Experts split on whether Wisconsin should reopen on a regional basis

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MADISON – Wisconsin leaders have agreed on some aspects of how to reopen the state, but one major issue divides them — whether to do it by region.

Democratic Gov. Tony Evers has resisted the idea, while Republican lawmakers have contended the best approach may be a regional one.

Some experts say opening by region could be risky, but others believe doing so smartly could yield data that we don’t yet have on how well certain social distancing practices are working. 

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Jim Conway, an infectious disease expert and associate director for health sciences at the University of Wisconsin-Madison’s Global Health Institute, argued loosening restrictions regionally is a short-sighted idea.

“It’s like being in a swimming pool and having one area of the pool that it’s OK to pee in,” he said.

Conway said because the economy relies on travel in many sectors, there would be no way to ensure new cases weren’t brought to areas with few cases and few restrictions under a regional plan — especially in a state like Wisconsin with a lot of recreational tourism in rural areas. 

“People work in one area and live in another — that’s where having a piecemeal system basically means you’re probably endangering everybody at the level of the least locked-down area,” he said. 

That’s why governors of neighboring states are banding together to have similar restrictions in place, he said, and why public health officials are trying to keep restrictions in place until the state has enough people to trace the contacts of each infected person and enough tests to give anyone who has been exposed. 

“If things get opened too quickly and we just return to thinking it’s business as usual, and start to see an acceleration of cases and start to see pressure on health care capacity, that’s when you’re to end up going back into safer at home,” he said, referring to Evers’ order requiring people to stay at home. 

But business leaders have argued the state needs to open soon and say taking a regional approach would allow that to happen more quickly.

Wisconsin Manufacturers & Commerce, one of the state’s most powerful lobbying groups, has offered a plan that would take into account regional infection data to determine when particular businesses could open.

“When four out of seven regions in our state have more hospitals than they do (COVID-19) patients, it’s time to think about reopening,” WMC Vice President Scott Manley told a committee of lawmakers Thursday. 

WMC wants to begin opening the state now while Evers plans to keep his stay-at-home order in place until May 26. The difference on timing is another issue that has split Evers and Republicans who control the Legislature, who have challenged Evers’ extended order before the Supreme Court. 

Regional approach would provide data

Some researchers say resuming a more normal life in some areas could provide informative data on whether the restrictions are working. 

Princeton University researchers Jessica Metcalf and Johannes Haushofer are studying how best to evaluate “non-pharmaceutical interventions” to the pandemic — that is, the school closures, bans on mass gatherings and business lockdowns Wisconsinites have been living with for more than a month. 

“There’s a number of levers that policymakers have been pulling,” Metcalf said. “If we could begin to get a handle on which works best, it might help guide (the return to daily life) most efficiently.” 

Rather than reopening broad swaths of the state at once, they recommend focusing tighter on a county-by-county level or small groups of counties and establishing representative samples in each grouping that could be used to determine whether that particular intervention cut down on transmission of the infection. 

For example, if businesses in one county remained closed and in another similar county were allowed to reopen and infections began to increase in the latter, it could be determined that closing those businesses was an effective social distancing tool to keep people safe from COVID-19.  

Testing those waters ethically, they explained, relies on policymakers to systematically evaluate the situation in each region and determine a gradual, phased approach to reopening.

Another more conservative strategy, Haushofer said, would be to pull back some social distancing measures in some places and different ones in others, rather than reopening every aspect of an area up at once.

As Evers and Republican lawmakers clash over whether to put economic health or public health first, Haushofer said that’s the central question that needs answering with better data. 

“We don’t know if remaining shut causes a lot of harm because it’s economically costly, or if opening up causes more harm,” he said. “Figuring out which is right would be really helpful.” 

Of course, the risk that public health experts are wary of remains: that one case of the virus, growing exponentially in an area that has loosened its restrictions, could overwhelm an older population with fewer health care resources — a profile that fits many of Wisconsin’s Northwoods counties. 

It’s why Conway and others say the state as a whole must get a better grip on the prevalence of infections before using a piecemeal approach to opening back up. 

“We need everyone who has reasonable suspicion of exposure to be able to get a test,” said Malia Jones, a social epidemiologist and assistant scientist in health geography at the Applied Population Laboratory at UW-Madison. “If I found out that my neighbor two doors down tested positive and he walks his dog past my house every day, I should be able to get a test.”  

In some rural counties, though the number of confirmed cases may be low, the number of people tested is also low, like Vilas County, which as of last week had tested 145 people, less than 1% of its population. 

Patrick Marley of the Journal Sentinel staff contributed to this report.

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