As of now, nearly one in three states — 17 in
total plus the District of Columbia — has a stay-at-home order that expires in
May or June.
Alaska
Gov.
Mike Dunleavy has ordered residents to stay at home until April 21.
Dunleavy has said that Alaskans can
again schedule elective surgeries for on or after May 4 and visit their doctors
for non-urgent needs.
Arizona
Gov.
Doug Ducey issued a stay-at-home
order that will expire on April 30.
"I
want to get the economy moving and people back to work as soon as possible --
when it is safe and healthy for people to do so," Ducey
said on Twitter on April 13.
The governor
emphasized the importance of maintaining social distancing and continuing to
make "responsible choices."
"It's
critical that we keep those efforts up as we plan for the future and a time
when we can begin to return some normalcy to people's lives," Ducey said.
On
April 15, the state issued Health Mandate 015, which allows for the resumption
of health care services contingent upon certain safety standards being met. The
order provides that health care services, such as non-urgent or non-emergent
elective services, that cannot be delayed beyond eight weeks without posing a
significant risk to quality of life may resume May 4. The order additionally
lays out a range of safety precautions that must be met in order for
facilities, which explicitly include ASCs, to provide elective services.
On April 15, the state issued Health Mandate 015, which
allows for the resumption of health care services contingent upon certain
safety standards being met. The order provides that health care services, such
as non-urgent or non-emergent elective services, that cannot be delayed beyond
eight weeks without posing a significant risk to quality of life may resume May
4. The order additionally lays out a range of safety precautions that must be
met in order for facilities, which explicitly include ASCs, to provide elective
services.
Arkansas
Gov.
Asa Hutchinson has not issued a stay-at-home order.
Schools
will be closed for the rest of the
academic term. Fitness centers, bars, restaurants and other public spaces are
closed until further notice.
Hutchinson told reporters on April 16
that he wants to bring back elective surgeries. "We want to get
(hospitals) back to doing the important health-care delivery that is important
in our communities," he said.
On April 3, the
Department of Health issued a directive on elective surgeries mandating that
"procedures, testing, and office visits that can be safely postponed shall
be rescheduled to an appropriate future date." The directive states that
emergent and urgent care are exempt from the mandate, and states that
exceptions should be made in the following circumstances: if there is a threat
to the patient’s life if the procedure is not performed; if there is a threat
of permanent dysfunction of an extremity or organ system if the surgery is not
done; if there is a risk of metastasis or progression of staging of a disease
or condition if surgery is not performed; if there is a risk that the patient’s
condition will rapidly deteriorate if surgery is not done, and there is a
threat to life or an extremity or organ system or a threat of permanent
dysfunction or disability.
California
Newsom told reporters to check back with him
in two weeks, when he may be able to outline exact dates if California sees a flattening,
and then decline, of coronavirus hospitalization rates, as well as a reduction
in the number of people in intensive care unit beds. A third major factor
determining the date, he said, would be building a workforce of health care
workers who can trace coronavirus infections in order to isolate the infected.
Gov.
Gavin Newsom issued a stay-at-home order on March 19 that has no set end date.
Newsom
announced a joint Western
States Pact with
Oregon Governor Kate Brown and Washington Governor Jay Inslee on April
13.
"Health
outcomes and science -- not politics -- will guide these decisions" to
reopen the states, according to a joint statement from the governors.
Newsom outlined a framework for
reopening the economy in the Golden State on Tuesday that he said was
predicated on the state's ability to do six things:
1.
expand testing to
identify and isolate the infected,
2. maintain vigilance to protect seniors and high risk
individuals,
3. be able to meet future surges in hospitals with a
"myriad of protective gear,"
4. continue to collaborate with academia on therapies and
treatments,
5. redraw regulations to ensure continued physical
distancing at businesses and schools and
6. develop new enforcement mechanisms to allow the state to
pull back and reinstate stay-at-home orders.
"I
know you want the timeline, but we can't get ahead of ourselves and dream of
regretting. Let's not make the mistake of pulling the plug too early, as much
as we want to," Newsom said.
"I
know you want the timeline, but we can't get ahead of ourselves ... Let's not
make the mistake of pulling the plug too early, as much as we want to,"
Newsom said.
Colorado
Gov.
Jared Polis extended the state's
stay-at-home order, which now remains in effect until April 26.
He said
April 15 that the key information state officials need to determine when parts
of the economy can be reopened is likely to come within the next five days.
The
governor warned that restrictions won't all be lifted at the same time, and
life will be different for some time. "The virus will be with us,"
Polis said. "We have to find a sustainable way that will be adapted in
real time to how we live with it."
Connecticut
Connecticut
Gov. Ned Lamont extended the mandatory shutdown in the state until May 20.
Connecticut
has joined a coalition with the Northeastern states of New Jersey, New York,
Pennsylvania, Delaware, Rhode Island and Massachusetts to coordinate the
reopening of the economy, according to a news release from New York Governor
Andrew Cuomo's office.
Lamont
said he believed it would take at least another month before the state could
decide on how and when to open things back up and emphasized "this is no
time to relax."
Looking to revive the state's economy,
Lamont announced Thursday the formation of the "Reopen Connecticut
Advisory Board."
Delaware
Gov.
John Carney issued a statewide
stay-at-home order that will remain until May 15 or until the "public
health threat is eliminated."
Delaware
has joined a coalition with the Northeastern states of New York, New Jersey,
Connecticut, Massachusetts, Pennsylvania, and Rhode Island to coordinate the
reopening of the economy, according to a press
release from NY Governor Andrew
Cuomo's office.
The governor said April 17 that once the state reopens, social distancing, face
coverings in public, washing hands, limited gatherings and vulnerable
populations sheltering in place will remain.
District of Columbia
Washington,
DC Mayor Muriel E. Bowser extended a stay-at-home order
until May 15.
"I
don't know if that means we will be open on May 16, but it will be a point for
us to check in. And if we need to extend it beyond that, we certainly
will," Bowser said during April 15 media briefing.
Florida
Florida
Gov. Ron DeSantis issued a stay-at-home order for Floridians until April
30.
DeSantis
plans to announce his reopening plan for the state of Florida next week, he
said April 16.
During a news conference Thursday, he
suggested it could start with allowing elective surgeries.
DeSantis
said he will meet April 17 with a task force that includes experts across
various industries throughout the state.
Southeast
Florida, which is the epicenter of the outbreak in the state, could be treated
differently than other parts, the governor said.
Georgia
Gov.
Brian Kemp issued
a statewide shelter-in-place
order that runs until April 30. The governor also extended the public health
emergency through May 13. All K-12 public schools will remain closed through
the end of the school year.
Kemp
emphasized the importance of expanding testing before reopening the
state.
"We're
a little behind the curve from when our peak is going to be to other states
around the country," Kemp
said during an April 13 press briefing. "That is certainly a day I am
ready for, but I think today specifically we have been focused on the surge
capacity, ramping up testing to do more than we're doing."
Hawaii
Gov.
David Ige issued a stay-at-home order for Hawaii
residents which will last through at least April 30.
He said Thursday the state doesn't
satisfy the federal criteria for phased reopening, one of which is a 14-day
downward trend in the number of cases. "We're making progress, but we're
not there yet, so please continue your hard work and perseverance, we will get
through this together," he said.
Idaho
Gov.
Brad Little amended his order April 15 to allow for some businesses and
facilities to reopen for curbside pickup, drive-in and drive-thru service and
for mailed or delivery services. It is now effective through the end of the
month.
Little
said that the measures were working and Idaho is "truly seeing a
flattening of the curve."
Little
said that the measures were working and Idaho is "truly seeing a
flattening of the curve."
"Our
goal is for most businesses to open after the end of the month, but with the
understanding that it may not be possible if there's an upward trend in severe
Covid-19 cases in Idaho between now and then," Little said.
Illinois
Gov.
J.B. Pritzker issued a stay-at-home order through at least April 30.
Pritzker
said during a media briefing Monday that he believes
the current state in Illinois has been enough to slowly start lifting
shelter-in-place orders so that some industry workers can go back to
work.
Although there is no clear time line,
he hopes that restarting production will go "industry by industry, and
maybe company by company."
On March 17, The Illinois Department of
Public Health posted an elective surgical procedure guidance, “recommending cancelling ALL elective surgeries and
procedures to immediately decompress the healthcare system during the COVID-19
response that are considered non-emergent or elective.” The guidance defines
“elective” as, “those procedures that are pre-planned by both the patient and
the physician that are advantageous to the patient but are NOT urgent or
emergent.” On March 20 Governor Pritzker issued a stay at home order for
state residents, directed non-essential businesses to cease operations and
prohibited public gatherings. The order provides that healthcare and public
health operations may continue and that individuals may leave the home to
access such services: the order notes that, “healthcare and public health
operations shall be construed broadly to avoid any impacts to the delivery of
healthcare, broadly defined.”
On
April 15 when asked about possibly extending the order into May he said:
"We're continuing to (consult health officials) and we'll be making
announcements about our decisions over the next several days."
Indiana
On March 30 Governor Holcomb issued a new executive order containing
provisions that supersede his order from March 16 regarding elective
procedures. The order states that, “to preserve PPE for health care providers
who are battling the COVID-19 pandemic, beginning April 1, 2020, all health
care providers, whether medical, dental or other, and health care facilities,
whether hospitals, ambulatory surgical centers, dental facilities, plastic surgery
centers, dermatology offices and abortion clinics, are directed to cancel or
postpone elective and non-urgent surgical or invasive procedures.” The order
provides that “elective and non-urgent" procedures mean any surgery or
invasive procedure which can be delayed without undue risk to the current or
future health of the patient as determined by the treating provider. The order
also notes that its provisions do not apply to any procedure that if performed
in accordance with the commonly accepted standards of clinical practice, would
not deplete the hospital capacity needed to cope with the COVID-19 outbreak.
Gov.
Eric Holcomb on April 17 extended the stay-at-home order through May 1.
The
extension will give the state additional time to look into what the best way is
to reopen sectors of the economy, Holcomb said. He said he would work with the state hospital association
to see when elective surgeries could resume.
Indiana
is part of a Midwest coalition of states looking at reopening possibilities
Iowa
Gov.
Kim Reynolds has not declared a stay-at-home order. Reynolds issued a State of Public
Health Disaster Emergency on March 17, ordering all nonessential businesses to
close until April 30.
The
governor formed an Iowa economic recovery task force consisting of state
leaders and private business leaders and announced plans to discuss with
education leaders about the possibility of reopening schools.
Reynolds
on April 16 announced that residents of the region of the state with the most
cases, where there was an outbreak at a food processing plant, cannot get
together until April 30.
"You
may gather only with members or your immediate household," Reynolds said,
adding there were a few exceptions like religious services with 10 worshippers
or fewer.
On March 26 Governor Reynolds issued an
additional disaster proclamation extending
the business closure order and impacting the operation health care facilities.
The order directs that effective at 5 p.m. on March 27 and until the disaster
proclamation expires, “all nonessential or elective surgeries and procedures
that utilize personal protective equipment (PPE) must not be conducted by any
hospital, outpatient surgery provider, or outpatient procedure provider,
whether public private or nonprofit.” The order provides that a nonessential
surgery or procedures, “…is one that can be delayed without undue risk to the
current or future health of a patient, considering all appropriate factors
including, but not limited to any: (1) threat to the patient’s life if the
surgery or procedure is not performed; (2) threat of permanent dysfunction of
an extremity or organ system; (3) risk of metastasis or progression of staging;
and (4) risk of rapidly worsening to severe symptoms.” The order directs
hospitals and outpatient surgery and procedure providers to limit the use of
PPE and requires such facilities to establish an internal governance structure
to ensure adherence to the requirements of the order. On April 2 Governor
Reynolds issued an updated proclamation of disaster emergency extending the expiration of the public health disaster
emergency, including the previous order regarding elective procedures, to April
30. On April 9, the Department of Public Health issued a PPE Shortage Order, which
states in part, “you shall immediately decrease demand for PPE by...comply(ing) with the ban on nonessential medical and dental
services issued in the Proclamation of Disaster Emergency on March 26, 2020,
and all subsequent extensions; cancel(ing) all other
elective and non-urgent procedures and appointments which utilize PPE.”
Kansas
Gov.
Laura Kelly issued a stay-at-home
order, which has been extended until May 3.
The
initial order was set to expire April 19.
Kelly
said Kansas expects to see its peak of coronavirus cases between April 19-29,
based on projections.
Kentucky
Gov.
Andy Beshear issued a "Healthy at
Home" orde March 25 that is in effect
indefinitely.
Kentucky
is working with six other states to coordinate reopening measures.
The
governor said April 16 it will be a phased-in approach "where we can have
that that symbiotic bump ... to make sure that the steps that we take
ultimately have a bigger reward or bigger output, because they are being
replicated in other areas that we already do so much business with."
On March 18, the Kentucky Cabinet for Health
and Family Services issued a directive stating that,
“…healthcare providers in the Commonwealth are hereby directed…to cancel all
procedures that in the opinion of a physician the delay will not cause harm to
the patient or negatively affect the patient’s life expectancy. This directive
takes effect at midnight March 18, 2020 and will include all levels of care.”
On March 23 Governor Beshear issued his own order on the topic. Noting that previously the
Governor had recommended that Kentucky hospitals cease performing elective
procedures on March 18, the order directs that, “ALL non-emergent, non-urgent
in-person medical, surgical, dental, and any other healthcare practice or
procedure must have immediately ceased effective close of business on March 18,
2020.” The order provides that the state will rely on healthcare professionals
to exercise their best clinical judgement in the implementation of the
restriction and provides the following guidelines: “emergent” is any healthcare
service that, were it not provided, is at high risk of resulting in serious
and/or irreparable harm to a patient if not provided within 24 hours; “urgent”
is any healthcare service that, were it not provided, is at high risk of
resulting in serious and/or irreparable harm to a patient if not provided
within 24 hours to 30 days; and “non-urgent” is any healthcare service that,
were it not provided, is unlikely to result in any serious and/or irreparable
harm to a patient if not provided for more than 30 days.
Louisiana
Gov.
John Bel Edwards extended the state's stay-at-home order through April 30.
The
governor announced on April 16 the formation of an economic recovery task
force.
"They're
going to look at our economy, make recommendations to make our businesses more
resilient so that we can open them up, get businesses open, get workers back to
work, but do so in a way that adequately affects public health," he said.
On March 11, Governor John Bel Edwards signed a
public health emergency for coronavirus. Another proclamation on March 16 limited gatherings to fewer than 50 people
following guidance from the CDC (from March 17 to April 13, 2020. On March 12,
the Department of Health issued guidance recommending (among other things) that all facilities
consider limiting or restricting all elective or voluntary medical procedures
for the next 30 days. Following this guidance, the Louisiana Department of
Health released a Healthcare
Facility Notice March 18 stating, “…any and all medical
and surgical procedures that…can be safely postponed for a period of thirty
(30) days, SHALL be postponed for a period of thirty (30) days. This thirty
(30) day period shall run from March 19, 2020, through April 21, 2020, unless otherwise
extended in writing by the Department.” On March 21 the State Health Officer
released a new Healthcare Facility Noticesuperseding the previous guidance on elective or voluntary surgeries.
The new notice provides that, “...any and all medical and surgical procedures
SHALL be postponed until further notice...”. Exceptions to the directive
provide that medical and surgical procedures are allowed in order to treat an
emergency medical condition as defined by 42 CFR 489.24. The notice
additionally grants an exception to medical and surgical procedures necessary
to avoid further harms from underlaying condition or disease. On March 24 the
President of the Louisiana State Board of Medical Examiners released an open letter to licensees to revisit
the order from the State Health Officer to halt elective procedures. “The LSMBE
will have a zero tolerance policy of licensees violating these LDH, State
Health Officer, orders. Complaints of violation of Dr. Guidy’s
orders will be investigated an physicians will (be)
subject to possible disciplinary action.” On April 7 the Louisiana Department
of Health issued an emergency order extending
a number of previously-issued orders until April 30: included in the list of
orders is #2020-COVID-ALL-007, which is the healthcare facility notice issued
on March 21 which directed the postponement of medical and surgical procedures
in the state.
Maine
Gov.
Janet Mills issued a "Stay
Healthy at Home" executive order through at least April 30. Mills extended the state's civil
state of emergency until May 15.
"We
are in the midst of one of the greatest public health crises this world has
seen in more than a century," Mills said in a news
release.
"This virus will continue to sicken people across our state; our cases
will only grow, and more people will die. I say this to be direct, to be as
honest with you as I can. Because saving lives will depend on us."
Mills
said she wished she didn't have to extend the state of emergency, but "the
continued spread of the virus demands a sustained response by the
State."
Maine
is in touch with neighbors New Hampshire and Vermont on reopening measures, the
governor said April 14.
On March 15 Governor Janet Mills signed a civil emergency proclamation responding
to the COVID-19 outbreak in Maine. While the proclamation itself is short and
makes no mention of elective surgeries, Governor Mills recommended at the time of signing
that, “all non-urgent medical procedures, elective surgeries, and appointments
at hospitals and health care providers across the state…” be postponed until
further notice. As part of this recommendation the Governor additionally
recommended that events with 50 or more people be postponed.
Maryland
Gov.
Larry Hogan issued a statewide
stay-at-home order on March 30. There is no current potential end date.
The
governor said during his appearance on CNN Newsroom on April 13 that the state
is discussing ways to safely reopen the state with health officials, and that
his priority is to save lives, not the economy.
"We've got to listen to the
doctors and scientists," Hogan said. "We've also got to be concerned
about people getting the help they need and getting on track, but doing so in a
gradual and safe manner when it's really the right time to do it."
Hogan said a cooperation
amongst other governors on when to reopen the states would be a "good
idea."
People
in Maryland will be required to wear face coverings in stores and on public
transportation as of April 18.
Governor Hogan issued an additional executive order on
March 16 related to health care services: the order includes a provision
authorizing the Secretary of Health to, “take actions to control, restrict, and
regulate the use of health care facilities for the performance of elective
medical procedures, as necessary to respond to the catastrophic health
emergency.” On March 23 the Maryland Department of Health released a Directive and Order Regarding Various Healthcare Matters. The directive provides that, “pursuant to the Executive
Order of March 16 relating to various health care matters...all licensed
hospitals, ambulatory surgical centers, and all other licensed health care
facilities shall cease all elective and non-urgent medical procedures effective
at 5 p.m., Tuesday, March 24, 2020 and not provide any such procedures for the
duration of the catastrophic health emergency.“
Massachusetts
Gov.
Charlie Baker issued an emergency order
requiring all nonessential businesses to close facilities until May 4.
Massachusetts
has joined a coalition with the Northeastern states of New York, New Jersey,
Connecticut, Pennsylvania, Delaware, and Rhode Island to coordinate the
reopening of the economy, according to a press
release from NY Governor Andrew
Cuomo's office.
Baker
told residents of his state that officials have begun conversations around
reopening the state but there's still a lot of work that needs to be done
before a plan is set into motion.
The state will need to have testing,
tracing, isolation and quarantine procedures in place to reopen, the governor
said.
"I think it's going to be really
important that we all pay attention to what the others are up to, and to make
sure that nobody does anything that puts somebody in a really bad spot, because
they just weren't thinking about what that impact was going to be on some other
part of the Northeastern part of the US," he said.
Governor Charlie Baker declared a state of emergency on
March 10. On March 15, the Governor issued an additional emergency order limiting
gatherings to 25 individuals and prohibiting on-premises consumption of food or
drink at bars and restaurants. Pursuant to the emergency powers authorized
under the declaration, Public Health Commissioner Monica Bharel announced that effective from
March 18, 2020, “until the State of Emergency is terminated by the Governor, or
until rescinded by me, whichever shall happen first,” all hospitals and
ambulatory surgery centers shall implement procedures issued by the Department
of Public Health regarding the scheduling, cancelation and performance of
non-essential elective invasive procedures. Additional guidance related to the order
was released by the Department of Public Health the same day: the guidance
recommends providers at hospitals and ASCs to use their clinical judgment on a
case by case basis regarding any invasive procedures that must be done to
preserve the patient’s life and health. Additionally, the guidance defines
“nonessential, elective invasive procedures” to mean, “procedures that are
scheduled in advance because the procedure does not involve a medical
emergency…However, the ultimate decision is based on clinical judgment by the
caring physician.”
Michigan
Gov. Gretchen
Whitmer extended the state's
stay-at-home order through April 30.
Whitmer
said during Monday's press briefing that reopening the state's economy will be
based on a "data-driven approach based on facts, based on science, based
on recommendations from experts."
The four factors the governor will take
into consideration before reopening Michigan include
1.
a sustained reduction in
cases,
2.
expanded testing and
tracing capabilities,
3.
sufficient healthcare
capacity, and
4.
the best practices for
the workplace.
At the
end of week that saw a protest at the Capitol and an anti-Whitmer tweet from
Trump, the governor said April 17: "There's no one I think is more eager
to start reengaging sectors of our economy than I am. But the last thing I want
to do is to have a second wave here and so we've got to be really smart."
She
said the first businesses to reopen will be in low-risk sectors.
The Governor also issued an executive order containing
provisions intended to enhance the operational capacity of health care
facilities in the state on March 17. On March 20, Governor Whitmer issued
an executive order requiring
“covered facilities” (defined to include freestanding surgical outpatient
facilities) to implement a plan to temporarily postpone, until the termination
of the state of emergency, all non-essential procedures. The order defines
"non-essential procedures" as a medical or dental procedure that is
not necessary to address a medical emergency or to preserve the health and
safety of a patient, as determined by a licensed medical provider. The order is
to take effect, “beginning as soon as possible but no later than March 21, 2020
at 5:00 pm, and continuing while the state of emergency...is in effect.”
April 16
Detroit hospitals resuming
surgeries, procedures after weeks of red ink
For the first
time in a month, Henry Ford Health System resumed outpatient surgeries in
specially designated operating rooms at its five hospitals, senior vice
president Dr. Steven Kalkanis revealed
Thursday.
Other health
systems, including Detroit Medical Center and Michigan Medicine, said they are
also easing into more surgeries.
…
"Today marks the first day where Henry
Ford Health System is launching a portal of opportunity for patients to have
surgeries for non-COVID, but still time-sensitive cases," Kalkanis said in a call with reporters.
…
"If you
need a diagnostic procedure or surgery, which if delayed would risk impairing
your health, function or well-being, we have made our hospitals safe for this
care," said Dr. Donald Weaver, specialist in chief, surgery, at the
Detroit Medical Center, in a statement. "This includes our emergency
departments, imaging departments, cardiac labs and operating rooms.
"In this
challenging time, we also recognize that patients continue to require medical
attention for conditions other than those due to COVID-19. Chronic diseases,
medical emergencies, new or worsening symptoms, childbirths and ongoing
conditions like cancer do not stop for COVID-19, and neither can their
care," Weaver said.
In addition,
Michigan Medicine, the Ann Arbor-based health system affiliated with the
University of Michigan, also has been performing "essential cancer
surgeries throughout the pandemic,” said Mary Masson, a spokeswoman for the
health system.
“We’ve been
able to gently increase our surgery volumes for time-sensitive procedures, even
now, for patients for whom further delay would create harm," she said.
While Whitmer
did issue an executive order prohibiting purely elective procedures, Masson
noted that it doesn't prohibit essential care.
"Essential
care includes cancer and cardiovascular procedures in individuals for whom
delays would be detrimental,” she said.
Michigan
Medicine, she said, is in “active planning stages” to expand the surgeries and
procedures it can provide to patients who are at highest risk for disease
progression.
“As always, we
would protect our patients from any infectious disease with careful procedures
that are always in place,” Masson said. “Throughout this pandemic, safety has
been a top priority and we have taken many steps to minimize the spread of
disease.”
Minnesota
Gov.
Tim Walz extended the state's
stay-at-home order through May 3.
He also
signed an executive order extending the peacetime emergency for an additional
30 days until May 13.
Walz emphasized the importance of
expanding testing and tracing the spread of the virus before opening the state.
The
governor's plan to open up the economy is to "test, we have to do contact
tracing, and we have to isolate the people who need to be isolated, and this
has to be on a massive scale," Walz said.
On March 19 Governor Walz signed an executive order directing
the delay of inpatient and outpatient elective surgery and procedural cases
during the COVID-19 peacetime emergency. The order directs that, “beginning no
later than March 23, 2020 at 5:00 pm, and continuing for the duration of the
peacetime emergency declaration…or until this Executive Order is rescinded, all
non-essential or elective surgeries and procedures, including non-emergent or
elective dental care, that utilize PPE or ventilators must be postponed
indefinitely. The order defines as non-essential surgery or procedure as “…a
surgery or procedure that can be delayed without undue risk to the current or
future health of the patient,” and provides examples of criteria to consider in
making this determination. The Minnesota executive order does not defer to the
professional opinion of physicians to the same degree that orders in other
states have, and it additionally includes a penalty of $1,000 fine or
imprisonment for not more than 90 days for a person who willfully violates the
order to indefinitely postpone such procedures.
Mississippi
Gov.
Tate Reeves has extended a shelter-in-place order to April 27.
Reeves
said April 17 the state will begin relaxing some of the restrictions on
nonessential businesses by allowing them to offer services via drive-thru,
curbside or delivery.
Reeves
has said the state needed to open things back up as quickly and as responsibly
as possible.
"We
know that we will not be able to return to our typical lives right away,"
Reeves said during a media briefing on April 13.
"There
are still more sacrifices to be made. We do want to look ahead to opening
things up, I know that there are many Mississippians whose lives and
livelihoods rely on our ability to get them back to work in a responsible
way."
During a press conference on March 16 with the
Governor, the State Health Officer and the Director of Mississippi Emergency
Management officials recommended that clinics cancel all unnecessary tests and
elective surgery procedures should be delayed at hospitals and clinics. On
March 19 the Mississippi Department of Health released an official Health Alert Network (HAN) Alert
ordering the postponement of elective medical procedures and non-essential
medical visits. The alert states, “physician, hospitals and medical centers
must defer surgical and diagnostic procedures until COVID-19 spread has been
diminished and the supply of protective medical equipment is restored.” The
alert additionally states that, “patients should rescheduled
any non-essential procedures, surgeries or medical visits until the threat of
COVID-19 is diminished." On April 10 Governor Reeves issued an executive order directing
that, “...all licensed health care professionals and all licensed health care
facilities shall postpone all surgeries and procedures that are not immediately
medically necessary to correct a serious medical condition of, or to preserve
the life of, a patient who without immediate performance of the surgery or
procedure would be at risk for serious adverse medical consequences or death,
as determined by the patient’s physician.” The order provides an exception to
any procedure that, if performed properly, would not have the potential to
deplete, “...the hospital capacity, medical equipment or PPE needed to cope
with the COVID-19 disaster.” The order will be in effect until April 27.
Missouri
Gov.
Mike Parson on April 16 extended the stay-at-home order through May 3.
The governor's office said they will
work with hospitals, healthcare providers, health officials, and business
leaders to develop a reopening plan.
"Our
reopening efforts will be careful, deliberate, and done in phases," he
said.
Montana
Gov.
Steve Bullock extended the state's stay-at-home order through April 24.
Bullock
held a governor's coronavirus task force tele-town
hall for
Montanans on Monday in which he said following the state's guidelines will
allow the state to reopen sooner rather than later.
Bullock
said he does not know when the stay at home order will be lifted and that while
he doesn't "want to have it in place any longer than what's
necessary," he is more concerned about completely reopening the state and
jeopardizing the work that has been done.
Nebraska
Gov.
Pete Ricketts issued the "21 Days
to Stay Home and Stay Healthy" campaign on April 10. Ricketts ordered that all hair
salons, tattoo parlors and strip clubs be closed through April 30 and all
organized group sports canceled until May 31.
Nebraska
is one of the states that has not issued a stay-at-home order to limit the
spread of coronavirus nationwide. Ricketts has not made any plans to reopen the
state.
The
state's campaign is based on six rules: staying home, socially distancing at
work, shopping alone and only once a week, helping kids
social distance, helping seniors stay at home and exercising at home.
Governor Ricketts resisted issuing a statewide
directed health measure ordering enforceable limits on public gatherings, the
closure of bars and restaurants, the closure of schools and a prohibition on
elective procedures, opting instead to issue directed health measures in a
piecemeal fashion, targeting various counties at a time. However, on April 3 a
statewide directed health order was
issued that, among other things, prohibits elective medical and dental
surgeries and elective medical and dental procedures. The order provides that
“elective” means, “...a surgery or procedure that is scheduled in advance
because it does not involve a medical or dental emergency,” and additionally
provides that, “surgeries or procedures that must be done to preserve the
patient’s life or physical health, but do not need to be performed immediately,
are allowed by a case-by-case determination of the medical or dental provider.”
Nevada
Gov.
Steve Sisolak issued a stay-at-home
order that expires April 30.
When
asked about how he'd make his decision to reopen the economy, Sisolak said "positive testing is
important but it's not my number one parameter."
"The things that I look at on a
daily basis are hospitalizations, intensive care unit hospitalizations, ventilator
usage, and people who pass," Sisolak added.
He said
April 16 that reopening would happen with gradual steps. "I cannot take
the chance of overwhelming our healthcare system," he said.
New Hampshire
Gov.
Chris Sununu issued a stay-at-home
order until May 4.
Sununu
told reporters on April 16 that he'll decide on whether to extend the order
before May 4.
"We
want to give people some flexibility and be able to plan," Sununu said. He
said that applies to restrictions on nonessential businesses and public
gatherings.
All
public and private schools will remain closed for the rest of the school year,
and students will continue remote learning, he said.
New Jersey
Gov.
Phil Murphy issued a stay-at-home
order on March 21 that has no specific end date.
New
Jersey has joined a coalition with the Northeastern states of New York,
Connecticut, Pennsylvania, Delaware, Rhode Island and Massachusetts to
coordinate the reopening of the economy, according to a news
release from New York Gov. Andrew
Cuomo's office.
"No
one has given more thought or is more eager to restart our economy than I am,
but if we don't get the sequencing right, we put more lives at risk. The only
path to a sustainable economic recovery is through a strong healthcare
recovery," Murphy said in a news
release.
"A
coordinated, regional approach, informed by a multi-state council of experts,
will help us avoid a major setback with potentially disastrous
consequences."
On March 23 Governor Murphy issued
an executive order directing,
“beginning at 5:00 p.m. on Friday, March 27, 2020, all ‘elective’ surgeries
performed on adults, whether medical or dental, and all ‘elective’ invasive
procedures performed on adults, whether medical or dental, are suspended in the
State.” The Governor’s order goes on to define “elective surgery or invasive
procedure” as, “…any surgery or invasive procedure that can be delayed without
undue risk to the current or future health of the patient as determined by the
patient’s treating physician or dentist.” The order additionally directs ASCs
to, “…coordinate any possible post-surgery admissions with local hospitals
prior to performing any surgery or invasive procedure,” and requires both
hospitals and ASCs to, “…establish written guidelines to ensure adherence to
the provisions of this Order…”.
New Mexico
Gov. Michelle Lujan Grisham extended the state's emergency
order to April 30.
She
said Thursday her state is evaluating
the federal guidelines but authorities cannot put the "cart before the
horse."
"Please
know that my administration is working doggedly to develop robust economic
recovery plans alongside a plan for a thoughtful, staged and flexible reopening
of our state -- and the moment we can safely implement those plans, they will
be implemented with the same dedication and focus that we are using to contain
this pandemic," the governor said.
On March 25 Governor Grisham announced the
release of a new order from Secretary of Health Kunkel aimed at
preserving PPE. The new order prohibits, “all hospitals and other health care
facilities, ambulatory surgical facilities, dental, orthodontic and endodontic
offices in the State of New Mexico…from providing non-essential health care
services, procedures, and surgeries.” The order defines “non-essential health
care services, procedures, and surgeries,” as those which can be delayed for
three months without undue risk to patient health. The order also provides
examples of criteria to consider when distinguishing between essential and
non-essential actions and states that the prohibition on non-essential health
care services, procedures and surgeries is not meant to apply to, “…(a) the
provision of emergency medical care or any actions necessary to provide
treatment to patients with emergency or urgent medical needs; (b) any surgery
or treatment that if not performed would result in a serious condition of a
patient worsening…and; (c) the full suite of family planning services.” The
order takes effect March 27 and requires health care providers and facilities subject
to the prohibition on non-essential procedures to submit a policy to the
Department of Health addressing how it will comply with the order and
identifying the procedures that will generally be deemed essential and
non-essential. Providers and facilities will have until March 30 to submit
their policy.
New York
Gov.
Andrew Cuomo issued a "New York
State on PAUSE" executive order which took effect on March 22. Schools and
nonessential businesses are ordered to stay closed
until April 29.
New
York has joined a coalition with the Northeastern states of New Jersey, Connecticut,
Pennsylvania, Delaware, and Rhode Island and Massachusetts to coordinate the
reopening of the economy, according to a press
release from Cuomo's
office.
The
governor has not come to any decision on when businesses will reopen and said
he rejected "any elected official or any expert who says I can tell you
what's going to happen four weeks from today."
The
governor said April 16 there are factors for when a business can reopen,
including how essential it is and what is the risk of catching the virus.
An additional declaration was
issued focusing on the health care system in the state, though it did not
contain provisions related to elective surgery. While the state government has
not issued guidance regarding elective surgeries at this time, New York City
Mayor Bill de Blasio issued an emergency executive order on
March 16 directing hospitals and ASCs in the city to cancel or postpone
elective procedures “within 96 hours of the issuance of this order”. Subsequent
information suggests the exact timing of the start of the ban to be 4:00 p.m.
on Friday, March 20. The emergency executive order directs hospitals and ASCs
to “identify procedures that are deemed ‘elective’ by assessing which
procedures can be postponed or cancelled based on patient risk considering the
emergency need for redirection of resources to COVID-19 response.” On March 22,
Governor Cuomo held a press conference during
which he announced that, “we’re also canceling all elective, non-critical
surgery for hospitals as of Wednesday. Elective, non-critical – the critical
surgery, fine. If it’s not critical then postpone it.” On March 23 Governor
Cuomo issued another executive order enacting
many of the items he discussed during the March 22 press conference. In the
order, the Commissioner of health is required to direct, “...all general
hospitals, ambulatory surgery centers, office-based surgery practices and
diagnostic and treatment centers to increase the number of beds available to
patients, including by canceling all elective surgeries and procedures, as the
Commissioner of Health shall define.”
North Carolina
Gov.
Roy Cooper issued a stay-at-home
order for the state effective until April 29.
The
governor said that the more people adhere to social distancing requirements in
April, the sooner the state will loosen restrictions.
"We
have a team examining how North Carolina can emerge with the right practices in
place to keep us healthy and strong and ready to jump start our economy,"
Cooper said in Monday's press
briefing.
"We're considering the most
effective ways to modify executive orders to help boost the economy while
continuing to prevent our hospitals from being overwhelmed with Covid-19
patients."
On March 20 North Carolina Department of Health
and Human Services Secretary Mandy Cohen released a letter to hospital and ASC leaders in the state
requesting that they suspend elective and non-urgent procedures as of March 23.
The letter defines such procedures as, “...any procedure or surgery that if not
done within the next 4 weeks would cause harm to the patient.” The letter also
stated that beginning March 20, “...hospitals and ambulatory surgery centers
should institute an explicit, real-time review of all non-time sensitive
procedures and surgeries.
North Dakota
Gov.
Doug Burgum has only shut down schools, restaurants, fitness centers, movie
theaters and salons. Burgum declared a state of
emergency on March 13.
North
Dakota is one of the states that has not issued a stay-at-home order.
Burgum
has said he hopes some businesses can start to reopen May 1.
Ohio
Gov.
Mike DeWine issued a statewide
stay-at-home order that will remain in place until May 1.
He said
April 16 that on that date the state will begin the first phase of reopening.
"We
are working on (specifics) and will be talking about this in the days ahead. We
will be dealing with the schools shortly, probably early next week," he
said.
As for
events with big crowds, he said, "We need to take this a few weeks at a
time to see where we are."
The order provides that healthcare and public
health operations may continue and that individuals may leave the home to
access such services: the order notes that, “healthcare and public health
operations shall be construed broadly to avoid any impacts to the delivery of
healthcare, broadly defined.”
Posted
Apr 15, 2020 at 4:46 PM
Ohio’s doctors and surgeons have one week to tell the governor what steps they would take to protect patients
and conserve personal protective equipment if he were to lift the ban on
elective surgeries.
Gov. Mike DeWine said he talked for about two hours Wednesday
with medical professionals worried about patients who can’t get help because of
the state’s restriction. He told the group to give him a plan that would still
minimize the use of personal protective equipment.
Doctors say the resumption of elective surgeries can’t happen
soon enough because their patients and businesses are suffering.
“Frankly, I’ve been financially devastated. My revenues at the
office are down about 78%,” Dr. Steve Tornik, a
family physician from Plain City, said during a legislative task force meeting.
“Bottom line, we’ve got to get back to normal as soon as we can.”
Oklahoma
Gov.
Kevin Stitt said April 15 that he is working on a plan to reopen the state's
economy, possibly as early as April 30.
At the
same time, Stitt extended Oklahoma's "Safer at Home" order for adults
over the age of 65 and other vulnerable residents until May 6. Elective surgeries will be
allowed to resume April 24.
Stitt
has said the state would have to ease into reopening its economy.
"We're
doing this with the guidance of the experts, being data driven... based on
what's happening in Oklahoma, not what's going on in a different state or
different city," Stitt said.
On April 15, Governor
Stitt issued an amended
executive order, extending the state’s “Safer at Home” order to May 6 and
allowing elective surgeries to resume in the state starting on April 24. The
order provides that, “Oklahomans and medical providers shall postpone all
elective surgeries until April 24th, 2020.
Elective procedures after April 24th, 2020
are subject to the guidelines set forth in Executive Memo 2020-02.” The order also directs
providers to the CMS Non-Emergent, Elective Medical Services, and Treatment
Recommendations when determining what is considered an elective surgery.
Oregon
Gov.
Kate Brown issued an executive
order directing Oregonians to
stay at home that "remains in effect until ended by the governor."
Brown announced a joint Western
States Pact with California Gov. Gavin Newsom and Washington Gov. Jay Inslee on
April 13.
"This
is not a light switch going on or off," Brown told CNN's Anderson Cooper
on April 14. "This is going to be making a change, testing it, modeling
it, seeing whether it works, and then if it does, you can make another
change."
Brown said she would not ease
restrictions before seeing six components in place:
1.
declining growth rate of
active cases,
2. sufficient personal protective equipment,
3. surge capacity in hospitals,
4. increased test capacity,
5. contact tracing and isolating positive cases, and
6. strategies to protect vulnerable communities.
On March 18, Governor Brown directed all hospitals,
outpatient clinics and health care providers to, “cease all non-emergency
procedures, in order to preserve personal protective equipment…for health care
workers treating COVID-19 patients.” to preserve masks, medical supplies.
Pennsylvania
Gov.
Tom Wolf issued stay-at-home orders
across the state until April 30.
Pennsylvania
has joined a coalition with the Northeastern states of New Jersey, New York,
Connecticut, Delaware, Rhode Island and Massachusetts to coordinate the
reopening of the economy, according to a press
release from New York Gov. Andrew
Cuomo's office.
Wolf
said April 17 there is "no magic wand to wave to get us back to where we
want to be."
He said
no one can flip a switch on the economy and the state shouldn't rush.
"We
can't be impulsive. We can't be emotional," he said.
On March 19 Governor Wolf issued a new order prohibiting the operation of all
businesses that are not life sustaining businesses: this was accompanied by a
similar order from the Secretary of Health and a listdetailing which businesses in the state are considered life
sustaining. The list provides that hospitals and ambulatory health care
services may continue physical operations elective procedures are prohibited.
On April 1 the Department of Health issued an amended order requiring ASCs to
complete the Ambulatory Surgical Facilities Survey on a daily basis for each
day a center is operational. The amended order takes effect immediately. On the
same day the Department released amended guidance to
reflect the new order. This updated guidance provides that, following the
original effective date of March 20, ASCs, “...may not perform any elective
surgeries or procedures unless the surgery or procedure would preserve an organ
function or avoid further harms from an underlying condition or disease.” The
update also prohibits ASCs from allowing the performance of, “...surgeries to
treat emergency or life-threatening conditions to occur in the facility, unless
no hospital is available for the procedure and the need for the surgery could
not have been anticipated.” Lastly, the updated guidance incorporates the requirement
that all ASCs complete the Ambulatory Surgical Facilities Survey on a daily
basis.
Rhode Island
Gov.
Gina Raimondo issued an emergency declaration extending the state's
stay-at-home order to last until May 8.
Rhode
Island has joined a coalition with the Northeastern states of New Jersey, New
York, Connecticut, Delaware, Pennsylvania, and Massachusetts to coordinate the
reopening of the economy, according to a press
release from NY Governor Andrew
Cuomo's office.
To
reopen the state, Raimondo said there would need to be advanced testing and contact tracing
put in place.
"It
is clear that what you're doing is working," Raimondo
said,
referring to residents staying at home. "It's keeping you safer. It's
keeping Rhode Islanders safer. And quite frankly it's making it so I can really
start thinking about reopening this economy sooner rather than later."
South Carolina
Gov.
Henry McMaster extended his previous
"State of Emergency" executive order through at least April 27.
"We
want to get all these businesses going back as soon as we can," McMaster
said during a news conference April 13.
"And
to that end, we will be announcing before long, a plan, a rejuvenation plan, a
revitalization plan in order to get our economy started again."
On March 17 news reports from multiple sources on indicated that Governor McMaster had
issued a number of additional orders that prohibited public events of over 50
people and required the closing of bars and restaurants. Reports suggest that
the orders include a recommendation (not an order) that medical and surgical
centers in the state halt all elective surgeries in the next 72 hours. On the
evening of March 17 the Governor signed a new executive order containing
a prohibition on large public gatherings, a restriction on restaurant and bar
service and provisions allowing coordination between the national guard and
health providers in the state. No provisions in the order addressed elective
surgeries, and no other official orders on the matter have been posted on the
Governor’s or Department of Health’s websites at this time.
April 16
With South Carolina
approaching its projected peak in the coronavirus pandemic, state officials are
discussing when elective surgeries that are critical to the financial health of
hospitals should resume.
Gov. Henry McMaster's
spokesman, Brian Symmes, said Thursday morning that
the Republican governor is working with the South Carolina Hospital Association
to "determine when and how hospitals can gradually resume elective
surgeries while keeping South Carolinians safe."This
comes after House Minority Leader Todd Rutherford of Columbia called for
hospitals to resume elective procedures.
"Now is the time for
the governor to clearly return the power of electing what surgeries to perform
back to our healthcare professionals," Rutherford said in a statement.
Hospital association
spokesman Schipp Ames confirmed that his group and
officials at hospitals in the state are involved in discussions with the
Governor's Office.
Last month McMaster asked
hospitals across the state to stop most elective surgeries to preserve supplies
of protective gear and protect patients from infection.
But
this move also led to a steep drop in income for hospitals, which in turn
triggered employee furloughs. Prisma Health, the state's largest hospital
system, announced last week that more than 10% of its 30,000 employees in the
Upstate and Midlands have either been furloughed or had their hours cut.
One
area of focus, Ames said, is what he described as "time-sensitive"
procedures.
"You have procedures that need to be
performed in a certain timeframe for the wellness of the patient," he
said. "We're not talking about cosmetic procedures."
The talks about resuming
elective surgeries come as state health officials estimate that South
Carolina's "peak resource use" related to the coronavirus pandemic
will occur in two weeks on April 30.
South Dakota
Gov.
Kristi L. Noem has not issued a stay-at-home order.
"We
have seen such an outstanding call to action among the people of South Dakota
that we actually have more people staying home than many of the other states
that have put in shelter in place orders and have put together directives to
tell people they can't leave their homes," she said at a town hall hosted
by South Dakota Public Broadcasting on April 15.
On April 6 Governor Noem
issued an updated executive order,
directing that all health care organizations in the state shall, “postpone all
non-essential surgeries to conserve (and thereby maximize) supplies of personal
protective equipment (PPE).” The order will expire on May 31
Tennessee
Gov.
Bill Lee extended the state's stay-at-home order until April 30.
Lee
said the state would begin reopening the economy in May.
"It'll
be smart, it'll be safe, it'll be measured but we do not have a definitive
decision on what those steps will be yet," Lee said during a news
conference April 13.
On March 23,
Governor Bill Lee signed a new executive order stating
that, “all hospitals and surgical outpatient facilities in the State of
Tennessee shall not perform non-essential procedures, which includes any medical
procedure that is not necessary to address a medical emergency or to preserve
the health and safety of a patient, as determined by a licensed medical
provider. All hospitals and freestanding surgical outpatient facilities must
postpone through the expiration of this Order, at a minimum, joint replacement,
bariatric surgery, and cosmetic surgery, except for emergency or trauma-related
surgery where postponement would significantly impact the health, safety, or
welfare of the patient.” The order excludes a number of procedures from
postponement: surgeries related to advanced cardiovascular disease that would
prolong life; oncological testing, treatment and related procedures;
pregnancy-related visits and procedures, including labor and delivery; organ transplantation;
procedures relating to dialysis; and emergency or trauma-related procedures
where postponement would significantly impact the health, safety and welfare of
the patient. The order takes effect at 12:01 a.m. on March 24 and shall remain
in effect until April 13.
On April 8
Governor Lee issued a new executive order related to
elective surgeries. Beginning on April 9, “all healthcare professionals and
healthcare facilities in the State of Tennessee shall postpone surgical and
invasive procedures that are elective and non-urgent. Elective and non-urgent
procedures are those that can be delayed until the expiration of this Order
because they are not required to provide life-sustaining treatment, to prevent
death or risk of substantial impairment of a major bodily function, or to
prevent rapid deterioration or serious adverse consequences to a patient’s
physical condition if the surgical or invasive procedure is not performed, as
reasonably determined by a licensed medical provider.” The order will remain in
effect until April 30.
Texas
Gov.
Greg Abbott ordered all Texans to stay
home through April 30.
Instead
of kicking off a full restart, the Texas governor announced April 17 that a
group of medical and economic experts will guide him through a series of
incremental steps aimed at slowly reopening the state's economy.
"Opening
in Texas must occur in stages," Abbott said during his briefing Friday.
"Obviously, not all businesses can open all at once on May 1." A
premature opening of private businesses, he said, would risk further outbreaks
and "be more likely to set us back, rather than to propel us
forward."
On April 17, Governor Abbott issued a new executive order loosening
the restrictions imposed on elective surgeries in March. Beginning at 11:59 pm
on April 21 and continuing until 11:59 pm on May 8, the order requires that all
licensed health care professionals and facilities continue postponing all
surgeries and procedures that are not medically necessary. However, the order
provides an exemption from the prohibition for: any procedure that would not
deplete the hospital capacity or the PPE needed to cope with the COVID-19
disaster; or any surgery or procedure performed in a licensed facility that has
certified in writing to the Texas Health and Human Services Commission both,
“...(1) that it will reserve at least 25% of its hospital capacity for
treatment of COVID-19 patients, accounting for the range of clinical severity
of COVID-l9 patients; and (2) that it will not request any personal protective
equipment from any public source, whether federal, state, or local, for the
duration of the COVID 19 disaster.”
Governor
Greg Abbott today held a press conference where he issued three new Executive
Orders to begin the process of reopening the state of Texas while revising
hospital capacity and certain social distancing guidelines. Within the orders,
select activities and services that pose minimal to no threat of spreading
COVID-19 are allowed to reopen using a "Retail-To-Go" model, certain
restrictions on surgeries have been loosened, and schools will remain closed
for the remainder of the 2019-2020 academic year.
Within
these orders, the Governor has established the Strike
Force to Open Texas—a team of nationally recognized medical experts and private and
public leaders who will advise the Governor on safely and strategically
reopening the state of Texas.
"Texans
are battling a colossal challenge—an invisible enemy that has tested our lives
and our livelihoods—but overcoming challenges is part of who we are as
Texans," said Governor Abbott. "We have shown that Texas can continue
our efforts to contain COVID-19 while also adopting safe standards that will
allow us to begin the process of reopening Texas. The Strike Force to Open
Texas brings together nationally recognized medical experts with public and private
sector leaders to achieve this mission. By coming together, we can get Texans
back to work, practice safe standards that will prevent the spread of COVID-19,
and we can overcome this pandemic."
James
Huffines will lead the advisory strike force and Mike Toomey will serve as
Chief Operating Officer. Lieutenant Governor Dan Patrick, House Speaker Dennis Bonnen, Attorney General Ken Paxton, and Comptroller Glenn Hegar will serve as consulting members.
In
addition, Governor Abbott has appointed Texas Department of State Health
Services (DSHS) Commissioner John Hellerstedt, MD, as
Chief Medical Officer of the strike force. Dr. Hellerstedt
will be supported by three Chief Medical Advisors:
John Zerwas, MD,
Executive Vice-Chancellor for Health Affairs at the University of Texas System
Mark McClellan, MD, PhD, Former Food and Drug
Administration Commissioner and U.S. Medicaid and Medicare Administrator
Parker Hudson, MD, MPH, Assistant Professor of
Internal Medicine and Infectious Diseases at Dell Medical School and program
director for the Internal Medicine Residency
These
health experts will develop a medical architecture to comprehensively test and
trace COVID-19 that will enable Texans to gradually and safely begin the
process of returning to work and other activities.
The
medical team will work alongside a Special Advisory Council who will share
innovative ideas to help businesses strategically reopen while containing the
spread of COVID-19. The council consists of 39 business leaders representing
the state's regions and industries. The advisory council will collaborate with
working groups to devise strategies, statewide standards, and appropriate time
frames to reopen the Lone Star State while prioritizing the health and safety
of all Texans.
The
strike force will immediately begin providing input on potential additional
openings of activities and services in Texas consistent with guidelines
provided by the Centers for Disease Control and Prevention (CDC). The Governor
will announce a revised plan for the state based on these initial
recommendations on April 27.
The
Governor’s third Executive Order (GA-15) relates to hospital capacity and personal
protective equipment (PPE) needed for the COVID-19 response. The order loosens
restrictions on surgeries put in
place by Governor Abbott in March. Beginning at 11:59pm on April 21
through 11:59pm on May 8, all licensed health care professionals and all
licensed health care facilities must continue to postpone all surgeries and procedures
that are not medically necessary to diagnose or correct a serious medical
condition of, or to preserve the life of, a patient who without timely
performance of the surgery or procedure would be at risk for serious adverse
medical consequences or death as determined by a patient's physician.
Exceptions now include:
Utah
Gov.
Gary Herbert extended the state's
"Stay Safe, Stay Home" directive through May 1. Schools will be
closed for the remainder of the year.
Utah
has not issued a stay-at-home mandate.
People
have been asked to stay home as much as possible and maintain 6 feet from
others when out. Restaurants are not allowed to have dining rooms open. School
are closed.
Herbert
said the state is making plans for how and when restrictions will be lifted,
but continued to urge citizens to stay home.
On March 24 Executive Director of the
Department of Health Joseph Miner released a State Public Health Order directing
that, “…effective as of 12:01 a.m. on March 25, 2020, all licensed health-care
professionals and all licensed health-care facilities shall postpone all
elective surgeries and procedures in accordance with version 3.15.20 of the CMS
Adult Elective Surgery and Procedures Recommendations, promulgated by the
Centers for Medicare & Medicaid Services on March 18, 2020.” The order
remains in effect until 11:59 p.m. on April 25, unless otherwise modified,
amended, rescinded or superseded.
Vermont
Gov.
Phil Scott issued a "Stay Home,
Stay Safe" order that has been extended until May 15.
Scott
on April 17 outlined a five-point plan to reopen the state while continuing to
fight the spread of the coronavirus during a news conference.
Part of
that plan includes certain businesses such as construction, home appraisers,
property management and municipal clerks to return to work on April 20, with
social distancing measures in place. These businesses will be allowed a maximum
of two workers.
On May
1, farmers markets will be able to operate with strict social distancing
guidelines in place, Scott said.
Governor
Scott issued an addendum to his state
of emergency declaration on March 20 related to the provision of medical care
during the outbreak. Governor Scott orders, “…all clinicians in Vermont to
expedite postponement of all non-essential adult elective surgery and medical
and surgical procedures, including all dental procedures in the safest but most
expedient way possible.” The order goes on to note that, “while case-by-case
evaluations will be made by clinicians, the following factors are to be
considered as to whether planned surgery should proceed: current and projected
COVID-19 cases in the facility and region; supply of PPE to the facilities in
the system; staffing availability; bed availability, especially intensive care
unit (ICU) beds; ventilator ability; health and age of the patient, especially
given the risks of concurrent COVID-19 infection during recovery; (and) urgency
of the procedure.” The order will remain in effect until April 15. On April 10,
Governor Scott issued addendum nineto his initial executive order declaring a state of emergency,
extending all directives contained in previous orders and addendums (including
those directives related to elective surgeries) until May 15.
Virginia
Gov.
Ralph Northam issued a stay-at-home
order effective until June 10.
"We
are in a public health crisis, and we need everyone to take this seriously and
act responsibly," Northam said in a news
release.
"Our message to Virginians is clear: stay home."
Northam has made it clear that the state must make decisions based on
"science, public health expertise, and data," Secretary of Health and
Human Resources Daniel Carey said.
On March 25 Governor Northam released
another executive order,
“…prohibiting all inpatient and outpatient surgical hospitals…free-standing
endoscopy centers, physicians’ offices, and dental, orthodontic, and endodontic
offices in the Commonwealth from providing procedures and surgeries that
require PPE, which if delayed, are not anticipated to cause harm to the patient
by negatively affecting the patient’s health outcomes, or leading to disability
or death.” The order provides that inpatient and outpatient surgical
facilities, free-standing endoscopy centers, physicians’ offices, and dental,
orthodontic, and endodontic offices may perform any procedure or surgery that
if delayed or canceled would result in the patient’s condition worsening, and
encourages outpatient surgical hospitals to work with their local inpatient
hospitals to assist with surge capacity needs. The order shall remain in force
until April 24.
Washington
Gov.
Jay Inslee extended Washignton's
stay-at-home order until May 4, saying "We are yet to see the full toll of
this virus in our state and the modeling we've seen could be much worse if we
don't continue what we're doing to slow the spread."
Inslee
announced a joint Western States Pact with California Gov. Gavin Newsom and
Oregon Gov. Kate Brown on April 13.
Before
deciding on when to reopen the state, Inslee said during an interview with Katy
Tur on MSNBC that there would need to be an "enormous expansions" of coronavirus testing
capabilities, a way to trace the spread in communities, and "for the
president to recognize that these decisions really are going to be made by
governors."
On March 19 Governor Inslee issued a proclamation to, “...prohibit all
hospitals, ambulatory surgical facilities, dental, orthodontic and endodontic
offices in Washington State from providing health care services, procedures,
and surgeries that, if delayed, are not anticipated to cause harm to the
patient within the next three months...this does not include outpatient visits
delivered in hospital based clinics.” The Governor’s proclamation includes
examples of procedures to delay and also provides an exception from the
prohibition for, “the full suite of family planning services and
procedures...(and) treatment for patients with emergency/urgent
needs...Hospitals and ambulatory surgical facilities may perform any surgery
that if delayed or canceled would result in the patient’s condition
worsening...”.
West Virginia
Gov.
Jim Justice issued a stay-at-home
order until further notice.
"That
curve is the curve we're looking for to be able to look at the possibility of
backing things off and going forward. We're not there yet," Justice said
during a news conference April 13.
Despite
numbers suggesting that the state is starting to do better, Justice said it
wasn't time to relax social distancing measures or asking people to stop staying
home.
"I'm
proud of each and every one of you so keep following the guidelines, stay at
home, social distance, practice good hygiene and when the time comes, and it
will, we'll cross the finish line together as West Virginians," Justice
said in a news
release.
On March 31 Governor Justice issued an executive order prohibiting
all elective medical procedures, “…provided that patients will still have
access to urgent, medically necessary procedures like those needed to preserve
the patient’s life or long-term health; and provided that this prohibition
applies equally to all types of elective medical procedures performed in
hospitals, offices, and clinics throughout the state.” The order provides that
“elective” includes, “…medical procedures that are not immediately necessary to
preserve the patient’s life or long-term health, except that procedures that
cannot be postponed without compromising the patient’s long-term health,
procedures that cannot be performed consistent with other law at a later date,
or procedures that are religiously mandated shall not be considered ‘elective’
under this Order.” The order takes effect at 12:00 a.m. on April 1; the order
does not include a repeal date.
Wisconsin
Gov.
Tony Evers has extended his state's stay-at-home order to expire May 26,
according to a statement from the governor's office.
The
extension also loosens some restrictions on businesses. Golf courses are
allowed to reopen, and public libraries and arts and crafts stores may offer
curbside pickup, the April 16 announcement said.
Wyoming
Gov.
Mark Gordon submitted a request asking for a federal disaster declaration for
Wyoming on April 9. Wyoming is one of the states without a stay-at-home
order.
"Though
Wyoming has not reached the dire situations of some states, this declaration
will help us to prepare and mobilize resources when we need them,"
Governor Gordon said in a news
release.
"I look forward to a swift response to our request from the federal
government."