The guidelines provide for a 14-day reopening of files. No state has met them.

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As a handful of states begin to relax home stay restrictions, no state that has chosen to reopen is close to 14 consecutive days of denial of cases recommended by the federal government.

Even though the United States hit the grim threshold of more than a million cases on Tuesday – a third of the world total – Georgia, Minnesota and other states are pushing to reopen businesses, even though new rates infection continues to increase.

Some states, such as Colorado and Kentucky, have reported fewer new cases in the past week. But no state has experienced a decline for 14 days.

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The 14-day guidelines, which President Donald Trump announced on April 16, “make sense,” New York Governor Andrew Cuomo said on Tuesday at a press conference, while acknowledging the economic dilemma.

“We want to reopen, but we want to do it without infecting more people or overwhelming the hospital system,” said Cuomo.

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The number of cases reported by the states each day does not necessarily reflect the patients diagnosed in the past 24 hours. There is often a delay in the test results and some infections are not identified immediately.

Yet the number of daily cases continues to increase in many states. And governors are struggling to balance what is best for the economy with what is best for public health.

“It’s a touchy conversation,” said Cameron Wolfe, associate professor of medicine at Duke University School of Medicine. “We are literally trying to find ways to coexist with COVID that don’t take us back to a secondary push in the cases. “

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Experts say the most important way to ensure a successful reopening is to have a large number of accurate tests to diagnose COVID-19 cases.

“The importance of diagnostic tests cannot be overstated,” said Dr. George Anesi, director of the Bioresponse medical intensive care team at the University of Pennsylvania Hospital.

Ideally, this means testing everyone, including people who never show symptoms. Correctly identifying asymptomatic spreaders – as well as infected people who are contagious before you start showing symptoms – would reduce the risk of people unknowingly spreading the virus to other vulnerable people.

If the nation reopens “in a way that is not based on continuous testing and understanding of how the disease continues to circulate in our population,” said Anesi, “then we could end up with new push and another stop. “

Once doctors are able to identify those who have been infected, they must have a system in place to find out who these patients may have infected. It is a proven method of containing infectious diseases called contact tracing.

This requires a staffing of public health personnel to contact each patient and ask detailed questions about the people with whom he has been in close physical contact in the past few days or weeks.

“It’s a big effort,” said Wolfe. “You need to have a very clear path by which you can follow up on contacts. Currently, I don’t think many states, unfortunately, have really thought about this. “

Meanwhile, it is becoming increasingly evident that other potential methods of containing the virus, such as therapy or a vaccine, remain unavailable or unproven. And experts advise against relying on antibody tests to prove immunity to the virus. A positive antibody test only shows that a person has been infected; it is too early to know if this means that a person cannot be infected a second time.

“People are talking about antibody tests that will give them a golden ticket, but that is not the case. People can talk about vaccines. It’s not here, “Wolfe told NBC News.

“The reality is that we have to find ways to do business that are a little bit different,” he said. “There has to be a real introspective look at how we reopen, because it’s not over. It’s not over for the rest of 2020, to be quite frank. “

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