Across the U.S. today, an increasing number of states are either reopening or feeling the economic pressures to reopen despite the guidance of the Centers for Disease Control and Prevention (CDC) and public health officials. The question remains, however, how much can the economy recover if people do not feel safe participating within it? And what about the potential for a resurgence of COVID-19? To find out more, Michael Weissman of GLG’s Healthcare team talked to Martin J. O’Malley, the former Governor of Maryland and Mayor of Baltimore City.

Governor O’Malley has been recognized by his fellow mayors, and then his fellow governors, as a leader on homeland security and preparedness. After the 9/11 attacks, Governor O’Malley became the Democratic Chair of the newly established Committee on Homeland Security of the U.S. Conference of Mayors, a leadership role performed every year thereafter. This interview has been condensed and edited for clarity.

With many U.S. states starting to open, I wanted to get your thoughts on the situation. What are the key statistics and metrics that are important to consider when making this decision to reopen?

One thing we are all experiencing is the conflict between the public health pressure – the fact that we should stay socially distant and not interact with others until 14 days of decline – and economic pressure. That public health pressure is now intersecting with the economic pressure because our society cannot function efficiently unless people are working and can feed their children.

As some states begin to reopen – contrary to the CDC’s and healthcare professionals’ advice – we need to watch for a virus flare-up. The virus remains as contagious now as it was before, and we’ll likely be playing whack-a-mole while doing our best to identify new outbreaks and track them, contain them, and isolate them to prevent another full-scale spread, which means everybody would need to go back to being socially distant.

In the Maryland, Virginia, and DC area, cases are still rising every day. We have not begun to see the 14-days-in-a-row decline that the public health people tell us is the first threshold to pass before getting to a phased reopening.

In one of Governor Cuomo’s recent press conferences, he introduced the concept of a “circuit breaker,” meaning that even with a phased reopening, there must be some objective criteria that tells us that we need to go back to quarantining and staying indoors. This “circuit breaker” has two criteria: one is that the hospitals reach 70% capacity, and the other is if the transmission rate they calculate rises to more than one-to-one.

Many governors are starting to reopen without seeing a plateau, let alone seeing cases drop. Do you think that’s too early? Do we need more testing before we can effectively understand the transmission rate?

The Johns Hopkins School of Public Health recently published a document called “Public Health Principles for a Phase Three Opening during COVID-19: Guidance for Governors.” It describes one condition that should be met and then three capacities that should be developed before the phased reopening begins.

The condition I already touched on: 14 days of declining cases. The capacities are adequate testing, adequate hospital capacity – including protective equipment for doctors and nurses – and, finally, adequate contact tracing. I don’t believe any of those capacities will be in place at a level of scale and effectiveness by the time the economic pressure overcomes the public health pressure. We will probably see states reopen before they are sufficiently ramped up in hospital capacity, contact tracing, or testing.

If I were a mayor or governor, I would do everything I could to hold off reopening until I saw 14 consecutive days of declining cases. Would you want to reopen if you were just going to see a spike again? We need to quickly do as much as possible to build those capacities. That said, economic pressure will win out in many cases, and states will feel forced to open before they’re ready. I think states will – and should – hold fast until they see 14 days of declining cases. Just because the burner is off and you can put your hand on it doesn’t mean that the fire’s not still there.

I think we’ll see flare-ups in Georgia and in other states and places that come back too quickly. And I think it’s going to force them back to square one.

Many state budgets are on a July 1 fiscal calendar. As we think about entering the next fiscal year, what types of services might to need to be cut or limited? Which programs will not get cut? How might this differ between states that are Democrat or Republican controlled?

I served as governor through the Great Recession. The current revenue downturn and the abruptness of the revenues being turned off for state budgets is something unprecedented, even compared to that experience.

During the recession, it was a limbo dance that never seemed to end. Every time we did a round of cuts to pull 100 or 200 million out of the budget, the people with the sharp pencils said, “You have to do it again. And again, and again.” The only thing that saved us as a nation was the Recovery and Reinvestment Act, which gave every state the money they needed not to lay off firefighters, police officers, and particularly teachers.

I would not even begin to guess at answering your question. Hopefully, Congress doesn’t run out of the public will necessary to pass a meaningful stimulus recovery act that will backfill state and local governments to compensate for the unprecedented turn-off of revenues.

Our state and local governments need to continue their continuity of operations, whether we’re discussing the sanitation workers – who are getting sicker at higher rates than anybody else – or the correctional officers in our jails or prisons, or teachers. We need all those people to continue to do their jobs. The next stimulus will be important to averting a great depression, not to mention maintaining the continuity of operations necessary for us to ramp up the public health response needed for our economic recovery.

As unemployment rises, more people will likely apply for Medicaid. How should states think about dealing with expanded Medicaid roles? Is that something that the federal government will have to help states out with?

The federal government needs to step up. But so do the governors of America, whose collective voices have never had as much credibility as they do right now.

This is a national emergency. This is a pandemic that has attacked our nation. It requires a robust public health response. Because stage and local governments cannot print money or do the level of borrowing that our federal government can, it necessitates a federal response. There is no way that clever state accounting or sharper pencils in Medicaid administration will get us out of this. We need a robust federal response and it must make our states and our county governments strong enough to pull us through this public health crisis.

You do not cut people off from healthcare when more and more of your citizens are becoming sick. In just two months of the pandemic, we have lost more people now than we lost in all of Vietnam. This is not a time to be shoving people off healthcare roles in the hopes that they might find miracle cures.

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About Martin J. O’Malley

Martin J. O’Malley was Governor of Maryland and previously served as Mayor of Baltimore City. Governor O’Malley has been recognized by his fellow mayors and then his fellow governors as a leader on homeland security and preparedness. After the 9/11 attacks, Governor O’Malley was the Democratic Chair of Committee on Homeland Security of the U.S. Conference of Mayors. Upon his election as Governor of Maryland, he became the Democratic Chair of the Taskforce on Homeland Security for the National Governors’ Association. Governor O’Malley held this role every year of the eight years he served. In 2012, President Obama appointed the Governor Co-Chair of the federally established Council of Governors, whose congressional mandate was to better coordinate state and federal responses to large-scale emergencies in the homeland, including hurricanes, terrorist attacks, and pandemics.

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This article is adapted from the May 1, 2020, GLG teleconference “Reopening the U.S. – Potential Timelines and Lingering Impact of COVID-19.” If you would like access to this teleconference or would like to speak with Governor O’Malley or any of our more than 700,000 experts, contact us.

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