluate whether these rules can be expanded to more businesses.
• At the other end of the spectrum, Tennessee rescinded its stay at home order and allows most employees to return to work, with the exception of personal services and entertainment businesses, and permits restaurants to reopen to limited dine-in service. Businesses must continue to meet CDC guidelines and restaurants can only operate at 50% capacity, yet these limits are less restrictive than other states.
• In between, Georgia has retained its stay at home order for high risk groups and its limits on social gatherings of more than 10 people, but has opened many businesses, including personal care service and recreational businesses.

Assessing Key Metrics

While there is no single metric for assessing when it is safe to begin easing social distancing measures, there are several that, when used together, can provide states with needed guidance. These include two metrics in the White House Guidelines, considered “gating criteria” that, with other criteria, should be satisfied before considering moving to a phased comeback:

• 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 (while testing volume remains flat or is increasing). A lower positivity rate suggests that a broader group of people without symptoms is being tested, rather than tests being concentrated among people who are already severely ill. The World Health Organization recommends that the positivity rate be at or below 10%. In South Korea, New Zealand, and Australia, for example, three countries that have seen a sustained reduction in daily cases and successfully controlled their outbreaks, the positivity rate is below 2%.

Using these metrics, we assessed where the 27 states fall (see Table 3):

• Trajectory of Cases: Over the past 14 days (using a 7-day rolling average of the percent change in daily cases, to smooth daily fluctuations), 13 of the 27 states show a decrease, while 14 continue to see new cases grow, including Colorado and Tennessee.
• Trajectory of Positive Tests: Over the past 14 days (using a 7-day rolling average of the percent change in positivity rate), 19 of the 27 states show a decrease, while 8 states show an increase.
• Current Positivity Rate: The current positivity rate ranges from 0.4% in Alaska to 22.5% in Iowa. It is above 10% in 12 of the 27 states, including above 20% in three states – Colorado, Iowa, and Nebraska.

Taken together, only nine of the 27 states – Alabama, Alaska, Florida, Idaho, Missouri, Montana, Oklahoma, Vermont, and West Virginia – meet the metrics examined here.

However, few of the states have sufficient testing capacity to consider reopening. While most of the 27 states increased testing in the past week, in four states, Mississippi, South Dakota, Utah, and Vermont, the number of tests conducted in the past week fell relative to the week before. The three states with positivity rates above 20%–Colorado, Iowa, and Nebraska—each increased the number of tests conducted by 50% or more in the past week. The share of the population tested in the past week ranges from 0.2% in Montana, Maine, and South Carolina to over 1% in North Dakota, Alaska and West Virginia. Our recent review of testing benchmarks suggests 0.9% is the minimum threshold, but still well below most targets for the share of the population that should be tested each week.

If states could ramp up testing substantially and other criteria are met (such as sufficient hospital capacity and contact tracing capabilities – see, for example, COVIDActNow, Center for American Progress, and AEI), some may be able to consider easing some social distancing requirements, but most still fall short.

A Difficult Balance

In the face of the devastating economic effects the coronavirus is having on the U.S. economy, the pressure for states to ease social distancing restrictions is building. States are making different judgments in balancing the desire to increase economic activity by loosening these rules against the risks to the public’s health of moving too quickly. Just as states’ scattershot approach to stay-at-home orders raised concerns about ongoing community transmission in the U.S., recent movements by some states to ease restrictions similarly raise concerns about new outbreaks. While some states appear to be taking an incremental approach to reopening, others are more aggressive. An assessment of key metrics shows a mixed picture, with only nine of the 27 states meeting the metrics showing a downward trajectory, which still represent just a subset of factors that should be considered for reopening.

As states begin to loosen social distancing requirements, broader testing coupled with enhanced contact tracing and the ability to isolate those who contract the virus will be needed to contain localized outbreaks. Ongoing assessment of key metrics will be important to inform future state action, including if and when the reinstatement of some or all social distancing measures is needed.