Businesses large and small face the challenge of how to reopen safely during the COVID-19 pandemic. Last week, a detailed plan for reopening from the Centers for Disease Control and Prevention was shelved by the Trump administration, with one official stating that it "would never see the light of day."

As an alternative to the buried CDC guidelines, the Johns Hopkins Bloomberg School of Public Health posted on May 7 a three-part "toolkit" that includes an instruction manual, a business risk worksheet and a risk assessment calculator. Reading through the material, I was impressed by its thoroughness and wide applicability.

* Here are some statistics:

As of May 11, 17,776 new U.S. cases had been reported in the previous 24 hours. The total cases that date was 1.38 million with 81,539 deaths. Because of limited testing, both figures underestimate true figures.

Nursing homes have been especially hard hit by COVID-19. Until recently, senior care facilities did not have to report to the CDC and the Centers for Medicare and Medicaid Services (CMS) their numbers of cases and related deaths. In 14 states, more than half of COVID-19 fatalities occurred among residents. These grim numbers document the extreme vulnerability to seniors who live in the shared space of nursing homes. The statistics highlight the need for repeated testing of both staff and residents of nursing homes.

The outlook for coming months: The Institute for Health Metrics and Evaluations ( was founded in 2007 by the Bill and Melinda Gates Foundation to analyze global health problems. The institute uses a wealth of data, which is continuously updated, to construct models that predict the behavior of COVID-19 in coming months. The most recent update foresees 137,184 deaths for the U.S. by Aug. 4, with a range of 102,000 to 223,000. Models for individual states relate predicted death rates to increased mobility of citizens within those states.

Learn more

Read the “Toolkit for Businesses Considering Reopening or Expanding Operations in COVID-19” at

* Some clinical observations:

Clinicians report occasional cases of "COVID toes," a bluish discoloration of one or more toes in patients who test positive for the coronavirus. The cause is unclear but may reflect clotting or impairment of small arteries to the affected toes.

Some survivors of more severe COVID-19 disease have symptoms that persist for days after their release from the hospital. Other patients deal with lasting damage to their hearts, kidneys and nervous systems. The presumed cause is damage to blood vessels to these organs.

How long can front-line, health care workers sustain their heroic efforts in those locations with continuing, large outbreaks of COVID-19? In wartime, front-line fighters are periodically pulled back for rest and recuperation. Nurses, doctors, other hospital staff and EMTs in the hospitals hardest hit by the epidemic have had no such opportunity. They work under continuous stress, the impact of which is documented by psychological testing. Given the likelihood of a second wave of outbreaks in the fall, our health protectors must have guaranteed, paid time off in which to address their own health needs.

* Staying safe in a time of uncertainty:

Remember to wash hands thoroughly and often, especially after trips from home; avoid touching your face; wear a mask when visiting stores or other locations where crowds may be present; maintain safe-distancing; cover coughs or sneezes with your sleeve or a handkerchief.

Contact Clif Cleaveland at