The promise was considerable and understandably greeted with excitement from a cooped-up public. Ahead of last week, Gov. Phil Murphy promised to lay out to New Jersey residents — at that point more than a month into a statewide lockdown — how the state would get to a point it could safely be reopened.
But when Murphy’s six-point plan was announced, on April 27, it failed to resolve some of the biggest questions surrounding the coronavirus in New Jersey. The plan offered no specific timeline, and it seemed to rely on a lot of things going right, during a crisis where a lot has gone wrong.
On Tuesday, Murphy emphasized that a timeline simply isn’t possible at this point. “I’m sorry we can’t give you more definitive guidance yet,” Murphy said during his daily coronavirus press briefing in Trenton. “We still have people getting sick, going to the hospitals, and sadly more than 300 we’re reporting (today) have died. So with all due respect, this is the fight of our lives.”
And the news might even be worse, according to experts who have reviewed the plan. Given the number of steps that need to be taken before we can reopen — and given that New Jersey has not yet surmounted even the first of Murphy’s six steps — it’s unclear when the state can safely reopen without risking a second, potentially even more serious outbreak of the coronavirus.
Oh, and even if we do meet all of Murphy’s criteria, it still might not be wise to reopen, experts caution.
“The United States and the state of New Jersey are not even remotely prepared to start putting in place measures to protect the general population from what’s likely to be a major second wave very soon,” said Sharon Abramowitz, a global health consultant for UNICEF and a former visiting professor at Rutgers. “And what you’re going to end up having is a massive wave… and there’s just going to be a lot of people who start to die again really quickly, which is going to result in the shutdown of the economy again.”
The governor has been firm that he won’t reopen the state until the time is right, and the six-point plan is the clearest he’s been on how the state gets there. But as more states across the country start to loosen their coronavirus restrictions — and as New Jersey’s economy continues to struggle — Murphy might start to feel some pressure to begin reopening the state.
Already he’s loosened the restrictions that closed state parks and golf courses. Both reopened this weekend with certain guidelines in place, done with the governor saying he trusts people to practice social distancing, but also with the threat that Murphy would close them if people aren’t being safe.
By Monday, it appeared the governor wouldn’t yet have to make good on his threats, as, by and large, residents took their first true taste of spring in stride. To some degree, though, what comes next remains anybody’s guess.
Sustained reduction of cases and hospitalizations
The first step in the plan is obvious. In order to have any confidence that businesses can reopen and people can emerge from quarantine, the number of coronavirus cases cannot still be growing.
On that front, New Jersey is already on its way. Murphy’s plan calls for “14-day trend lines showing appreciable and sustained” drops in coronavirus cases and hospitalizations. According to data from the state Department of Health, new hospitalizations have been trending down since April 22, though the number did tick up again last week. Those numbers are based on a three-day average, which is useful to control for day-to-day fluctuations.
In terms of new cases, the state is also showing a sustained decline. The three-day rolling average of new cases on Tuesday was 2,292, compared to an average of 3,446 new cases on the three days ending on April 20, according to the COVID Tracking Project. (This is based on data from the COVID tracking project, not from Murphy’s daily announcements.)
The numbers are promising, especially the decrease in new hospitalizations, which lessens the burden on the state’s healthcare systems. If those numbers, along with new cases of coronavirus, continue decreasing, Murphy will be more confident about starting to return things to normal.
Despite the promising statistics, the next two parts of the governor’s plan are concerning, experts say.
Even as the number of new coronavirus cases continues to fall, the rate of positive tests in New Jersey remains among the highest in the nation. As of Tuesday, 45.4% of all people tested in the state had the virus.
The World Health Organization says that a 10 percent positive rate indicates that a government has a solid grasp of the virus in its jurisdiction. What New Jersey’s rate says is that the state continues to test only the sickest people, surely missing tens of thousands of others who have the virus but are unable to get tested.
For weeks Murphy has been beating the drum about expanding testing in the state, though the number of daily tests has hovered mostly between 7,000 and 9,000 in that time. But a couple of new developments could mean a dramatically increased testing capacity in the next month.
First, Rutgers University is rolling out a saliva test for the coronavirus, which figures to be much more efficient than the widely used method that involves sticking a swab deep into the nose.
Brian L. Strom, the chancellor of Rutgers Biomedical and Health Sciences, said the university has ordered enough equipment to test 20,000 people a day, which is already more than double what the state is currently doing.
Murphy has called for at least a doubling of tests by the end of May.
“We can go up to 50,000 a day,” Strom said. “Again, we can’t do it overnight. But we can do it, certainly the end of May doubling is not difficult at all.”
Also helping matters is a promise from the federal government to supply New Jersey with 550,000 testing kits and 750,000 swabs. Murphy announced that deal on Thursday afternoon after meeting with President Donald Trump at the White House earlier in the day.
Still, it looks like the state will need all that assistance and then some. A recent analysis from Harvard University and the health news outlet STAT found that New Jersey would need to increase testing 10-fold in order to safely be able to reopen.
Even if New Jersey is able to double the number of daily tests by the end of the month, or even expand capacity beyond that, it won’t be much use without a legion of people to check on those who might have come into contact with an infected person.
“The testing thing sounds really good...but testing is half the equation,” said Stephanie Silvera, an epidemiologist at Montclair State University. “Testing without contact tracing is a recipe to see cases start to spike again.”
Strom said that there should be about 80 contact tracers per 100,000 people. Extrapolating that out to New Jersey’s 8.9 million people, the state would need more than 7,000 tracers. There just aren’t enough right now, Strom said, adding that more aren’t currently being trained.
“That’s a whole lot of contact tracers and right now the numbers are a handful, maybe two handfuls,” he said. “I don’t know the exact numbers, but it’s very small and no one’s doing training because we have the only school of public health in the state and we’d be doing it.
“We need an army of people out there tracing their contacts, which we did not have and we still do not have.”
Abramowitz also cast doubt on the state’s ability to trace people who might have come in contact with someone with coronavirus, particularly in dense, urban areas.
“Do you know how hard contact tracing is with an asymptomatic disease that’s passed through aerosolized transmission? In a reopened state?” she asked. “Just think about it: You get on a train. Contact tracer, go find everybody that I’ve breathed on, on the 9:57 subway pulling out of Grand Central.”
Newark is launching its contact tracing effort on Tuesday, Mayor Ras Baraka told NJ Advance Media on Monday, adding that the city has trained more than 200 people to try and trace the virus. Still, Newark appears to be ahead of the curve statewide, with many cities and counties unprepared for contact tracing.
Unfortunately, the remainder of Murphy’s plan for reopening the state hinges on the steps mentioned above, including the big question mark of contact tracing.
How can the state safely and efficiently isolate infected people — Step 4 — like has been done with success in other countries, like South Korea, without an expansive team tracking down those people?
Can Murphy responsibly restart the state’s economy — Step 5 — if potentially sick people aren’t found and notified, and, if necessary, isolated? And how can New Jersey ensure it learns the lessons the coronavirus has so harshly taught — the sixth and final step — if steps 3-5 are incomplete?
Abramowitz flatly denounced plans to reopen the economy, both New Jersey’s and the country’s, saying she doesn’t think we could possibly do it safely.
“The truth is, the economic situation and the epidemiologic situation are going to march forward together hand-in-hand.” she said. “The state’s going to reopen, it’s not going to be prepared to do so, they’re not going to take the measures that are required in order to ensure social distancing in all of the buildings, including for example schools and hospitals and public transportation.
“You should be scared because there will be a second wave when things reopen and lots and lots of people are going to die. Because there’s absolutely no reason they shouldn’t. The disease hasn’t gone anywhere. It’s just out there.”