Controlling coronavirus cases will take effort, cooperation as states reopen, Johns Hopkins and MIT experts say

As states like Maryland begin to reopen, the burden increasingly will be on individuals and businesses to act responsibly to ensure coronavirus cases don’t surge back again.

This was the message from a panel of experts from Johns Hopkins’ Bloomberg School of Public Health convened Thursday to discuss how to reopen responsibly. Most states, including Maryland, have at least partially lifted stay-at-home orders.


Early evidence suggests people are willing to wear masks, distance themselves from others and avoid large crowds, among other necessary actions, said Dr. Tom Inglesby, director of the Johns Hopkins Center for Health Security. Surveys suggest people also are not all flocking to public spaces even when restrictions are lifted, he said.

“It’s concerning to see images of people gathering in large numbers at restaurants and beaches, but I think they are in the minority," Inglesby said. “For the most part, people are acting appropriately and acting cautiously.”


Nationally and in Maryland, cases have begun to trend downward overall, though some communities still are recording increases or have plateaued.

There have been more than 43,500 cases and more than 2,000 deaths in Maryland. There have been more than 1.5 million cases and almost 94,000 deaths across the country.

Inglesby joins other university and federal officials who say there could be a second big wave of coronavirus cases in the fall and even a number of smaller waves over the summer. The size of the outbreaks will be linked in part to how diligent people remain in taking precautions.

The U.S. Centers for Disease Control and Prevention, as well as Hopkins and others, have offered advice to people, businesses and states to responsibly reopen.

Crystal Watson, a senior scholar in the Hopkins Center for Health Security, said businesses need to consider how to keep both their staffs and customers safe.

They need to provide protective gear to workers and access to sanitizer or hand washing and regularly clean shared surfaces, she said. They could in some cases take employee temperatures to catch potential cases, though not everyone infected has a fever. Business owners need to reconfigure their shops to make sure customers can stay apart inside and consider other factors such as how long they remain.

“These are layered approaches,” she said. “Combined, the steps can reduce our risk.”

Beth Blauer, executive director of the Hopkins’ Centers for Civic Impact, emphasized that there is no one-size-fits-all approach because the virus has hit different communities harder than others. Prisons, nursing homes and meat packing plants have been hot spots. And seniors and black and Hispanic populations have been hit particularly hard.

She said it matters how risks and precautions are relayed.

“We need to make sure the messages are spoken in a language people can understand,” Blauer said.

In addition to personal and business responsibilities, she said officials still have responsibilities after reopening. They should track data such as cases, hospitalizations and deaths. They should ensure testing and tracing capabilities are in place to identify cases and potential cases so those people can be isolated.

The testing also should show that less than 5 percent are positive, according to the World Health Organization. That’s a sign enough people are being tested. Hopkins researchers say Maryland is still closer to 18 percent.

A study released Thursday also suggests that states need to consider what steps other states are taking, in the absence of a federal plan.

This is particularly true for states and those with which they are “socially connected,” according to a study from the Massachusetts Institute of Technology. As states and localities reopen in a patchwork fashion, the MIT study warns that the impact of lifting restrictions can extend beyond those jurisdictions — and it can be “devastating.”

The study, from the MIT Initiative on the Digital Economy, found the connections are particularly strong these days and the bonds aren’t only among neighbors. New York and Florida, for example, have a strong connection, “presumably through digitally mediated social influence or travel,” the study said, even though they are geographically distant.

The study found that when a third of a state’s “social and geographic” peers adopt shelter-in-place policies, it reduces residents’ mobility as much as if the state itself adopted such restrictions. When states don’t coordinate, a state’s stay-at-home policy can be drastically less effective if its “peer” states fail to implement similar measures.

The stricter state then has to compensate for the other states’ laxness by imposing even stricter and more costly policies, the study found.

Maryland has such connections with Virginia and Washington, D.C., jurisdictions that Maryland Gov. Larry Hogan said he consults with regularly. Maryland also connections to Pennsylvania and Delaware.

Maryland has lifted it’s stay-at-home order, but Baltimore City and some suburban Baltimore and D.C. counties kept restrictions in place. Washington is expected to remain restricted until at least next week. Virginia began lifting restrictions, though not yet in Northern Virginia. Delaware has taken some steps such as reopening beaches. Pennsylvania reopened somewhat and now plans to more fully open some counties Friday.

“Our findings indicate that any given government’s decision to lift a social distancing policy will likely affect the behavioral and health outcomes of not only their own citizens,” the MIT study said, “but also the citizens of geographically and socially proximate communities.”

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