Recover, Restore and Re-open: A Stanford Medicine framework for bouncing back from pandemic | News Center

Last spring, as office buildings emptied and local governments ordered residents to shelter in place, Stanford Medicine faculty members and executives sprang into action to understand more about the mysterious new coronavirus.

Even in the early months of the pandemic, it was clear that a return to normal — bringing students back to classrooms, workers back to offices and travelers back to airlines — would take complex and scientifically grounded policies and guidance.

Now, Stanford Medicine has launched a website to advise various segments of society on getting back to healthy functioning. The effort is called Recover, Restore and Re-open, or R3.

“Our experts’ immediate and steadfast response to the pandemic has built a valuable resource that we feel is imperative to share with the broader community,” said Priya Singh, chief strategy officer and senior associate dean for strategy and communications at Stanford Medicine. “We see the R3 framework as a collection of resources that community members — whether you’re from academia, industry or government, or you’re an individual — can use to inform and guide how they adapt to the uncertainties wrought by COVID-19.”

At the onset of the pandemic, experts from the School of Medicine, Stanford Health Care, Stanford Children’s Health, University HealthCare Alliance and Stanford University began building a framework for broad-based recovery. The group considered the needs of the community, such as developing a strategy for expanded coronavirus testing and building a public health surveillance system to track new cases, and used lessons learned from Stanford’s hospitals to inform preparedness for future inevitabilities, such as a surge in cases and a lack of personal protective equipment.

The R3 framework, which was commissioned by Lloyd Minor, MD, dean of the School of Medicine; David Entwistle, president and CEO of Stanford Health Care; and Paul King, president and CEO of Stanford Children’s Health, is powered by more than a dozen Stanford Medicine faculty and leaders. Along with Singh, Bob Harrington, MD, professor and chair of medicine; Mary Leonard, MD, MSCE, professor and chair of pediatrics; and Catherine Krna, MBA, president and CEO of the University HealthCare Alliance, led the R3 committee. Based on the committee’s expertise, the framework is a culmination of the lessons learned while delivering patient care, conducting research and forming policy recommendations as the pandemic evolved.

“Our success in responding so quickly at the beginning of the pandemic was, in part, due to the alignment between the School of Medicine and the clinical enterprises, Stanford Health Care and Stanford Children’s Health,” Krna said. “We would not have been as successful if it weren’t for the joint accountability of our faculty and clinicians and the staff who work with them to care for our patients.”

Guiding current and future response

The R3 framework is a guide to making policy, conducting research and developing treatments, among other things. It’s both a resource for helping communities deal with the pandemic and recover from it. For example, it offers recommendations for protecting vulnerable populations from the virus and safely

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Quebec fitness centres back off threat to reopen, but province still ready to crack down

Quebec deputy premier Geneviève Guilbault says the province will go ahead with a new decree to allow fines for fitness centres that reopen their facilities, even though a group of owners has backed off its threat to defy red zone regulations.

With the province entering a new four-week partial lockdown, a coalition of fitness centre owners had threatened to reopen their businesses even if the government didn’t allow them to, citing the need to preserve the physical and mental health of their members.

“We will be ready, if ever they were to change their minds,” said Guilbault, after thanking the coalition for its decision this morning while speaking to reporters. “If we have to be severe with people who go to the gym when it is not allowed, we will be ready to do so.” 

Customers who go into the exercise facilities would also be subject to fines, once the province adopts the decree.

Instead of reopening, the coalition encouraged members to gather in front of their respective fitness centres to protest the province’s restrictions.

“This protest — peaceful and in accordance with public health guidelines — will be the first step for a movement we hope will grow to make the Legault government realize it can’t govern just for COVID,” the group said in a written statement.

Ivanoh Demers/Radio-Canada

Most Quebecers respect rules, Guilbault says

Guilbault also slammed provincial opposition parties — most notably the Liberal Party — for statements she deemed “irresponsible” in regard to Quebecers’ willingness to continue following public health rules.

Opposition parties criticized the CAQ government on Tuesday, saying Quebecers will not blindly follow guidelines unless the province provides more details behind the reasoning for prolonging the red zone restrictions.

Liberal Leader Dominique Anglade said “social peace” was at risk if the government failed to be more transparent.

Guilbault shot down Anglade’s comments, referencing recent survey results from Quebec’s public health research institute, obtained by Le Devoir, that show that more than 75 per cent of Quebecers respect public health guidelines.

“We often play political games, it’s normal,” said Guilbault. “But I think that in the context we’re living in, a public health emergency, we all have to behave responsibly.”

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Ontario fitness industry urges members to pressure Ford government to allow gyms to reopen

Goodlife Fitness is urging its members to pressure the Ontario government to allow gyms to reopen in parts of the province where they’ve been forced to close because of rising COVID-19 cases.

In an email sent to members across the province Tuesday, the fitness giant is encouraging its members to write a letter to their local MPP, Premier Doug Ford and Health Minister Christine Elliott among others.

“Between mandated shutdowns, capacity restrictions, and ongoing questions about the safety of fitness facilities, our industry is facing the most difficult time in its history,” the email reads.

Jason Sheridan, senior vice-president of operations at Goodlife, said the email was sent to more than 175,000 members.

The campaign is led by the Fitness Industry Council of Canada. Other businesses who are part of the industry council will also take part.

“Through this campaign . . . we are keen to advance the discussions with the Ontario government and public health and to help co-create any enhanced guidelines for gyms across Ontario,” Sheridan told the Star.

“We are open to navigating this situation together and working to develop solutions that would allow us to continue to invest in the health and wellness of Ontarians.”

The letter, sent with the subject line Stand Up for Fitness, discusses the impact the shutdown has had on the province’s fitness industry, citing the benefits of physical benefits on mental health during the pandemic and reducing the strain on local health-care systems as a result.

As cases spiked in the province, and concerns that group activity in indoor spaces may be adding to the transmission of the virus, Ford ordered the closure of all gyms in Ottawa and parts of the GTA on Oct. 10.

In Quebec, a group of fitness centre owners says its members are no longer planning to open Thursday in defiance of that government’s lockdown orders.

On Monday, a coalition of more than 250 gym owners threatened to open their doors this week, prompting a warning from Premier Francois Legault that they and their clients would be fined.

Gym owners in Ontario have not gone that far, but are still heated over the impact from the temporary closure.

The office of Lisa MacLeod, Ontario minister of heritage, sport and tourism, acknowledges the struggles the fitness industry is going through but says the government will continue to follow public health advice.

“This is a difficult time for so many businesses that are already struggling, which is why we are working hard to make $300 million available as soon as possible to cover fixed costs,” minister spokesperson Dakota Brasier said.

“We will continue to take prudent and progressive action to reopen based on expert public health advice as soon as it’s safe to do so.”

Sweat and Tonic, a Toronto boutique fitness studio is part of an online petition in collaboration with the Ontario Independent Fitness Studios Association and 300 other businesses to advocate for the re-opening of fitness studios.

Morgan Thomas, general manager at Sweat and

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Some Quebec fitness businesses says they will reopen despite COVID-19 restrictions

MONTREAL – Some Quebec gym, yoga, dance and martial arts business owners say they intend to reopen their doors on Thursday in defiance of provincial health rules.

A coalition of fitness businesses is calling on Quebec Premier Francois Legault to lift restrictions that forced their facilities to close this month amid a second COVID-19 wave.

They urged Premier Francois Legault to consider their plight ahead of an expected announcement Monday and said that without evidence they are contributing to outbreaks, they should be allowed to reopen.

When Legault announced the measures affecting the province’s high-alert red zones, including Montreal and Quebec City, they were scheduled to come to an end after Oct. 28, but he has recently hinted that some of the restrictions will have to remain in place.

“For the moment, we are ready to open on the 29th, because there hasn’t been any recommendations to the contrary,” said Christian Menard, vice-president of ProGym in east-end Montreal.

“We want the premier to take into consideration the opinion and the lives of those on the ground and those who use these facilities.”

While some the coalition’s 253 members have vowed to reopen their doors on Thursday even if the lockdown is extended, not all have committed to doing so.

Menard said above all, the group wants the government and public health officials to consider them as an asset to the health system and acknowledge their facilities contribute to the population’s overall physical and mental well-being.

“There’s a part of the population in distress that needs these services, and as the winter months inch closer, these services will become essential,” Menard said.

On Monday, Quebec reported 808 new COVID-19 cases as well as 10 further deaths linked to the virus. The province has a seven-day average of 940 cases daily, roughly 110 people per million population.

The number of hospitalizations dropped by eight from one day earlier to 543. Of those, the number of intensive care cases dropped by four to 93.

Since Quebec announced a 28-day partial lockdown in Montreal and Quebec City beginning Oct. 1, several other regions have been declared COVID-19 red zones. The measures closed bars, restaurant dining rooms and theatres, among other venues, and a week later gyms were added to the list.

The coalition of fitness company owners said in a statement the lockdown measures will force them out of business after they made significant investments to comply with health measures during the pandemic.

Menard said his own gym has a key card system that acts as a registry, and as a precaution he’s installed a temperature-screening device at the entrance.

While some of the facilities across the province intend to reopen, the statement suggested they would back down if health authorities can demonstrate by Thursday that their operations have led to outbreaks.

“If they want to close us, they have to give us the facts,” Menard said.



“We were open for four months, they kept tabs on us

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About 200 fitness businesses in Quebec say they intend to reopen despite COVID-19 restrictions

A coalition of about 200 Quebec gym, yoga, dance and martial arts business owners say they intend to reopen their doors on Thursday in defiance of provincial health rules.

The businesses are calling on Quebec Premier Francois Legault to lift COVID-19 restrictions that forced fitness facilities to close this month.

In a statement, they say their facilities contribute to the overall physical and mental health of the population and they were not the source of COVID-19 outbreaks.

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They say the lockdown measures will force them out of business after they’ve made significant investments to comply with health measures during the pandemic.

The owners say they intend to reopen across the province but will back down if health authorities can demonstrate by Thursday that their operations have led to outbreaks.

On Oct. 8, Quebec introduced new public health measures for regions under the province’s highest COVID-19 alert level, shuttering gyms, putting limits on team sports and making masks mandatory for high school students.

Last week, Legault hinted that some red zone restrictions would remain in place even as the initial 28-day lockdown in Montreal and Quebec City come to an end on Wednesday.

Legault, Health Minister Christian Dube and Dr. Horacio Arruda, Quebec’s director of public health, are to hold a news conference this afternoon.

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Dr. Zeke Emanuel says this is what it will take to fully reopen the U.S.


a man wearing a suit and tie: Oncologist Ezekiel ‘Zeke’ Emanuel is an adviser to the Biden campaign and served as a special health adviser to the Obama White House, where Emanuel’s brother Rahm was chief of staff before becoming mayor of Chicago. Another brother, Hollywood talent agency executive Ari, makes a cameo in this interview.

© MarketWatch photo illustration/Getty Images, iStockphoto
Oncologist Ezekiel ‘Zeke’ Emanuel is an adviser to the Biden campaign and served as a special health adviser to the Obama White House, where Emanuel’s brother Rahm was chief of staff before becoming mayor of Chicago. Another brother, Hollywood talent agency executive Ari, makes a cameo in this interview.

This interview is part of a series of conversations MarketWatch is conducting with some of the leading voices in the U.S. on the COVID-19 pandemic.


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Even within one-party families, there is debate about how long it will take to get the U.S. out of the COVID-19 pandemic.

Dr. Ezekiel Emanuel, an oncologist, adviser to Democratic presidential candidate Joe Biden and vice provost for global initiatives at the University of Pennsylvania, says Americans have a tough 12 months ahead. On the other hand, his brother, Ari Emanuel, the Hollywood agent and CEO of entertainment agency Endeavor, predicts things will get better by July as long as a COVID-19 vaccine is authorized or approved in December.

“It’ll be closer to November, closer toward the end” of 2021, Zeke Emanuel told MarketWatch. “But it’ll probably be enough to begin opening colleges and universities [and] schools, again depending on how we distribute this thing and how effective we can be on that.”

For now, however, the focus is reducing transmission of the virus at a time when we are all starting to spend more time indoors and as pandemic fatigue is setting in. “There are four things that increase transmission: indoors, crowds, long periods of time, and then coughing, sneezing, singing [and] yelling,” he said. “If you put a group of people indoors, [and] one of whom is infected, it’s predictable what’s going to happen.”

MarketWatch: You published research that found the U.S. has had more deaths from COVID-19 than other countries and one of the highest per capita death rates worldwide. Why do you think we’re seeing this?

Dr. Zeke Emanuel: It’s a concatenation of problems. We never had an efficient testing regime so we could quickly identify people, isolate them and prevent spread. We didn’t have effective implementation uniformly across the country, with the public health measures: physical distancing, face-mask wearing, limiting crowds, which I think has gotten too little attention and needs more attention. If the main spread is by “superspreaders,” limiting crowds is critical to that. Hand hygiene. [At the beginning of the pandemic], we all focused on the fomites, the packages coming from Amazon and washing them down and all that nonsense. As it turns out, that’s probably totally irrelevant.

Then we had the problem of states saying, ‘Well, we don’t have it here,’ and not understanding epidemiology. You’ve got a small number of cases, but that means it’ll explode. We’ve seen that. Why is it all up and down the Midwest, whether it’s Wisconsin or Missouri or South Dakota or North Dakota? Because they were cavalier, saying: “We don’t have it here.” You have 500,000 people

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LAMB charter school won’t reopen yet

So LAMB, a diverse school of more than 500 students and 120 staff members, was one of the first to inform parents that all students would probably have the option of returning to physical classrooms in October for a few days a week.

Then two weeks later, another message went out to families. The school no longer expected to return to in-person learning later that month and instead hoped to bring students into classrooms in January.

The health data hadn’t changed much in the District, but there were logistics that still needed to be figured out, said LAMB Executive Director Charis Sharp. One of the main issues: Teachers did not want to return to classrooms.

The abrupt change of plans at LAMB shows how, on a small scale, teacher reluctance can stop a school from reopening. Despite a new building, a top-notch air-filtration system, a non-unionized teaching staff and families who want to return, LAMB could not start in-person classes.

“Like everyone, we have been barely one step ahead since March. This is all unknown for us,” Sharp said in an interview. “Staff members are afraid that if they say they are unwilling to come back, then they will lose their jobs, and I don’t feel that is a good message to send my staff. If I don’t have enough virtual work for everyone who wants to do that, then I will have to furlough some people.” 

Before initially deciding to reopen, Sharp said she had followed health metrics and listened to experts who said that, with the proper safety precautions, opening school buildings can be safe. LAMB planned to have small class sizes, mask mandates, health assessments and thorough cleaning.

But Sharp said that much of the planning occurred over the summer when staff was not working — and she conceded that school leaders failed to properly field teacher input before announcing that the school would launch an in-person, hybrid model in October.

The school didn’t survey teachers until after the announcement. More than half said they would return only because they feared they would lose their jobs, and 90 percent said they thought returning to school was the wrong decision.

Even without a union, teachers do have leverage in the reopening plans. LAMB teachers have special licenses to lead Montessori and bilingual classes. Sharp said she could not just push out teachers who refused to return and find qualified replacements.

And, even if she could find replacements, Sharp said she wouldn’t want to. She and LAMB parents like their teachers and want them to stay at the school.

Sharp also realized that with the main public school systems in the District and surrounding jurisdictions mostly closed for in-person learning, it was harder to convince her teachers that reopening was the right decision.

“The more important thing to me is that my staff feel safe in whatever we are doing,” Sharp said. “Because if they do not feel that way, they are not going to give me or students

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Alameda County Moves Up Timeline To Reopen Restaurants And More

ALAMEDA COUNTY, CA — Alameda County will allow restaurants, worship houses, theaters, indoor retail and malls to serve customers indoors beginning Friday, with safety restrictions.

The following services will be able to take place indoors as of Friday:

  • restaurants (25 percent capacity or 100 people; whichever is less)

  • worship houses (25 percent capacity or 100 people; whichever is less)

  • theaters (25 percent capacity or 100 people; whichever is less)

  • indoor retail and malls (half-capacity and with limited food court services)

  • gyms and fitness centers (25 percent capacity; no indoor pools allowed)

  • weddings and funerals (25 percent capacity or 100 people; whichever is less)

The county will also allow outdoor non-contact fitness classes of up to 20 people, including the instructor.

County health officials announced that Alameda County will come into alignment with the state’s new guidance on gatherings, which says people may engage in outdoor gatherings with a stable group of up to three households. People of different households must stay six feet from each other and wear face coverings when not eating or drinking.

Stable and decreased case, positivity and hospitalization rates prompted the county to enact the changes and reopen more sectors earlier than previously scheduled, officials said Wednesday in a news release.

“A few days should have little impact on local disease conditions,” said Alameda County Public Health Department spokesperson Neetu Balram in an email.

The news is welcome to restaurant owners such as Todd Utikal of Pleasanton’s SideTrack Bar + Grill, who has lost business due to high wait times to seat customers outdoors. Now, he’ll be able to seat another 35 people at his restaurant.

“We’re totally ready,” he said.

The move comes a week after the county moved into the orange tier, which indicates a moderate COVID-19 risk level. This is the second-best tier on the state’s four-tiered, color-coded risk system.

The state will allow restaurants in orange-tier counties to serve customers indoors at half-capacity or up to 200 people — whichever is fewer — but counties can always enact stricter restrictions. Red-tier counties may allow indoor dining at 25 percent capacity or up to 100 people; whichever is fewer.

Alameda County once more declined to allow indoor dining after its move into the orange tier, but announced that on Oct. 26, it would allow indoor reopenings of certain indoor services under red tier-level restrictions.

Restaurant owners were pleased to hear that the county moved up the deadline to allow indoor dining on a Friday instead of Monday, which allows them to benefit from business over the weekend, said Utikal.

Utikal is part of the Tri-Valley Restaurant Group, a cohort of more than 80 restaurant owners in Dublin, Pleasanton and Livermore that was formed during the pandemic.

Restaurant owners are confident that this will be a good thing, partly because they’ve had the benefit of watching restaurants in other counties reopen first, Utikal said. Restaurants are hiring back staff in preparation for Friday’s reopenings.

Though restaurants will be limited in the number

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Fitness Australia calls on Daniel Andrews to reopen Victorian gyms

A top chief executive in Victoria’s fitness industry is demanding the government reopen the struggling sector, claiming current restrictions preventing gyms opening their doors are “based on ignorance”.

In an open letter to the state Premier Daniel Andrews, Fitness Australia chief executive Barrie Elvish called for an end to “archaic” restrictions and implored that gyms were able to enforce COVID-safe strategies.

“This consistent ‘anti-gym’ messaging leads me to conclude it can only be based on ignorance or a deliberate strategy to use the sector as some form of litmus test for ‘proving’ an ongoing extension of draconian lockdown restrictions are justified,” Mr Elvish wrote.

“You have once again persisted in maintaining gyms are unsafe and cannot be made safe. This is despite evidence to the contrary in every other Australian state where the sector is safely operating with a range of COVID-safe protocols.

“But Premier, how would you, or your department, know? To date the Victorian government’s engagement with the fitness sector has been the worst in Australia.

“Your recent comments also ignore the most recent data that indicates the hospitality sector has more than five times the number of transmissions as the fitness sector.”

Gyms were not among the list of industries, announced on Sunday, where restrictions would be eased.

When questioned about when they could reopen, Mr Andrews maintained they were “high-risk environments”.

“That’s not my opinion, that’s not a matter that I’ve come up with, that’s the international evidence,” he said.

“We’ve gone further in relation to outdoor (exercise), but it is a very challenging environment, and it’s one of those things where no one’s taking any joy out of that.”

He said gyms were “unsafe” by nature and work was under way to determine when they could reopen.

“There’ll be a time when they can, and we’re looking at that closely, but I can’t just give them the news they want now because it wouldn’t be safe to do that,” he said.

But Mr Elvish contended all gyms interstate were operating safely and effectively with COVID-safe protocols in place.

“With 1500 facilities employing 40,000 Victorians and supporting 900,000 members, it is safe to say gyms are commercial enterprises,” he wrote.

“Unlike the hospitality sector, gyms have had hygiene protocols in place for 10 years; not months

“In some states COVID-safe protocols include a dedicated staff member not just ensuring social distancing but also cleaning.

“Our specific proposals for Victoria made allowance for the provision of temperature checks on entry, masks and gloves for members.”

Mr Elvish then pleaded with the Premier to review a specific COVID-safe plan fitness sector executives submitted to the deputy chief health officer on September 25.

As of Tuesday, Melbourne’s 14-day rolling virus average had fallen to 6.4.

Regional Victoria has a daily case average of just 0.4.

The Premier has this week hinted at more significant announcements to easing of restrictions this weekend if infections remain low.

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Maharashtra Allows Gyms, Fitness Centres To Reopen From October 25 On Dussehra

Activities like steam bath, sauna, Zumba and Yoga will remain shut at these centres. (Representational)


The Maharashtra government has given permission to gymnasiums and fitness centres to reopen from October 25, on the occasion of Hindu festival Dussehra, with certain restrictions amid the ongoing coronavirus pandemic.

Chief Minister Uddhav Thackeray interacted with representatives of various gyms and fitness centers in the state today to set a standard operating procedure for their services. Preventive measures for COVID-19 were discussed during the virtual meeting.

Activities like steam bath, sauna, Zumba and Yoga, however, will continue to remain shut at these centres.

Gymnasiums and fitness centres are for the welfare of citizens, so care should be taken to ensure that there is no virus spread, the chief minister said.

Mr Thackeray said the state government was going slow on lifting COVID-19 restrictions because there should be no complacency.

Safety measures such as disinfecting premises every hour, physical distancing, sanitisation and use of masks would be mandatory, the chief minister said, adding that health checks of trainers and employees should be done regularly.

The state government had earlier allowed outdoor centres for exercise and gymnastics to function from August 5, following social-distancing and hygiene protocols.

The Centre in July had issued a notice allowing all gymnasiums and yoga institutes in the country to reopen from August 5 but several states and cities had kept them shut due to rising number of COVID-19 cases.

Gym owners in the state have been asking the government for several weeks to approve the opening of their centres after being financially hit due to the lockdown.

Maharashtra recorded 10,259 new COVID-19 cases today which took the state’s caseload to 15,86,321. The death count rose to 41,965 as 250 patients died today, according to news agency PTI.

India’s COVID-19 caseload went past 74 lakh today, while the number of people who have recuperated from the disease crossed 65 lakh pushing the recovery rate to 87.78 per cent, according to data updated by the Union Health Ministry.

(With inputs from PTI)

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