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Governor John Bel Edwards gives an update on the presence of coronavirus in the state of Louisiana during a media availability and press conference Tuesday afternoon, April 21, 2020, at GOHSEP in Baton Rouge, La.

Gov. John Bel Edwards on Tuesday signaled Louisianans could be living under fewer restrictions on May 1, when the state’s stay-at-home order is set to expire, as officials scramble to determine what the first phase of reopening will look like.

But health experts say Louisiana is in a precarious position given the high prevalence of diabetes, high blood pressure, obesity and other ailments that have given the state one of the highest rates of death per capita in the nation. Compared to other states, many of which have begun the reopening process, the stakes are higher in Louisiana, where a new wave of cases could bring with it a surge of deaths.

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When the state does ease back on restrictions, officials said those in high-risk categories – the elderly and those with underlying health conditions – will still be urged to stay home. That is especially true given the huge unknowns about who has immunity to the virus, something that new tests for antibodies may not be able to answer for many people in the near-term, said Alex Billioux, assistant secretary for the state’s Office of Public Health.

“We’re still going to be giving guidance that says if you’re older than 65 with a lot of medical conditions, don’t expect to see something different,” Billioux said. “Because we still know that we don’t have an answer to keep you safe yet.”

Residents and businesses will still be faced with a litany of restrictions aimed at preventing a major resurgence of the virus in the coming weeks, officials said, even if the governor begins lifting restrictions May 1 following a two-week downward trajectory in cases, reported flu-like symptoms and hospitalizations. Edwards cautioned people to have “realistic expectations” for what the reopening will look like, and officials noted recommendations for social distancing and wearing masks in public will remain in place for a long time.

Epidemiologists noted that the prevalence of obesity, diabetes and other health conditions in Louisiana makes the prospect of reopening a dicier one than in other states.

“As soon as we loosen these restrictions, we will see a second wave,” said Susanne Straif-Bourgeois, a former assistant state epidemiologist and current assistant professor at LSU Health Sciences Center New Orleans. “There’s no doubt about it. It will go up again.”

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The goal should be to minimize that second wave of cases, Straif-Bourgeois said, and perhaps most importantly, protect those who are most vulnerable to make sure it doesn’t cause a spike in deaths.

Louisiana has consistently ranked near the top of the list of states with the highest rates of deaths from the coronavirus, compared to population. Three parishes, St. John, Orleans and St. James, are in the top 20 in deaths per capita compared to all U.S. counties, and another two – Bienville and Jefferson parishes – are in the top 25.

That represented some improvement from past weeks, but the death toll has continued to mount in Louisiana, rising to at least 1,405 on Tuesday. Most of those people had underlying health conditions, including nearly 60% with hypertension, 35% with diabetes and 20% with kidney disease.

Edwards said when the “phased reopening” begins, the state will still be encouraging those in higher risk categories to exercise more caution. White House guidance released last week calls for “all vulnerable individuals” to remain sheltered in place, referring to the elderly and those with serious underlying health conditions.

For instance, there will still be restrictions limiting the size of crowds in Louisiana, Edwards said. But that limitation applies to people who are “relatively young and healthy,” not the more vulnerable, who should avoid crowds altogether.

That will likely be the case until there is an effective treatment and a vaccine for the virus.

Louisiana is currently working to not only slow the spread of the virus through social distancing, but also gain the ability to test dramatically more people for the virus and increase the number of contact tracers at the state’s disposal tenfold.

The idea is to be able to identify a new case of coronavirus, deploy contact tracers to find out who that person came into contact with and test everyone who was in contact with them at least 48 hours before they began showing symptoms. All those people would then be told to self-isolate.

Dr. G.E. Ghali, chancellor of the LSU Health Sciences Center Shreveport, said the state should also “stratify” people into different risk categories. For instance, May 1st “may be okay for certain groups of people” to return to work, he said.

“There may be a situation where if someone is significantly high risk ... they may not necessarily be able to get about until there’s a vaccine for this,” Ghali said, a prospect that could be a year or longer away.

Dr. Catherine O’Neal, an infectious disease specialist at Our Lady of the Lake who is counseling state leaders on the response to the virus, said recent trends in Louisiana’s numbers are “encouraging,” the result of people complying with the governor’s stay-at-home order.

“However, we have a higher death rate and more infections than many states, which makes decisions to relax restrictions more challenging,” O’Neal said in an email. “Testing is key to every decision we are going to make.”

O’Neal also said “reopen” is a broad term, and any loosening of restrictions should be done in a “scaled manner” that can be adjusted based on the number of cases the state sees over time.

Edwards said this week the state needs a minimum of 140,000 tests per month – and ideally around 200,000 – to begin reopening, and officials are working to have that in place by May. Officials with the Louisiana Department of Health say they have directed 75 staffers to work as contact tracers, as part of an effort to get 700 contact tracers available in Louisiana to track down those who test positive and their contacts.

As soon as you loosen these public health restrictions like shelter in place you really want to catch these people who are reported cases right away,” Straif-Bourgeois said. “And even more important, not only isolate the cases but make sure everyone who was in contact with them are themselves in quarantine.”

“You would need a lot of manpower to actually do all this work.”

Staff writer Gordon Russell contributed to this report.

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