As states slowly experiment with reopening their economies, there is a deep sense of frustration in policy circles about the lack of a clear national response to the coronavirus.
Part of this has to do with the United States having a system in which many key decisions, such as the closing of businesses or opening of schools, are left to state and local governments. Part of it has to do with mismanagement at the highest levels of the federal bureaucracy. Part of it has to do with having a president with a limited attention span. And part of it has to do with American suspicions of central planners.
Even though the response seems haphazard, it’s not quite accurate to say that the U.S. has no strategy at all on the coronavirus. A more accurate way of putting it is the country is doing a little bit of everything.
Aside from waiting for a vaccine or treatment, there are a few grand plans that have been advocated in response to the coronavirus.
One involves remaining in a sustained state of lockdown, or at least delaying reopening, until there is a much more significant decline in cases. Given that tens of millions have lost their jobs, recently thriving businesses have collapsed, schools have been shut, and social isolation has taken a significant psychological and emotional toll on people, indefinite lockdowns are not a sustainable long-term solution.
At the other extreme, there are those who believe that life should more or less go back to normal, allowing the public to develop herd immunity over time. But this is a questionable strategy, given that our understanding of coronavirus immunity is quite limited. Even if there is some degree of immunity for those who become infected, we don’t know how long that immunity could last. If the immunity wears off after just a few months, for instance, then this strategy wouldn’t work, because by the time enough people will have been infected to establish herd immunity, those who were infected early would start to become susceptible again.
Another option is to develop a sophisticated system, along the lines of South Korea, to widely test people for the coronavirus, and then trace and isolate their contacts. It should be noted that South Korea had years of experience dealing with smaller outbreaks, such as SARS. In addition to the challenges of scaling up a sophisticated testing and tracing system over eight weeks, privacy concerns make tracing a bigger obstacle in the U.S.
Furthermore, the idea of testing and tracing is more effective early on in an epidemic, when there are a limited number of cases and early intervention could prevent an outbreak. When there are already millions of cases of COVID-19 floating around, testing is less helpful, and contact tracing is effectively impossible.
Yet another approach emphasizes isolating older or more vulnerable populations while leaving younger and healthier people free to go about their business. But segregating the population by age is easier said than done. Those who are vulnerable interact with family members and caregivers. Not to mention that adding older people to those with obesity, high blood pressure, cancer, asthma, diabetes, or another underlying health issue would encompass more than half the population.
While there are obstacles to having an overarching plan focused on any one single idea for combating the spread of the virus, people in the U.S. seem to be stumbling into an approach that does a little bit of everything.
That is, many states are still maintaining stay-at-home orders, and even those that are reopening are maintaining many restrictions. Even though it falls short of what a lot of experts want, testing capacity is in fact increasing, and states are investing more in contact tracing. There is no concerted strategy to isolate the vulnerable, but older people are more skittish about resuming regular activities. And as more people get the virus over time, there may be some marginal benefit to immunity, even if it may fall far short of the percentage needed to create true herd immunity.
On top of these things, the public’s habits are changing. Individuals are still practicing social distancing in places where they are legally allowed to ramp up activities. Even though there isn’t universal mask-wearing, the practice of wearing face coverings in public is significantly more widespread than it was at the beginning of the outbreak. In May, people are much more likely to wash their hands frequently and to stay at home when they’re sick than they were in February.
So, instead of wringing their hands over the lack of a coordinated national response, public health officials may want to just embrace the reality of the “little bit of everything” approach and devise lots of smaller interventions that can help at the margins. Plowing more resources into making nursing homes safer, for instance, would eliminate a significant part of the death toll.
It’s possible, as some warn, that this will be the worst of all worlds. That is, there will be sustained and significant disruption to people’s lives, but that disruption won’t do enough to prevent large-scale outbreaks. Instead of choosing between a catastrophic death toll and a sustained economic depression, we could get both. But it also could turn out to be a uniquely American way to forge a path toward normalcy.
