“Brace yourselves for a long, slow burn. We will not get our epidemic under control in the US.
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The president of the United States has made a decision—sort of—that despite the lack of sufficient testing, resources to embark upon the tracing of the contacts of all people testing positive for Covid-19, and the ability to humanely isolate those infected, we are nevertheless reopening as a country. Of course, the president cannot simply order this to happen; states and localities have responsibility for these kinds of public health decisions, not the federal government. But his message is clear: “We have met the moment and we have prevailed,” he announces, declaring victory over the pandemic at least in his own rear view mirror.
The reality, of course, couldn’t be more stark. Even as the president proclaimed “mission accomplished,” the White House was in a panic over an outbreak of Covid-19 at 1600 Pennsylvania Avenue, evincing a newfound interest in personal protective equipment like masks, as three of the most senior health officials in the nation went into self-isolation after possible exposure to the coronavirus in the West Wing.
But this is what’s in store for us as a country. Two sets of rules: policies and procedures guided by sound public health principles in the circle around the president, while state governors who heed the president’s call to reopen ignore basic advice, even the White House’s own “Opening Up American Again” guidelines, with more than half of the states reopening seeing rising, not falling, Covid-19 case counts.
Every epidemiologist, every public health expert knows what’s going to happen. As Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said in an e-mail to reporters this week: “If we skip over the checkpoints in the guidelines to ‘Open America Again,’ then we risk the danger of multiple outbreaks throughout the country. This will not only result in needless suffering and death but would actually set us back on our quest to return to normal.” Already, new kinds of hot spots are emerging across the country, and they aren’t the large metropolitan areas across the nation you’d expect. Top of the list for the highest number of cases per 100,000 residents are Trousdale, Tenn.; Dakota, Ne.; and Lincoln, Ark. New York City is 28th on that list now.
It’s hard for us to make sense of it all. There are plenty of people who haven’t had someone get sick with Covid-19 in their immediate family, while the economic pain for millions is acutely evident. Yet even the conservative model from the Institute for Health Metrics and Evaluation at the University of Washington is predicting around 900 deaths per day by the end of this month. That means every three days, we could see a number of causalities equivalent to the death toll in the collapse of the Twin Towers on 9/11. With these deaths spread out across the American landscape, it’s hard to feel the impact of Covid-19 directly in our lives. It’s not only epidemiologists warning about the dangers of premature reopening. Economists now suggest a double-dip recession is likely if relaxing social distancing measures isn’t accompanied by testing, contact tracing, and isolation among other disease mitigation efforts.
Yet, here we go. No one is going to challenge foolhardy governors. Like the president, those governors have the deep desire to get “back to normal” that all of us feel on their side. Though many Americans worry about reopening too soon, those fears may wane as spring makes staying indoors less and less attractive, the chance to see friends and relatives too appealing, and mounting debts make the need to open up stores, restaurants, and other commercial venues a necessity for many business owners and workers.
But the impact of state reopenings isn’t going to fall equally on all residents. Those of us who can work from home will continue to do so, minimizing exposure to the virus even if we aren’t in full lockdown mode. It’s those who work in jobs that require close face-to-face contact—and those who cannot work from home—who will face the brunt of new outbreaks of the coronavirus. As Simon Mongey, an economist from the University of Chicago, and his colleagues suggested in a recent paper, people who are less educated, have limited health care, and are toward the bottom of the income distribution will suffer most, as social distancing is hardest for them, even when state restrictions are in place. My Yale colleague economist Zack Cooper is even more blunt:
We can reopen the economy without adequate testing, a move that raises the likelihood of a second wave of infections and places the costs of reopening squarely on the backs of essential workers. Alternatively, Congress could allocate more money for Covid-19 testing and the White House could use those funds to test essential workers at the same rates White House staff are tested. This is both economically justifiable and our moral imperative.
Brace yourselves for a long, slow burn. We will not get our epidemic under control in the US. Some states will do better than others, but we really are all in this together. This isn’t a call for solidarity or a “kumbaya” moment but a simple epidemiological fact. You can’t put out a house fire in one room, let it keep burning in others, and expect to be safe. One week after Georgia reopened its businesses, over 60,000 people each day traveled from out of state to patronize restaurants, hair salons, bowling alleys, and movie theaters, all returning home from these close-quarters visits, some likely bringing Covid-19 with them. Perhaps we’ll get lucky and the coronavirus will find the summer heat unpalatable and we’ll see a dip in numbers for a few weeks, just in time for schools and universities like mine to reopen on the cusp of flu season, setting us up for a double-whammy in the fall, which we just missed this winter, of influenza and Covid-19 outbreaks happening at the same time.
The United States of America is not going to do the right thing. Already, blame is shifting to the victims of Covid-19 for bringing this on themselves, with Secretary of Health and Human Services Alex Azar recently suggesting that social habits and living conditions of workers at meatpacking plants were the reason for recent Covid-19 outbreaks there. In March, Trump said: “I don’t take responsibility at all,” for the response to Covid-19. He may still refuse to wear a mask or practice social distancing himself, but he washed his hands thoroughly months ago. He washed his hands of us.“