No one should kid themselves. We’re not at the end of the COVID-19 epidemic. We’re not even at the beginning of the end. But to paraphrase Winston Churchill, we are approaching the end of the beginning; and that means the severe social distancing restrictions, which were imposed to achieve certain goals in the early stage of pandemic response, can and should be adjusted in recognition of our growing ability to deal with the disease in a more targeted way.
As always, context is important. The extraordinary social distancing measures were designed to slow the spread of the virus. They were a hedge against the worst-case scenario – a spike in the number of severe infections that would overwhelm local health care systems. That kind of spike happened in China and in Italy, and no one wanted it to happen anywhere else.
There were other benefits to the restrictions. They bought time to gather information about the virus, build greater surge capability in the health system, pursue effective medical countermeasures, and develop and scale up diagnostic testing. They also convinced the public, as nothing else would have, of the importance of learning and practicing the kind of hygienic protocols that health officials have been urging people to adopt for years.
The measures have succeeded beyond the expectations of health authorities. This epidemic will continue to claim too many victims, but the infection rate is slowing, and the virulence of the disease looks to be less than feared. As a result, we now can have greater confidence that there is enough reserve capacity in the health system to provide everyone who needs it with intensive care.
That means the severe restrictions have served their primary purpose and the benefit of the doubt should be given to lifting them in the next few weeks. This is not a question of weighing economic concerns against health concerns. Public health authorities know better than anyone that general quarantines – and that is essentially what has been imposed in many places – have mixed health implications and that where it is not necessary to continue them it is necessary that they be lifted.
To take one example, the severe restrictions mean that elective medical tests and procedures are not being performed, and “elective” is being defined very loosely. It’s not as if he only thing being put off is cosmetic surgery. All over the country people with chronic conditions are without sufficient access to their health professionals; others who have suspicious symptoms cannot get the tests that would confirm whether they have a serious illness requiring immediate care.
It need hardly be added that the people most at risk from COVID-19 – the elderly and those with underlying health issues – are also the people who most need to manage their general health. We do them no favors when, to protect them from the virus, we increase the risk that they will die from heart disease or cancer or complications from diabetes because they were unable to access the health care system.
Postponing routine examinations is less dangerous, but those exams are performed for a reason, and when huge numbers of them are all delayed at the same time, and for a long time, it creates a backlog that could take years to work off. Moreover, as every doctor knows, many people don’t like taking such exams in the first place and will look for excuses never to get them.
Finally, shutting down all elective procedures is an enormous financial burden on hospitals. By and large, those are the procedures that keep them out of the red and enable them to afford emergency care.
Another problem with severe social distancing measures is that the longer they are in force the harder it is to get the public to comply with them. The United States isn’t China; we’re simply not going to weld people into their homes. If the public believes that extraordinary measures have continued for longer than warranted, the worst of all worlds becomes possible: the measures may be flouted to such a degree that they are no longer effective in containing the disease, while their very presence continues to stifle social and economic life and to undermine the public’s faith in the judgment of the medical establishment.
All of that is in addition to the economic damage which the restrictions cause and which also has a direct impact on the health of Americans. Nothing about the loss of thousands of small businesses and millions of jobs is good for public health. Lifting the restrictions does not mean retreating in the fight against the disease. As public health capabilities ramp up, the core epidemiological responses should be pursued with growing energy. These include an expanded regime of testing, not just for the presence of the virus but to determine those who have recovered from it and are therefore presumably immune, robust experiments with different therapeutics, isolation of the sick and their households, voluntary social distancing for higher risk people, and implementation by businesses and individuals of the hygienic practices which are the single most effective way to interrupt the vectors of disease transmission.
Everybody should plan on washing hands rather than shaking hands for the duration.
There will also likely be a need for certain localities at certain times to impose or reimpose stricter social distancing. The United States is a big country, and it’s already clear that there are vast differences in how this virus has penetrated communities across the nation. The public should be prepared for governors and mayors to play periodic whack-a-mole with the disease until either a vaccine is developed or the efficacy of medical countermeasures is confirmed.
The fight against COVID-19 is going to last for a long time, but wars are not won by evacuations. We need to begin moving from a defensive to an offensive posture, from dodging the disease to balancing the additional risk it creates against the other important health and economic and social equities that are also at stake. The global campaign has already vastly increased the tools that are available to strike a prudent balance. We can strike it, and in the weeks ahead governments across the United States need to let us try.