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AP Exclusive: CDC Docs Stress Plans for More Vrus Flareups

Associated Press

   GAINESVILLE, FLORIDA - Advice from the nation's top disease control
   experts on how to safely reopen businesses and institutions in the
   midst of the coronavirus pandemic included detailed instructive
   guidance and some more restrictive measures than the plan released by
   the White House last month. The guidance, which was shelved by Trump
   administration officials, also offered recommendations to help
   communities decide when to shut facilities down again during future
   flareups of COVID-19.
   The Associated Press obtained a 63-page document that is more detailed
   than other, previously reported segments of the shelved guidance from
   the U.S. Centers for Disease Control and Prevention. It shows how the
   thinking of the CDC infection control experts differs from those in the
   White House managing the pandemic response.
   The White House's "Opening Up America Again" plan that was released
   April 17 included some of the CDC's approach, but made clear that the
   onus for reopening decisions was solely on state governors and local
   officials.
   By contrast, the organizational tool created by the CDC advocates for a
   coordinated national response to give community leaders step-by-step
   instructions to "help Americans re-enter civic life," with the idea
   that there would be resurgences of the virus and lots of customization
   needed. The White House said last week that the document was a draft
   and not ready for release.
   It contains the kinds of specifics that officials need to make informed
   decisions, some experts said.
   "The White House is pushing for reopening but the truth of the matter
   is the White House has just not had a comprehensive plan where all the
   pieces fit. They're doing it piecemeal," said Dr. Georges Benjamin,
   executive director of the American Public Health Association.
   Such detailed advice should have been available much earlier, said
   Stephen Morse, a Columbia University expert on the spread of diseases.
   "Many different places are considering how to safely develop
   return-to-work procedures. Having more guidance on that earlier on
   might have been more reassuring to people. And it might have have
   prevented some cases," Morse said.
   From the start, CDC staffers working on the guidance were uncomfortable
   tying it specifically to reopening, and voiced their objections to the
   White House officials tasked with approving the guidance for release,
   according to a CDC official granted anonymity because they were not
   cleared to speak with the press.
   The CDC's detailed guidance was eventually shelved by the
   administration April 30, according to internal government emails and
   CDC sources who were granted anonymity because they were not cleared to
   speak to the press. After The AP reported about the burying of the
   guidance last week, the White House asked the CDC to revive parts of
   it, which were sent back for approval, according to emails and
   interviews.
   On Tuesday, CDC Director Robert Redfield testified before a U.S. Senate
   committee that the recommendations would be released "soon." He
   provided no further details. Internal government emails show that
   Redfield had repeatedly sought White House approval for CDC's guidance,
   starting as early as April 10.
   Both the CDC document and the White House's published plan recommend
   communities reopen in phases as local cases of coronavirus subside.
   One of many differences, however, is advice for when communities should
   allow for the resumption of nonessential travel.
   The shelved CDC guide advises communities to avoid all nonessential
   travel in phases of reopening until the last one, when cases are at the
   lowest levels. Even then, the CDC is cautious and advises only a
   "consideration" of the resumption of nonessential travel after 42
   continuous days of declining cases of COVID-19.
   The White House plan, by contrast, recommends that communities
   "minimize" travel in Phase 1, and that in Phase 2, after 28 consecutive
   days of decline, "Non-essential travel can resume."
   As of Tuesday, CDC's web page on travel guidance during the pandemic
   still linked to the White House plan. The stricter guidance is not
   there.
   Another stark difference in the final White House plan and that
   designed by epidemiologists at the CDC is the latter's acknowledgment
   that COVID-19 cases will likely surge after states reopen, and that
   local governments need to continuously monitor their communities
   closely.
   The White House's final reopening plan lacks guidance on how local
   communities can track information beyond positive cases. But the CDC
   document offers thoughts on how to plan for where case increases might
   occur more quickly, using demographic information. The CDC says local
   leaders could take special notice of the number of households with
   limited English literacy in an area, how many people live in poverty or
   have no health insurance coverage, and even what it calls areas of
   "civic strain" caused by the virus, such as places where many workers
   were sick or lost wages due to shutdowns.
   The White House plan offers few such specifics and instead provides
   broad guidance, such as "Protect the health and safety of workers in
   critical industries," and advises states to "protect the most
   vulnerable" by developing "appropriate policies."
   On Tuesday, Dr. Anthony Fauci, the nation's top infectious disease
   expert, warned that lifting stay-at-home orders too quickly could lead
   to serious consequences, both in deaths and economic hardship.
   President Donald Trump, meanwhile, has continued to push states to act
   to right a free-falling economy.
   The CDC's guidelines stress the dangers of states and regions going it
   alone in such perilous times. The agency advises a national approach,
   rather than a patchwork, because policies in one state will in time
   affect others.
   "Travel patterns within and between jurisdictions will impact efforts
   to reduce community transmission too. Coordination across state and
   local jurisdictions is critical -- especially between jurisdictions
   with different mitigation needs," the report states.