Policymakers around the world are in a triangular tug of war between fighting COVID-19, economic rehabilitation, and ensuring societal normalcy, well-being, and health. There are no easy answers or cookbook recipes to how and when to open the economy.

However, it is becoming increasingly evident that we cannot make decisions based on social, cultural, religious, or economic preferences alone. Also, decision making cannot be an absolute top-down approach, but a regionally driven strategy with citizen engagement.

Here are a few suggestions for our leaders and the public:

• Analyze regional data on COVID-19 such as number of cases and deaths, racial/ethnic distribution of the disease, age and gender groups most affected, and social and medical history of those who are affected. This will help define the unique nature and extent of disease spread among communities and to strategize for customized prevention priorities. We need more testing based on population density so that the maximum number of infected people can be quarantined.
• Include the number of COVID-19 cases, deaths, and recoveries mapped by the smallest geographic unit; the total population of the region with sociodemographic distribution; the number of primary care and emergency services; and the number of hospitals and health care facilities, COVID-19 testing capacity, and healthcare-related assets available.
• The rates of increase or decrease in COVID-19 cases should play a major role in estimating regional transmission patterns. If a geographic region does not witness a new case for more than a week, that’s positive news. Once the two-week mark is crossed without a new positive case, plans to allow many essential human activities should be formulated and implemented.
• Redefine services as highly essential, needed, and wanted. And based on relative importance, we should use a staggered time-phased opening approach. These classifications should keep in view, for each service, the amount of human-to-human contact, needs and capacities, the potential for large gatherings, demand versus supply of the service, the cost versus benefit of these services, and preparedness at service facilities as it relates to practicing aggressive hygiene and sanitation measures and social distancing for the clientele served.
• Increase the base of health-prepared and health-trained people in the communities. Rapid and swift measures to educate and train lay health workers, non-physician professionals, and accelerating volunteer health services could be a priority. Throughout the phased opening, ensure and prioritize the protection of frontline and healthcare workers.
• Be prepared for closing services again based on real-time regional evidence on COVID-19. We must also estimate how long after we open the economy will business and industries flourish and how much time it will take to bring normalcy to life. Despite phased openings, we will still see fewer workers, fewer service demands, and less clientele.

It is time to use these strategies and aggressively prepare for the next phase – opening the economy and looking into the future. We have saved millions of lives by avoiding the disease and cannot lose our gains. However, we also have to be mindful not to lose lives due to other diseases, poverty, and psychological upheaval.

Based on regional data and the unique nature of COVID-19 in a community, counties and local governments should decide on opening the economy. Such decisions should also engage regional health care providers, scientists, business owners, and representatives of the general public. It is high time, we think global, but act local.