Letter to Massachusetts governor’s office

While the COVID-19 case count is relatively low in Massachusetts, it is no longer dropping, and the effective reproduction rate has in fact risen from a low of 0.8 to just over 1.0. It's not clear how much is due to our own reopening and how much is due to cases imported from other states that are handling this much worse, but I think it's clear we're not handling this a well as we need to. So, I sent in a note to the governor's office:

Massachusetts is no longer seeing declining case count. We should be holding off on or even reversing our reopening until the numbers improve. Additionally, in ascending order of difficulty:

- We need mandatory outdoor mask wearing in all public spaces. In Somerville, we are now allowed to take off the mask if we're at least 6 feet away from others, but the 6 foot rule is based on outdated science; sneeze and cough plumes can extend for 25 feet. People also put on their masks too late, or don't realize that other people are nearby.

- Indoor businesses should not reopen in general, unless they can demonstrate adequate ventilation (to reduce aerosol transmission). I don't know what the right threshold would be, but I would suggest 6 air changes per hour off the top of my head. Energy-recovery ventilation can be used to make this compatible with air conditioning, and CO2 meters would be a cheap way of measuring ventilation levels.

- Travelers should not only be asked to quarantine, but also randomly selected for followup. This can be done by gathering contact information at airports and train stations, and even toll booths where they still exist on interstates. The contact tracing program could be expanded to randomly check on out of state travelers, especially from high-risk states, and ask about compliance with quarantine. I don't know what kind of power the state has to actually confirm compliance or enforce it, but many travelers may comply voluntarily if it is known that MA is doing this.

(I am not an epidemiologist or public health expert, but I have some biology and systems background. Please run these recommendations past your panel of experts and at least seriously consider them.)

(If you have more expertise and think I'm wrong, I encourage you to send in your own recommendations!)

Update 2020-07-24: Starting August 1st, Massachusetts will impose a $500/day fine for travelers who do not quarantine, with a number of exceptions, including people traveling from Hawaii and the Northeast (low-risk states). I don't know how they're planning on actually enforcing this, though.

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