The Perils of Rolling Back Public Health Measures Too Quickly
A number of government officials, pundits, and data modelers believe the worst is behind us. They may be profoundly mistaken.
Rapid rollback disaster
If all public health measures were immediately lifted, the pandemic could reignite with full fury. At this point, there is no vaccine. There are no effective drugs. Testing is still woefully inadequate. And the vast majority of people are still completely susceptible to infection.
Slow Motion Pandemic
Alternatively, if public health measures were slowly lifted, it could lead to a slow motion pandemic in which the health system would no longer be in peril of being overwhelmed.
If the only deaths that are prevented are the excess deaths from an overwhelmed health care system, the result would still be tragic.
Unfortunately, in this second scenario, nearly everyone at risk who was at increased risk before would still be at risk: older individuals, those with underlying health conditions, those living in communal situations, minorities, the impoverished, the unhoused, and those attending large events.
Individuals at risk need to be protected both as a moral imperative and as a way of stopping the further spread of the virus and the ongoing impact that will have on everyone.
Behavioral defense
In the absence of drugs, vaccines, or pervasive testing, only behavioral measures stand between the relative calm of post peak rates of infection and disaster.
The extent to which disease and death are averted will be a function of how well we maintain “viral distancing”, how much we have access to and use masks and gloves and sanitizer, how long we avoid mass gatherings, how well we isolate symptomatic individuals and those with exposure risks, and the extent to which there is testing and contact tracing.
Yes, the economy can be reopened; but only with pervasive public health measures in place. Access to gloves, masks, and sanitizer should be considered a human right and these supplies should be freely available, as Singapore has done. Proper equipment and scrupulous attention to public health measures would allow food production to be carried out safely and supply chains to be maintained. As the incidence of infection begins to fall, people in the service sector of the economy can re-engage. With public health measures and vigilance, testing and contact tracing, recreation areas can be judiciously re-opened.
Large events pose large risks
Until there is a vaccine and/or effective treatments, however, large social gatherings of the pre-pandemic type are formulas for viral spread and potentially death. Events of this type include conferences, performances and concerts, and sports events.
Remarkably, we still do not know the infection fatality rate. Ongoing serological surveys may soon help to clarify that number. It might be as low as 1 person in a thousand or it may be a lot higher.
But even the most hopeful predictions could still mean that people who attend large events or their contacts may contract this virus and die painfully and alone. For example, consider the risk of attending a New York Knicks home game with 19,000 potentially infectious fellow fans. Or a Dallas Cowboys home game with 90,000 others — shooting, cheering, yelling, coughing. Will every event come with a risk disclaimer like those on cigarette packs?
Unfortunately, with a less optimistic infection mortality rate, these numbers could be a lot higher.
If everyone attending these events wore masks and gloves and scrupulously washed their hands, the death rates would be lower. They would be even lower if touching were limited. Or if we left one empty seat between each individual. Or if we all watched from home.
So the questions are: 1) to what extent are we willing to maintain these behavioral interventions? and 2) what is the number of deaths we are willing to tolerate?
Even if it were available, testing would not help much for large attendance events because it is expensive, inconvenient, and the results are delayed. Moreover, a single negative test does not guarantee that a person is safe. In the case of the PCR test, the result may be negative simply because the sample was inadequate. The antibody test may be negative early in infection before the immune system has had time to react. Therefore individuals with negative antibody tests may be asymptomatic, but highly contagious.
The impact on schools
Children and young people will have a particularly hard time maintaining public health measures. So, unfortunately, schools may remain a potential source for spreading infection, which students can bring home to their families.
Until the incidence in a region is brought to zero, we will be in the midst of an “active infector” in the classroom situation. And it is not a drill.
Looking to the future
Creative solutions are needed to help confront the ongoing burdens associated with continuing public health measures.
Even now, many new jobs and new types of jobs are being created, not in spite of, but because of the pandemic. There is a need to scale up jobs in the manufacturing sector such as producing diagnostic tests, medical equipment, and protective gear; and jobs in the service sector such as delivery services, health care provision, and in monitoring public health vigilance. New types of jobs are being created in the education sector, communication sector, in data management, and in creation of tools for working remotely. There is also a need to vastly increase scientific and medical research.
This new economy can flourish in unimaginable ways.
We are all being tantalized by the promise that drugs, vaccines, and return to the-way-things-were are all just around the corner. But we cannot be certain of any of those things.
In the face of uncertainly, is it better to run the risk of having our hopes dashed? Or is it better to take a pessimistic view and be relieved that things were not so bad after all?
Perhaps there is a third path of learning to live with uncertainty and taking one step at a time towards a new future.
Notes:
This piece was written and submitted to Fox on 4–14–2020. It was published as an OpEd on their web site on 4–15–2020.
Any differences, including modifications to the title were made by Fox following submission.
Thanks so much for invaluable editorial comments from Wendy Max, Devon Zander, Stephanie Baum, Jack Owicki, and Joe Nation.
Thanks also to Kate Paddock for the Angry Virus image.
