Testing Key for Task Force Advising Lamont, “Small Steps” Beginning in June Continuing until the New Year

State officials say that a massive expansion of testing capability in Connecticut will be needed before lifting restrictions put in place to slow the spread of the coronavirus, but Governor Ned Lamont today announced the first steps toward reopening the state, including an advisory group to develop a strategic plan by May 20.

“The most important objective or goal for this initial step when we think about reopening Connecticut is really increasing the capacity of testing for COVID-19,” said Dr. Albert Ko, an epidemiologist at Yale School of Public Health and co-chair of the new advisory group. 

Ko explained that the threshold of adequate testing should be reached when the total number of positive tests drops to about 10 percent of the population tested — at least that is the goal assuming that the majority of individuals have not yet contracted the virus. 

For co-chair former PepsiCo CEO Indra Nooyi, once adequate testing is in place, the next question is how do businesses, schools and hotels reopen without sparking a flood of patients — a problem the state has so far largely avoided.

Luckily, according to Lamont, Connecticut has far less to reopen than most of its peers. 

“As you think about reopening the state in a thoughtful way, remember we didn’t close as much of the state as our peer states did,” said Lamont at a press conference on Thursday afternoon. “We were a state that did not close down manufacturing, especially our defense related manufacturing… We never closed down our state parks and beaches. We never closed down gardening and landscaping. Daycare we kept going as well. We had big pieces of our economy that we kept going.”

67 percent of workers in Connecticut have been able to continue working during the coronavirus pandemic. But for the rest of the state, there needs to be a plan to get them back to work and for everyone to be able to return to a sense of normalcy. 

“It’s not a simple decision to pick a scenario. We have to think about what testing is needed, what hospital capacity and what the consequences could be,” Nooyi said. “We will be loosening very carefully in small steps starting in June and then keep progressing to the end of the year.”

Although concerns of public health — as Nooyi and Ko put it — will always be at the forefront, the fact that nearly 400,000 residents have now filed for unemployment is a close second. 

How we got here

In a series of rule changes and executive orders since March 10, the state has closed schools, restaurants and bars, restricted gatherings of more than 5 people, encouraged the public to work from home, limited parking at state parks and required masks in public spaces.

“The goal originally was to not overwhelm the healthcare system,” said Max Reiss, spokesperson for Governor Lamont’s office. “But, as this has evolved, as we have learned more about the virus, it has turned into a how do we protect our neighbors and our loved ones.”

Whether these restrictions are intended simply to “flatten the curve” to give hospitals time to handle cases, or whether the intent is more ambitiously to stop the spread of the virus — how these restrictions are understood varies between local, regional, and state  officials, leaving much of the public unsure when, why and how exactly social distancing rules will be rolled back.

“The goal originally was to not overwhelm the healthcare system,” said Max Reiss, spokesperson for Governor Lamont’s office. “But, as this has evolved, as we have learned more about the virus, it has turned into a how do we protect our neighbors and our loved ones.”

The turning point, Reiss said, was when the Centers for Disease Control and Prevention announced that any individual could be a carrier of COVID-19 and simultaneously be asymptomatic.

“It’s the reason for the mask order,” Reiss said. “It’s more to prevent me who might be a carrier from infecting you at the grocery store if I see you.”

It’s that shift in purpose — from addressing issues of hospital capacity to reducing as much as possible the transmission of the virus — that has spurred state officials to extend the original timeline for shutting down business in Connecticut from the end of April, until May 20.

“The goal of all these measures is overall saving lives, but with an understanding that it is incredibly difficult to contain a virus from spreading through community transmission,” Reiss said.

Now, the goal has become ramp up testing to provide enough data to allow the Governor and advisory group to decide on a reopening plan. 

“We don’t have to test every person in Connecticut, we just need to do a representative sample,” Ko said. 

Ko said that this will include antibody testing, but she declined to provide a target for the number of weekly or monthly tests, or a total number of tests that would need to be administered. 

Ko said that the focus should be on identifying healthcare workers and those who move in and out of communities that may be asymptomatic carriers. “We have seen high transmission in our under-served communities and these may be serving as reservoirs — or sources of transmission — that infect the rest of the state.”

On Tuesday, Lamont announced that the state will be soliciting proposals from potential partnering organizations to aid in efforts to increase testing.

According to a statement released by the Governor’s Office, “the state is planning to significantly build out its capacity to test people who are not exhibiting any symptoms” in addition to current testing of patients and care providers already exhibiting symptoms of COVID-19.

According to state officials, the immediate goal of the plan is to increase availability of testing in urban and underserved communities that have been most significantly impacted by the virus.

“The sooner we can identify people with the infection, the sooner they can self-isolate and we can trace their contacts,” Lamont said. “That’s how we will drive infection rates down and prevent rebounds in infection rates as we begin to reopen.”

The reason behind the restriction

Although reasoning behind current restrictions can at times appear arbitrary — why liquor stores, for example, remain open while many other businesses are shuttered — the common objective of the measures is to limit as much as possible the locations and events that typically bring groups of people together.

“It’s a difficult position until we have either enough transmission over a period of time to achieve herd immunity or we develop a vaccine,” Cohen said.

“Our main means of minimizing morbidity and mortality is by reducing the number and intensity of social contacts. The goal is to bring the average number of secondary cases that come from each case below one,” said Ted Cohen, a professor of epidemiology of microbial diseases at Yale School of Public Health. “If you can sustain that, the epidemic would be driven to eradication locally at least.”

That is, if for every person infected, the virus spreads to less than one other person, the coronavirus will eventually die away on a local level.

But Cohen acknowledged that without substantial data on the spread of infection, loosening social distancing guidelines will remain a tough call.

“It’s a difficult position until we have either enough transmission over a period of time to achieve herd immunity or we develop a vaccine,” Cohen said.

Rather than viewing the response to the coronavirus purely as a matter of medicine, Cohen said that state officials will be forced to consider carefully the broader implications of the shutdown. 

“These types of social distancing interventions may have immediate health benefits, but they also have really large social, economic and political costs,” Cohen said. “Those matter too. But, how do some of these policies get relaxed? That’s the question. The consequences of doing that too rapidly could be very dangerous.”

The key, and the common refrain, is more data, specifically more testing on the local level as soon as possible.

The challenge of expanding testing

When testing became available in Connecticut over the last weeks, its availability was limited largely to healthcare workers and those already exhibiting signs of infection. 

“Our challenge is, and one of the reasons we’ve chosen three different testing strategies is, the supply chain. We do not know if we have a consistent supply chain for all the tests,” said Dr. Tom Balcezak, chief medical officer for Yale New Haven Hospital.

On top of issues with the supply chain, Ko said that the reliability of the nasal swab tests has been inconsistent. According to Ko, the problem is not with the tests, however, but the difficulty of administering them. She said that Jackson Laboratories and Yale are both working to evaluate and introduce saliva tests which should be be easier, quicker, more accurate and cheaper to administer. 

With efforts to increase the state’s capacity to test for the virus and with more testing facilities already opening in Connecticut — including three new centers opening just today in New Haven for any resident free of charge — the hope is that the needed testing can scale up quickly before May 20. 

“Testing is going to be incredibly important for us if we are going to reopen,” said Dr. Keith Churchwell, executive vice president of Yale-New Haven Hospital. “Having it widely available will ensure that those that see us as their community hospital will be able to be treated and treated effectively.”

The process of reopening

With adequate testing in place, stores, restaurants and workplaces can begin to open up, said Lamont. But, as Nooyi put it, “it won’t be a big bang opening all in one shot.” 

“The understanding is large gatherings won’t happen any time soon, but if we can ramp up testing in ways that we can have good data it will inform better decisions,” said Reiss. 

According to Reiss, the Governor’s task force has not yet made any definite decisions about which businesses will open or in what order, but at present the understanding is that if a workplace can assign employees to A and B days, or shifts that would minimize social contact, then they can open. Restaurants that can enforce adequate capacity restrictions could also open.

“They are working to have that laid out clearly in the coming days,” Reiss said.

In addition to the in-state task force, the Governor will continue to collaborate with neighboring states to ensure that the decision making will be coordinated across the region. Reiss explained that because Connecticut is such a small state, and driving to another region or state can take less than an hour, coordination is essential.

“When people are going to criticize us for a regional approach I say, we have to be regional, we cannot help what is going to happen across the border unless we are coordinating,” Reiss said.

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