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Internists Identify Essential Elements to Ease Social Distancing Protocols, Address White House Guidance to “Re-open” the U.S.

Washington, DC (April 17, 2020) -- The American College of Physicians (ACP) this afternoon said it supports the goal of the administration’s newly released “Guidelines for Opening Up America Again” to make decisions in phases based on evidence of disease mitigation, but cautions against reducing social distancing efforts prematurely, and calls for an evidence-based approach to ensure key essential elements are in place and scaled appropriately in communities before easing restrictions. 

“We agree with the goals of the administration’s guidance,” said Robert McLean, MD, MACP, president, ACP.  “However, premature easing of restrictions could lead to a resurgence of the virus and potentially overwhelm health system capacity and result in grave consequences for the health and well-being of millions of Americans.”

ACP identified five necessary elements that need to be in place and sufficiently scaled up at the population and health care system level in order to safely ease restrictions.  ACP also noted that these are not currently ready in most communities. 

Population Level

1. Screening and Testing:
Widespread administration of a reliable method of testing for COVID-19 and accurate/reliable emerging antibody testing, on a scale to accurately determine that a sustained downward trajectory is being evidenced and sustained. Consent and sufficient privacy protections for patients being tested must be in place.

2. Prevention Measures:
An approach to scale up tracing of the contacts of those who test positive (contact tracing) that balances public health needs with confidentiality and privacy protections for patients. Centers for Disease Control and Prevention Director Robert Redfield says contact tracing is “critical” to preventing “multiple community outbreaks that can spiral up into sustained community transmission.” [National Public Radio Interview, Morning Edition, April 10, 2020). We agree, but this must be done with great care. Consent and sufficient privacy protections for patients must be in place.

3. Infrastructure:
Sufficient workforce and supply capacity to do the testing, analysis, and follow up.

Health Care System Level

4. Resources:
Personal Protective Equipment (PPE) for every frontline physician, nurse, or other professional health care worker.

5. Infrastructure:
Sufficient hospital, physician, and health system capacity to treat patients with the virus.

ACP noted that the White House guidance gives state and local officials the authority to determine decisions about easing social distancing, and it urged those officials to make decisions based on the best available evidence. ACP also called on the federal government to do more to ensure that the required tests, workforce capacity, supplies, and PPE are available and distributed based on need. ACP also stated that until an effective vaccine and therapies are available that the U.S. and the world must be prepared for sustained social distancing as part of the “new normal.”

“Our approaches to easing social distancing protocols from the COVID-19 pandemic must be guided and supported by the best available evidence,” said Dr. McLean. “The health of the American public must remain paramount.”

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About the American College of Physicians

The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 159,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter, Facebook, and Instagram.

Contact: Jackie Blaser, (202) 261-4572​, jblaser@acponline.org