Special City Council meeting- This is the plan to reopen Joplin

(UPDATE: The Joplin City Council approved the reopening plan, but with numerous changes. More information to come.) 

Joplin City Council began discussing this COVID-19 response and recovery plan tonight during a special meeting that began at 6 p.m.

City of Joplin Plan for Response and Recovery

Introduction

This framework is built upon the guidance outlined in National Coronavirus Response:

A road map to reopening by the American Enterprise Institute.

Within the plan, there are four phases:

• Phase 1: Slow the Spread

• Phase 2: Reopen, State by State [Community by Community] a.k.a. Recovery

• Phase 3: Establish Protection Then Lift All Restrictions

• Phase 4: Rebuild Our Readiness for the Next Pandemic

Although we are currently in Phase 1 of our COVID-19 response, we should be looking to take steps to resume normal life---while preventing steps backward. This planning document will focus on the current state of our community as well as look forward to how we move into Phase 2.








Phase 1:

Slow the Spread

Most counties within Southwest Missouri now have confirmed cases of COVID-19. Additionally, there are cases in nearby Southeast Kansas, Northeast Oklahoma and Northwest Arkansas. Within Phase 1, there are 8 recommended components:

1. Maintain Physical Distancing Community leaders in Joplin have taken a proactive role in adopting incremental social distancing ordinances culminating in the community stay at home order.




2. Increasing Testing Capacity and Rapid Test Results Testing capacity plays a key role in detecting and isolating cases and their associated contacts. A new drive through testing clinic is providing an anticipated 200 additional test per day. This additional capacity will bolster pre-established testing provided by local health care providers and MO DHSS lab. Rapid result and antibody testing methods will be pursued as they become more widely available.

3. Ensure Functioning of the Healthcare System Healthcare providers have taken preventive measures to reduce the risk of infection. Freeman and Mercy hospitals have increased bed and ventilator capacity to accommodate a surge of COVID19 patients. Additionally, both hospitals are communicating directly and frequently with local public health to improve the response to COVID-19.

4. Increase the Supply of Personal Protective Equipment The hospital operations are not currently exceeding the supply of PPE, but availability in the supply chain remains low. Others healthcare providers such as long-term care facilities and emergency medical services continue to have PPE availability challenges. The Joplin Chamber of Commerce has initiated a PPE acquisition project whereby they provide mask to local business, long term care facilities and emergency medical providers. The PPE supply will continue to be monitored.

5. Implement Comprehensive COVID-19 Surveillance Systems- With the increase in testing capacity there will be more data available to provide detection and reporting of COVID-19 in the community. Channels are in place to direct this information to the Health Department where it will be used to inform health policy and respond to active cases.

6. Massively Scale Contact Tracing and Isolation and Quarantine- The Joplin Health Department has grown the epidemiology team from one person to nine by reallocating staff within the Department. Additional staff are being identified for further increased capacity. Current capacity with existing staff for this function is estimated at 12 new cases per day. To date the maximum number of cases reported was two in a single day. Contact tracing modeling suggests that contract tracing personnel staffing should be between 15 to 30 professionals per every 100,000 population. With our current staffing of nine, this puts the Joplin ratio at approximately 18 per 100,000.

7. Offer Voluntary Local Isolation and Quarantine- The local Homeless Coalition in conjunction with One Joplin has established a shelter project, which will allow for isolation and quarantine for homeless individuals.

8. Encourage the Public to Wear Masks- The CDC has issued guidance regarding wearing face masks. Our current focus remains on people staying home when symptomatic and using physical distancing strategies. Currently the use of masks in public setting is not mandated, but strongly encouraged when going into public settings.

Triggers for Moving to Recovery Phase 

As the community prepares to reopen, it must have confidence that it is prepared to do so. Following the response plan, the community should not proceed into the Recovery Phase until the following four elements are achieved:

1. Sustained decrease in prevalence of cases for at least 14 days;

2. Hospitals are able to treat all patients with COVID-19 without crisis standards of care;

3. All symptomatic people can be tested; and

4. Public health can maintain active case and contact isolation and monitoring

1. Sustained decrease in prevalence of cases for at least 14 days- Joplin did not see its first case until March 20th. Cases appear to have peaked the 8th of April. Due to the strong community response the City has been able to suppress the spread of the disease. JHD will continue to closely monitor and report relevant metrics on this progress on an ongoing basis.

2. Hospitals are able to treat all patients with COVID-19 without crisis standard of care- Exceeding hospital capacity has a detrimental effect on the community. Currently, hospitals have been able to treat all patients with COVID-19. The Joplin Health Department is working with hospital partners to determine metrics to share that will quantify this element.

3. All symptomatic people can be tested- Testing has significantly improved since the start of the outbreak in our region. With the new testing clinic coming online it is anticipated that all symptomatic people can be tested. Testing is also available for all healthcare workers and first responders. Additional capacity will be pursued to include rapid result testing and antibody testing as they become available.

4. Public health can maintain active case and contact isolation and monitoring- Currently, public health can maintain active case and contact isolation and monitoring. Our department has taken steps to increase the capacity to conduct epidemiology activities. For the foreseeable future, case investigation, isolation, and quarantine can be maintained.

Regional Considerations

As Joplin moves towards reopening the community, the spread of and response to COVID-19 throughout the region must be taken into consideration. Community leaders and policy makers will need to review information beyond Joplin.

Phase 2

Recovery

During Phase 2, the community will take steps to reopen and recover, while still implementing multiple measures to check the spread of disease. When reopening the community, it is vital that it occurs with ultimate regard for maintaining life and reducing morbidity while balancing the vital need to restart the economy.

If a community is reopened too aggressively, the virus can spread quickly, overwhelming the healthcare and public health systems, nullifying much of the work and community sacrifice that has been made.

If reopened too slowly and conservatively, it will become increasingly more challenging for the economy to recover, making the long-term impact of the virus even more devastating. It is also important that individual communities and counties across Southwest Missouri take these steps in a coordinated manner, adjusting as needed. Throughout the duration of Recovery, vigilant surveillance of available data is required.

Using data to drive decision-making in reopening the community will allow for a balanced, responsive approach.

Within implementation of the Recovery Phase there are three key elements:

• Adjust physical distancing strategies

• Maintain focus on testing, isolation strategies and healthcare

Individual and corporate responsibility 

During all steps of Phase 2, relative to nursing homes, long-term care facilities, retirement homes, and assisted livings homes shall abide by the latest guidance and requirements set forth by the President, the CDC, the Centers for Medicaid and Medicare Services, and the Missouri Department of Health & Senior Services.








1. Adjust Physical Distancing Strategies- Prior to the current statewide stay-at-home order, there were multiple phased-in actions taken by the City to increase physical distancing. A similar, stepwise approach is required as communities are reopened.

The following outlines several recommended steps in this continuum.

Movement through each step will be determined by the spread or containment of disease. Each step within Recovery should be a minimum four weeks and may be as long as several months.

If the spread of COVID-19 increases to unacceptable levels, the recommendation is to move backwards through the steps up to and including resuming a stay at home order.

Throughout the steps, physical distancing standards must be applied, which includes remaining physically separated by 6 feet at all times and frequent disinfecting of surfaces of common areas and in between groups’ use of a space.

This provision shall apply in all situations, including but not limited to, when customers are standing in line or individuals are using shared indoor or outdoor spaces. During Recovery, travel outside of the community and region should only occur for essential activities.

Step 1:

Reopen business and organizations with occupancy limitations, no mass gatherings 

Step 1 begins to relax the community mitigation strategies to cautiously resume some normal community activities while keeping many measures in place to limit physical interactions and the spread of disease.

Individuals at high risk should continue to stay at home and not interact with others except for vital activities.

Business: current essential, non-retail businesses and organizations will continue operations. All businesses and organizations that were not essential, except for the industries specified below, can be reopened but are restricted to 25 percent of the entity’s authorized fire or building code occupancy for locations less than 10,000 square feet, and 10 percent of the entity’s authorized fire or building code occupancy for locations 10,000 square feet or greater. All businesses must continue to apply physical distancing strategies in all facilities.

When possible, operations should be conducted remotely.

Bars: continue to be closed. Gyms: all fitness centers and gyms can be reopened but are restricted to 25 percent of the entity’s authorized fire or building code occupancy. No group or team activities or classes are permitted. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, gyms must comply with the attached requirements for reopening gyms, attached hereto as Exhibit A.

Outdoor Pools: all outdoor pools can be reopened but are restricted to 25 percent of the entity’s authorized fire or building code occupancy. All outdoor pools must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, outdoor pools must comply with the attached requirements for reopening outdoor pools, attached hereto as Exhibit B.

Personal Services: all barbers, cosmetologists, massage therapists, practitioners of tattooing, body piercing, and branding, tanning salons, and other providers of personal services can be reopened but are restricted to 25 percent of the entity’s authorized fire or building code occupancy. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, barbers, cosmetologists, massage therapists, practitioners of tattooing, body piercing, and branding, and other providers of personal services must comply with the attached requirements for reopening personal services, attached hereto as Exhibit C.








Places of Worship: all places of worship can be reopened but are restricted to 25 percent of the entity’s authorized fire or building code occupancy. All places of worship must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, places of worship must comply with the attached requirements for reopening places of worship, attached hereto as Exhibit D.

Restaurants: all restaurants can be reopened but are restricted to 25 percent of the entity’s authorized fire or building code occupancy. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, restaurants must comply with the attached requirements for reopening restaurants, attached hereto as Exhibit E.

Theaters: all theaters can be reopened but are restricted to 25 percent of the entity’s authorized fire or building code occupancy. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, theaters must comply with the attached requirements for reopening theaters, attached hereto as Exhibit F.

Mass gatherings: Mass gatherings are not permitted, except for funerals. A mass gathering is any gathering of 10 or more individuals in a location where physical interaction is possible, whether spontaneous or scheduled. All mass gatherings are required to apply physical distancing standards. Outdoor sports are permitted consistent with the requirements in Exhibit G.

Schools: continue to be closed consistent with the Missouri Department of Health & Senior Services Director’s Order dated April 27, 2020.

Step 2:

Reduce limitations for businesses and organizations, reintroduce limited mass gatherings 

Step 2 continues the reopening of communities by relaxing the occupancy limitations and begins to resume mass gatherings on a limited basis. All interactions within the community are required to maintain physical distancing strategies.

High risk individuals should continue to limit interactions to those that are considered vital. Business: current essential, non-retail, businesses and organizations will continue operations.

For all other business and organizations, occupancy restrictions are relaxed to 50 percent of the entity’s authorized fire or building code occupancy. All businesses and organizations must continue to apply physical distancing standards in all facilities. When possible, operations should be conducted remotely.

Bars: all bars can be reopened but are restricted to 25 percent of the entity’s authorized fire or building code occupancy. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely.

Gyms: all fitness centers and gyms can be reopened but are restricted to 50% of the entity’s authorized fire or building code occupancy. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, gyms must comply with the attached requirements for reopening gyms, attached hereto as Exhibit A.

Outdoor Pools: all outdoor pools can be reopened but are restricted to 50% of the entity’s authorized fire or building code occupancy. All outdoor pools must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, outdoor pools must comply with the attached requirements for reopening outdoor pools, attached hereto as Exhibit B.

Personal Services: all barbers, cosmetologists, massage therapists, practitioners of tattooing, body piercing, and branding, tanning salons, and other providers of personal services can be reopened but are restricted to 50 percent of the entity’s authorized fire or building code occupancy. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, barbers, cosmetologists, massage therapists, practitioners of tattooing, body piercing, and branding, and other providers of personal services must comply with the attached requirements for reopening personal services, attached hereto as Exhibit C.

Places of Worship: all places of worship can be reopened but are restricted to 50% of the entity’s authorized fire or building code occupancy. All places of worship must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, places of worship must comply with the attached requirements for reopening places of worship, attached hereto as Exhibit D.

Restaurants: all restaurants can be reopened but are restricted to 50 percent of the entity’s authorized fire or building code occupancy. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, restaurants must comply with the attached requirements for reopening restaurants, attached hereto as Exhibit E.

Theaters: all theaters can be reopened but are restricted to 50 percent of the entity’s authorized fire or building code occupancy per individual theater. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely.  Additionally, theaters must comply with the attached requirements for reopening theaters, attached hereto as Exhibit F.

Mass gatherings: Mass gatherings of less than 50 individuals may resume. The limitation of 50 individuals pertains to all individuals at an event or location, except for funerals. All mass gatherings are required to apply physical distancing standards. Outdoor sports are permitted consistent with the requirements in Exhibit G.








Schools: continue to be closed consistent with the Missouri Department of Health & Senior Services Director’s Order dated April 27, 2020.

Step 3: 

Remove limitations for business, maintain limited mass gatherings, reopen schools

Step 3 allows for further reopening of the community, while still limiting mass gatherings, which are a risk for rapid community spread of the virus. Interactions throughout the community need to continue to maintain physical distancing strategies.

With the increase in physical interactions, individuals and organizations must increase the focus on personal protection through hand hygiene, respiratory etiquette, and self-isolation with symptom onset. High risk individuals should continue to limit interactions to those that are considered vital.

Business: all occupancy restrictions for businesses are removed. Businesses must continue to apply physical distancing strategies in all facilities. When possible, business operations should be conducted remotely.

Bars: all bars can be reopened but are restricted to 50 percent of the entity’s authorized fire or building code occupancy. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely.

Gyms: all occupancy restrictions for fitness centers and gyms are removed. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, gyms must comply with the attached requirements for reopening gyms, attached hereto as Exhibit A.

Outdoor Pools: all occupancy restrictions for outdoor pools are removed. All outdoor pools must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, outdoor pools must comply with the attached requirements for reopening outdoor pools, attached hereto as Exhibit B.

Personal Services: all occupancy restrictions for barbers, cosmetologists, massage therapists, practitioners of tattooing, body piercing, and branding, tanning salons, and other providers of personal services are removed. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, barbers, cosmetologists, massage therapists, practitioners of tattooing, body piercing, and branding, and other providers of personal services must comply with the attached requirements for reopening personal services, attached hereto as Exhibit C.

Places of Worship: all occupancy restrictions for places of worship are removed. All places of worship must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, places of worship must comply with the attached requirements for reopening places of worship, attached hereto as Exhibit D.

Restaurants: all occupancy restrictions for restaurants are removed. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, restaurants must comply with the attached requirements for reopening restaurants, attached hereto as Exhibit E.

Theaters: all occupancy restrictions for theaters are removed. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, theaters must comply with the attached requirements for reopening theaters, attached hereto as Exhibit F.

Mass gatherings: Mass gatherings and the restrictions in Step 2 remain the same.

Schools: All schools are permitted to reopen. Physical distancing and personal protection strategies should be applied to full capability.

Step 4:

Expand mass gathers

Step 4 takes a final step in reopening the community with restrictions, relaxing the maximum allowable attendance at mass gatherings to 250. Step 4 will be maintained until a transition to Phase 3 is achievable. High risk individuals should continue to limit interactions to those that are considered vital.

Business: all occupancy restrictions for businesses are removed. Businesses must continue to apply physical distancing strategies in all facilities. When possible, business operations should be conducted remotely.

Bars: all occupancy restrictions for bars are removed. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely.

Gyms: all occupancy restrictions for fitness centers and gyms are removed. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, gyms must comply with the attached requirements for reopening gyms, attached hereto as Exhibit A.

Outdoor Pools: all occupancy restrictions for outdoor pools are removed. All outdoor pools must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, outdoor pools must comply with the attached requirements for reopening outdoor pools, attached hereto as Exhibit B.

Personal Services: all occupancy restrictions for barbers, cosmetologists, massage therapists, practitioners of tattooing, body piercing, and branding, tanning salons, and other providers of personal services are removed. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, barbers, cosmetologists, massage therapists, practitioners of tattooing, body piercing, and branding, and other providers of personal services must comply with the attached requirements for reopening personal services, attached hereto as Exhibit C.

Places of Worship: all occupancy restrictions for places of worship are removed. All places of worship must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, places of worship must comply with the attached requirements for reopening places of worship, attached hereto as Exhibit D.

Restaurants: all occupancy restrictions for restaurants are removed. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, restaurants must comply with the attached requirements for reopening restaurants, attached hereto as Exhibit E.

Theaters: all occupancy restrictions for theaters are removed. All businesses must continue to apply physical distancing strategies in all facilities. When possible, operations should be conducted remotely. Additionally, theaters must comply with the attached requirements for reopening theaters, attached hereto as Exhibit F.

Mass gatherings: Mass gatherings expand to have up to 250 individuals. Schools: All schools have reopened. Physical distancing and personal protection strategies should be applied to full capability.

2. Maintain Focus on Testing, Isolation Strategies and Healthcare 

As the community engages in Step 1 – Step 4 of Recovery to reopen the community, there is an ongoing need to maintain focus on the following:

• testing is available to everyone who is symptomatic

• individuals with COVID-19 and their contacts are isolated

• that healthcare has adequate capacity to treat individuals needing care. Testing supplies and laboratory services must be able to maintain turnaround time of testing of less than 72 hours, with a goal of less than 24-hour turnaround.

This will provide public health and healthcare with information needed to respond to the disease and provide community leaders with accurate and timely information for decision making.

Public health must maintain the increased capacity to conduct epidemiological processes. As efficiency and effectiveness permits, public health and healthcare should implement initiatives to provide targeted and rapid testing and containment strategies with newly identified cases. These approaches may prove beneficial to limit the spread of disease.

During Recovery, healthcare will continue to treat the symptoms and secondary effects of the disease. Therapeutic modalities will be introduced as they become available. Significant progress in treatment may also encourage the reopening of the community.

3. Individual and Corporate Responsibility

During Phase 2’s implementation of reopening the community, individual and corporate responsibility is the most important component, and the most challenging to ensure.

The major assumption throughout Recovery is that the success and continued reopening depends on largescale compliance with the guidance that has issued.

While community leaders are responsible for determining the timing and implementation of reopening, the full adoption of the spirit behind the steps is incumbent of everyone.

Businesses, associations, churches, and organizations must take responsibility for taking appropriate measures for their employees, members, and patrons.

Applying physical distancing strategies including the limitations of occupancy, maintain a six-foot distance, providing remote accessibility, and not allowing anyone with symptoms to be present will greatly affect the community’s wellbeing.

It is each of our own individual decisions and actions that will ultimately determine the spread of COVID-19. Diseases are fueled by sick people in contact with healthy people and insufficient hygienic practices.

We also know that people can spread disease up to 48 hours before becoming symptomatic. Choosing to abide by requirements and recommendations at each step of community reopening will allow communities to more quickly emerge from the impacts of COVID-19.

When we focus on the community’s response and recovery, not just ourselves, we all benefit.

Adjusting the Response and Trigger for Phase 3

How quickly and effectively the community can reopen is directly related to the spread of COVID19, which depends on the community’s response.

When all rules and guidance in each step are followed, the likelihood for a more rapid reopening occurs. When rules or guidance are not followed, the reopening process is likely to take significantly longer.

The progression of COVID19 will be monitored by public health officials and community leaders. When the spread of disease is slow or reduced progression into and through Recovery will occur.

If the spread of disease is rapid or hits elevated levels that exceed hospital capacity, it is likely that the community will have to regress with reopening the community and may include an additional stay at home order.

When the community has sustained a low level of COVID-19, allowing it to progress through the steps of Recovery, there are three triggers that could prompt movement into Phase 3:

• availability of a vaccine

• widespread availability of effective treatment

• minimal active cases

Phase 3 will introduce long-term solutions to mitigate the spread of disease and lift all restrictions. associated with COVID-19. More detailed plans for transitioning into Phase 3 will be developed as the time nears.

Exhibits mentioned above can be found at the bottom of the page at this link.