A comprehensive shutdown may be required in much of the country.
By John M. Barry
July 14, 2020
When you mix science and politics, you get politics. With the coronavirus, the United States has proved politics hasn’t worked. If we are to fully reopen both the economy and schools safely — which can be done — we have to return to science.
To understand just how bad things are in the United States and, more important, what can be done about it requires comparison. At this writing, Italy, once the poster child of coronavirus devastation and with a population twice that of Texas, has recently averaged about 200 new cases a day when Texas has had over 9,000. Germany, with a population four times that of Florida, has had fewer than 400 new cases a day. On Sunday, Florida reported over 15,300, the highest single-day total of any state.
The White House says the country has to learn to live with the virus. That’s one thing if new cases occurred at the rates in Italy or Germany, not to mention South Korea or Australia or Vietnam (which so far has zero deaths). It’s another thing when the United States has the highest growth rate of new cases in the world, ahead even of Brazil.
Italy, Germany and dozens of other countries have reopened almost entirely, and they had every reason to do so. They all took the virus seriously and acted decisively, and they continue to: Australia just issued fines totaling $18,000 because too many people attended a birthday party in someone’s home.
In the United States, public health experts were virtually unanimous that replicating European success required, first, maintaining the shutdown until we achieved a steep downward slope in cases; second, getting widespread compliance with public health advice; and third, creating a work force of at least 100,000 — some experts felt 300,000 were needed — to test, trace and isolate cases. Nationally we came nowhere near any of those goals, although some states did and are now reopening carefully and safely. Other states fell far short but reopened anyway. We now see the results.
While New York City just recorded its first day in months without a Covid-19 death, the pandemic is growing across 39 states. In Miami-Dade County in Florida, six hospitals have reached capacity. In Houston, where one of the country’s worst outbreaks rages, officials have called on the governor to issue a stay-at-home order.
As if explosive growth in too many states isn’t bad enough, we are also suffering the same shortages that haunted hospitals in March and April. In New Orleans, testing supplies are so limited that one site started testing at 8 a.m. but had only enough to handle the people lined up by 7:33 a.m.
And testing by itself does little without an infrastructure to not only trace and contact potentially infected people but also manage and support those who test positive and are isolated along with those urged to quarantine. Too often this has not been done; in Miami, only 17 percent of those testing positive for the coronavirus had completed questionnaires to help with contact tracing, critical to slowing spread. Many states now have so many cases that contact tracing has become impossible anyway.
What’s the answer?
Social distancing, masks, hand washing and self-quarantine remain crucial. Too little emphasis has been placed on ventilation, which also matters. Ultraviolet lights can be installed in public areas. These things will reduce spread, and President Trump finally wore a mask publicly, which may somewhat depoliticize the issue. But at this point all these things together, even with widespread compliance, can only blunt dangerous trends where they are occurring. The virus is already too widely disseminated for these actions to quickly bend the curve downward.
To reopen schools in the safest way, which may be impossible in some instances, and to get the economy fully back on track, we must get the case counts down to manageable levels — down to the levels of European countries. The Trump administration’s threat to withhold federal funds from schools that don’t reopen won’t accomplish that goal. To do that, only decisive action will work in places experiencing explosive growth — at the very least, limits even on private gatherings and selective shutdowns that must include not just such obvious places asbars but churches also a well-documented source of large-scale spread.
Depending on local circumstances, that may prove insufficient; a comprehensive April-like shutdown may be required. This could be on a county-by-county basis, but half-measures will do little more than prevent hospitals from being overrun. Half-measures will leave transmission at a level vastly exceeding those of the many countries that have contained the virus. Half-measures will leave too many Americans not living with the virus but dying from it.
During the 1918 influenza pandemic, almost every city closed down much of its activity. Fear and caring for sick family members did the rest; absenteeism even in war industries exceeded 50 percent and eviscerated the economy. Many cities reopened too soon and had to close a second time — sometimes a third time — and faced intense resistance. But lives were saved.
Had we done it right the first time, we’d be operating at near 100 percent now, schools would be preparing for a nearly normal school year, football teams would be preparing to practice — and tens of thousands of Americans would not have died. This is our second chance. We won’t get a third. If we don’t get the growth of this pandemic under control now, in a few months, when the weather turns cold and forces people to spend more time indoors, we could face a disaster that dwarfs the situation today.
John M. Barry is a professor at the Tulane University School of Public Health and Tropical Medicine and the author of “The Great Influenza: The Story of the Deadliest Pandemic in History.”