How do we open our society, economy, and businesses up again? I think I wrote a similar post in the summer of last year. Currently we are seeing various counties and states loosening restrictions at different paces, so it's an important question to consider. We need a slow, deliberate, and individualized approach. I worry that a scattershot, uncoordinated, or rapid reopening will cause harm in the long term.

All the same considerations as before apply. We need to protect our health care resources from being overwhelmed. Our public health departments need to be able to contact trace effectively. Our businesses must operate responsibly. And we need to prevent superspreader events. This is all balanced against the importance of protecting jobs, giving our emotional and mental selves a break, addressing the educational needs of our children, and finding a new normal.

There are a few lessons that we've learned the hard way. First, communities must move slowly. The time lag between viral exposure to intensive care admission can be significant. When rules are relaxed, we won't see the impact on hospitalizations and health care utilization for weeks. After making a change, we need to be patient to see where our case numbers end up before making the next change. As an anesthesiologist, I find this akin to managing a medication with a long half-life. For example, fentanyl patches and methadone cannot be titrated rapidly or we will overshoot the effect. Slow, measured changes are the way to go.

Secondly, we now have to consider variants. Variants that increase spread will make modeling and prediction a lot more difficult. I would caution us to err on the side of moving gingerly. We don't want to overextend and run out of hospital beds, nurses, oxygen, and resources again. Furthermore, variants arise more readily when more people are infected since they occur with viral replication. Keeping the numbers down may thus prevent even more dangerous, worrisome, or serious mutations from happening.

All this is balanced against our ability to vaccinate our population. From a purely pandemic management standpoint, we would ideally achieve herd immunity before reopening, though of course this is not practical. But I think it can guide our public health efforts. Should we vaccinate teachers before opening schools? I think so, though there are a lot of stakeholders in that question. It is near impossible to weigh public health against individual health considerations, educational quality, and jobs. But it is more the reason to vaccinate professions like these as soon as we can.

Finally, as we open up, we need to think specifically about minorities. The disproportionate impact on minorities is something we cannot ignore. Minority groups, especially African Americans and Hispanics (at least in California), have significantly higher infection rates and poorer outcomes from COVID. Minorities also make up many of the service industries that have shed jobs during the last year. They are also less likely to get vaccinated. The impact from health and economic standpoints is enormous, and as we look to open up our communities and economy, we need to mitigate these racial, ethnic, educational, and socioeconomic disparities.