Lifting Social Distancing Measures in America: State Actions & Metrics

We recently wrote about the scattershot approach states and communities took toward implementing social distancing measures, particularly stay-at-home orders.  While some moved relatively early – and there are indications that this is paying off– others only implemented stay-at-home orders after the White House announced federal social distancing guidelines would extend through April. However, with those guidelines now expired, and the release of the White House’s “Guidelines for Opening Up America Again”, a growing number of states have begun to ease social distancing requirements, even without clear indications that they are successfully controlling their outbreaks. Here we review which states have done so, the approaches taken, and look at several key metrics for assessing their readiness for reopening.

A Range of Approaches

As of May 4, more than half of the states (27) had loosened social distancing restrictions in some way (See Table 1), and others have announced changes that will take effect in the coming weeks. In some cases, these restrictions were only in place for a relatively short period of time, such as in South Carolina (13 days) and Georgia (21 days), whereas in others, they were in place for much longer, such as in Indiana (41 days). As of this writing, the longest across all states, including those that have not begun lifting restrictions, is 48 (California).

In addition, states have taken very different approaches to easing social distancing measures. Some are making small and incremental changes, phasing them in over a period of time, while others are adopting broad changes all at once (see Table 2). For example:

  • On one end of the spectrum, Vermont is keeping its stay at home order in place, but relaxing rules for outdoor and construction work as well as services provided by single workers, such as realtors, attorneys, etc. as long as these businesses can meet strict social distancing standards. In two weeks, the Governor will evaluate whether these rules can be expanded to more businesses.
  • At the other end of the spectrum, Tennessee rescinded its stay at home order and allows most employees to return to work, with the exception of personal services and entertainment businesses, and permits restaurants to reopen to limited dine-in service. Businesses must continue to meet CDC guidelines and restaurants can only operate at 50% capacity, yet these limits are less restrictive than other states.
  • In between, Georgia has retained its stay at home order for high risk groups and its limits on social gatherings of more than 10 people, but has opened many businesses, including personal care service and recreational businesses.

Assessing Key Metrics

While there is no single metric for assessing when it is safe to begin easing social distancing measures, there are several that, when used together, can provide states with needed guidance. These include two metrics in the White House Guidelines, considered “gating criteria” that, with other criteria, should be satisfied before considering moving to a phased comeback:

  • Downward trajectory of documented cases within a 14-day period; or
  • Downward trajectory of positive tests as a percent of total tests within a 14-day period (while testing volume remains flat or is increasing). A lower positivity rate suggests that a broader group of people without symptoms is being tested, rather than tests being concentrated among people who are already severely ill. The World Health Organization recommends that the positivity rate be at or below 10%. In South Korea, New Zealand, and Australia, for example, three countries that have seen a sustained reduction in daily cases and successfully controlled their outbreaks, the positivity rate is below 2%.

Using these metrics, we assessed where the 27 states fall (see Table 3):

  • Trajectory of Cases: Over the past 14 days (using a 7-day rolling average of the percent change in daily cases, to smooth daily fluctuations), 13 of the 27 states show a decrease, while 14 continue to see new cases grow, including Colorado and Tennessee.
  • Trajectory of Positive Tests: Over the past 14 days (using a 7-day rolling average of the percent change in positivity rate), 19 of the 27 states show a decrease, while 8 states show an increase.
  • Current Positivity Rate: The current positivity rate ranges from 0.4% in Alaska to 22.5% in Iowa. It is above 10% in 12 of the 27 states, including above 20% in three states – Colorado, Iowa, and Nebraska.

Taken together, only nine of the 27 states – Alabama, Alaska, Florida, Idaho, Missouri, Montana, Oklahoma, Vermont, and West Virginia – meet the metrics examined here.

However, few of the states have sufficient testing capacity to consider reopening. While most of the 27 states increased testing in the past week, in four states, Mississippi, South Dakota, Utah, and Vermont, the number of tests conducted in the past week fell relative to the week before. The three states with positivity rates above 20%–Colorado, Iowa, and Nebraska—each increased the number of tests conducted by 50% or more in the past week. The share of the population tested in the past week ranges from 0.2% in Montana, Maine, and South Carolina to over 1% in North Dakota, Alaska and West Virginia. Our recent review of testing benchmarks suggests 0.9% is the minimum threshold, but still well below most targets for the share of the population that should be tested each week.

If states could ramp up testing substantially and other criteria are met (such as sufficient hospital capacity and contact tracing capabilities – see, for example, COVIDActNow, Center for American Progress, and AEI), some may be able to consider easing some social distancing requirements, but most still fall short.

A Difficult Balance

In the face of the devastating economic effects the coronavirus is having on the U.S. economy, the pressure for states to ease social distancing restrictions is building. States are making different judgments in balancing the desire to increase economic activity by loosening these rules against the risks to the public’s health of moving too quickly. Just as states’ scattershot approach to stay-at-home orders raised concerns about ongoing community transmission in the U.S., recent movements by some states to ease restrictions similarly raise concerns about new outbreaks. While some states appear to be taking an incremental approach to reopening, others are more aggressive. An assessment of key metrics shows a mixed picture, with only nine of the 27 states meeting the metrics showing a downward trajectory, which still represent just a subset of factors that should be considered for reopening.

As states begin to loosen social distancing requirements, broader testing coupled with enhanced contact tracing and the ability to isolate those who contract the virus will be needed to contain localized outbreaks. Ongoing assessment of key metrics will be important to inform future state action, including if and when the reinstatement of some or all social distancing measures is needed.

Table 1: Statewide Stay at Home Orders by Date
State Date Announced Effective Date End Date
Alabama April 3 April 4 April 30
Alaska March 27 March 28 April 24
Arizona March 30 March 31 May 15
Arkansas
California March 19 March 19 Until revoked
Colorado March 26 March 26 April 26*
Connecticut March 20 March 23 May 20
Delaware March 22 March 24 May 15
District of Columbia March 30 April 1 May 15
Florida April 1 April 3 May 4
Georgia April 2 April 3 April 30*
Hawaii March 23 March 25 May 31
Idaho March 25 March 25 April 30
Illinois March 20 March 21 May 30
Indiana March 23 March 24 May 4
Iowa
Kansas March 28 March 30 May 3
Kentucky March 22 March 26 Until revoked
Louisiana March 22 March 23 May 15
Maine March 31 April 2 May 31
Maryland March 30 March 30 Until revoked
Massachusetts March 23 March 24 May 18
Michigan March 23 March 24 May 15
Minnesota March 25 March 27 May 18
Mississippi March 31 April 3 April 27
Missouri April 3 April 6 May 3
Montana March 26 March 28 April 26
Nebraska
Nevada March 31 April 1 May 15
New Hampshire March 26 March 27 May 31
New Jersey March 20 March 21 Until revoked
New Mexico March 23 March 24 May 15
New York March 20 March 22 May 15
North Carolina March 27 March 30 May 8
North Dakota
Ohio March 22 March 23 May 29
Oklahoma
Oregon March 23 March 23 Until revoked
Pennsylvania March 23 April 1 May 8
Rhode Island March 28 March 28 May 8
South Carolina April 6 April 7 May 4
South Dakota
Tennessee March 30 March 31 April 30
Texas March 31 April 2 April 30
Utah
Vermont March 24 March 24 May 15
Virginia March 30 March 30 June 10
Washington March 23 March 23 May 31
West Virginia March 23 March 24 Until revoked
Wisconsin March 24 March 25 May 26
Wyoming
* Stay at home order rolled back to high risk groups only. Source: KFF analysis of state documents and press releases.
Table 2: Rolling Back Social Distancing Measures
State Effective Date of Stay at Home Order Date Social Distancing Rollback Begins Details
Alabama April 4 April 30 Stay at home order lifted; large gathering and restaurant limits remain in place; some non-essential businesses can reopen with reduced capacity, elective procedures can resume
Alaska March 28 April 24 Stay at home order lifted; large gathering limit increased but remains in place; some non-essential businesses (including personal care) can reopen with reduced capacity; restaurants can reopen to dine-in customers but must follow physical distancing and capacity limits; elective procedures can resume
Colorado March 26 April 27 Stay at home order rolled back to high-risk groups; large gathering limit increased but remains in place; phased-in reopening for non-essential businesses (including personal care) with reduced capacity; restaurant limit remains in place; elective procedures can resume
Florida April 3 May 4 Stay at home order lifted, but limit on large gatherings remains in place; retail businesses can reopen at 25% capacity; restaurants can reopen at 25% capacity; elective medical procedures can resume
Georgia April 3 April 24 Stay at home order rolled back to high-risk groups; large gathering ban remains in place; some non-essential businesses (including personal care and gyms/fitness facilities) can reopen with reduced capacity; restaurants can reopen to dine-in customers with capacity limits; elective procedures can resume
Idaho March 25 May 1 Stay at home order and large gathering ban are lifted; many non-essential businesses can reopen with certain precautions; restaurants remain closed to dine-in service
Indiana March 24 May 4 In all but three counties, stay at home order lifted; limit on large gatherings loosened to ban groups of more than 25 people; most non-essential business can reopen; retail buisnesses can reopen at 50% capacity; restaurant limits remain in place
Iowa May 1 In 77 counties, some non-essential businesses can reopen at 50% capacity and restaurants can resume dine-in services at 50% capacity; non-essential businesses remain closed in remaining counties; elective procedures can resume
Kansas March 30 May 4 Stay at home order lifted, but limit on gatherings of 10 or more people remains in place; most non-essential businesses, including restaurants, can reopen if they adhere to social distancing requirements, but personal care services businesses remain closed
Maine April 2 May 1 Stay at home order and large gatherings ban remain in place; some non-essential businesses, including drive-in theaters, certain recreational facilities, barbershops and salons, may reopen; elective procedures can resume
Michigan March 24 April 24 Some non-essential businesses,(bike repair, landscaping, garden supply, moving and storage, workers who process remote orders for pick-up/delivery) may reopen
Minnesota March 27 April 27 Some non-essential businesses (non-critical industrial and manufacturing, office-based work) may reopen; All workers who can work from home must still do so
Mississippi April 3 April 27 Stay at home order expired; non-essential businesses except gyms, clubs, personal care and grooming facilities may reopen with precautions; retail businesses cannot exceed 50% capacity and other requirements; restaurants and bars remain limited to drive-through, curbside and/or delivery
Missouri April 6 May 4 Stay at home order and limit on large gatherings lifted; all businesses can reopen; retail businesses, including restaurants, must adhere to capacity limits
Montana March 28 April 27 Stay at home order and large gathering ban lifted; retail businesses can reopen with capacity limits and strict physical distancing; restaurants, bars and distilleries can reopen to limited dine-in services
Nebraksa May 4 Limit on gatherings of more than 10 people remains in place; in 10 of 19 local health districts, previously closed personal care services businesses can reopen; restaurants can reopen to dine-in services at 50% capacity
North Dakota May 1 All businesses can reopen with certain precautions
Ohio March 23 May 4 Stay at home order and ban on large gatherings remain in effect; certain manufacturing businesses and offices can reopen; most non-essential retail businesses must remain closed, except for carry-out, delivery, and by-appointment services only; elective medical procedures can resume
Oklahoma Apirl 24 Personal care businesses can reopen; restaurants, movie theaters, sporting venues, and gyms can reopen next week if they maintain social distancing protocols
South Carolina April 7 April 20 Stay at home order lifted, but ban on large gatherings remain in effect; certain retail stores can reopen at 20% capacity; beaches can reopen; restaurants can reopen for outside dining only; lifted mandatory quarantine for travelers from certain states; large gatherings ban remains in effect
South Dakota May 4 Limits on retail business operations lifted
Tennessee March 31 April 27 Stay at home order lifted, but limit on large gatherings remains in place; restaurants can reopen to dine-in customers at 50% capacity; retail businesses can reopen at 50% capacity
Texas April 2 April 30 Stay at home order lifted; but limit on large gatherings remains in place; restaurants, retail stores, malls, movie theaters, museums, and libraries can reopen at 25% capacity
Utah May 1 Restaurants, personal care, and retail businesses can reopen if they maintain social distancing protocols; large gathering ban eased but remains in place; travel restriction rolled back; elective surgeries can resume
Vermont March 24 April 20 Stay at home order and limit on large gatherings remains in place; limited businesses can reopen with social distancing and maximum of ten workers; outdoor retail spaces can reopen with a maxiumum of 10 people total
West Virginia March 24 May 4 Stay at home order lifted; limit on large gatherings eased to allow gatherings of up to 25 people; some non-essential retail businesses, including barbershops and nail and hair salons, can reopen
Wyoming May 1 Limit on gatherings of more than 10 people remains in place; previously closed personal care businesses can reopen if they meet social distancing requirements
*IA, NE, ND, OK, SD, UT, and WY did not issue a stay at home order, but did require some or all non-essential businesses to close. Source:   KFF analysis of state documents and press releases
Table 3: Readiness Metrics
State
Percent Change in Daily Cases 4/13
and 4/27
(7-day Rolling Average)
Percent Change in Positivity Rate 4/13
and 4/27

(7-Day Rolling
Average)
Current Share of Tests with Positive Results
(7-Day Rolling Average)
Percent Change in Weekly Tests
(4/16-4/30)
Share of Population Tested in the Past Week
Alabama -23.5% -61.3% 5.4% 112.6% 0.7%
Alaska -72.3% -90.9% 0.4% 103.1% 1.0%
Colorado 52.3% -19.4% 21.9% 101.9% 0.4%
Florida -42.1% -38.0% 6.2% 10.6% 0.3%
Georgia -14.1% -56.7% 11.0% 44.9% 0.5%
Idaho -58.3% -79.3% 6.3% 368.9% 0.6%
Indiana 50.3% 27.0% 19.8% 9.7% 0.3%
Iowa 269.8% 48.6% 22.5% 56.1% 0.4%
Kansas 239.1% 73.4% 16.4% 98.4% 0.4%
Maine -33.1% 84.8% 5.2% 2.5% 0.2%
Michigan -16.7% -56.4% 14.1% 52.6% 0.5%
Minnesota 285.6% 46.0% 10.3% 89.7% 0.3%
Mississippi 21.8% 100.4% 11.6% -35.5% 0.4%
Missouri -24.7% -56.8% 8.3% 141.3% 0.3%
Montana -82.0% -81.6% 0.8% 5.2% 0.2%
Nebraska 441.4% 115.4% 22.4% 57.1% 0.4%
North Dakota 188.7% -45.4% 4.2% 140.6% 1.5%
Ohio 14.9% -22.0% 13.5% 14.8% 0.3%
Oklahoma -10.4% -41.0% 3.9% 14.9% 0.4%
South Carolina 3.5% -8.5% 10.6% 23.8% 0.2%
South Dakota -42.9% -35.1% 15.2% -15.7% 0.3%
Tennessee 61.2% -34.5% 4.9% 19.4% 0.7%
Texas 7.2% -46.2% 6.3% 34.8% 0.3%
Utah 28.2% -18.8% 3.4% -9.9% 0.9%
Vermont -71.9% -11.5% 2.0% -23.2% 0.3%
West Virginia -32.7% -83.8% 1.1% 99.9% 1.1%
Wyoming 60.6% 288.0% 7.1% 57.1% 0.3%
SOURCE: KFF analysis cases and testing data; see State Data and Policy Actions to Address Coronavirus at https://www.kff.org/health-costs/issue-brief/state-data-and-policy-actions-to-address-coronavirus/