The public health community has long railed against abstinence-only education by noting that teenagers are going to have sex regardless, so it’s better to encourage them to practice safer sex when they inevitably do. Yet now, public health officials are effectively embarking on a massive nationwide attempt to impose social abstinence in an effort to contain the spread of the coronavirus. It will not be sustainable.
Don’t get me wrong. I’ve heeded the calls and have read the research on the imperative of dramatically reducing human interactions to flatten the growth curve of the coronavirus so that the medical system does not get overwhelmed. I’ve even written about and encouraged the social distancing approach. That said, to be more effective, at some point we’re going to have to figure out some creative solutions that recognize that it will be hard to ensure compliance for very long.
Already, we’ve seen the viral videos of young people out at bars and college students crowding beaches over spring break. Give this another few months or even weeks, and it won’t be just them. From people being cooped up inside apartments and houses, to parents trying to juggle work and home-schooling without the help from neighbors or grandparents, to kids wanting to play with other kids, to singles and young couples who want to congregate with their friends, to workers in restaurants and bars that depend on that congregation for their income, there will be rebellion against draconian social distancing measures.
Understandably, at the moment, the primary focus must be on trying to avoid an Italy type scenario in which the medical system becomes overwhelmed. But we have to think of things in terms of a three-part strategy.
We know that the short-term requires as much social distancing as possible. And that the long term involves, hopefully, a vaccine. But finding a vaccine, testing it for safety and efficacy, and making it widely available, is likely at least 18 months away. If the grim Imperial College study is our future, and the choice is between maintaining draconian social distancing for 18 months or risking up to millions of deaths, we’re ultimately doomed.
So what we need is to simultaneously discuss a midterm strategy that recognizes that we live in a free society and people are going to start cracking at some point. We have to find a way of allowing people to return to some semblance of normal lives while we await a medical breakthrough — even if it is a new normal. If we do not, the economic devastation and social isolation could end up having even worse public health implications than the coronavirus itself. It will also drive people to defy guidance.
In the wake of the Sept. 11 attacks, life went on in the United States. We just had to endure added inconveniences like taking off our shoes at airports and having our bags checked at sporting events. I think we need to get to the point where we think of this in a similar way.
That is, it’s possible we’ll consider temperature checks in airports, sporting events, and other crowded places. We’ll need to have more disinfecting of public areas. Maybe bars and restaurants are allowed to reopen but with much lower maximum capacity limitations. Some grocery stores have already adopted separate hours for those over 60, and maybe that practice gets extended to movie theaters, which then have to ramp up sanitation between showings.
Some ideas might be employed sooner rather than later. Former FDA Commissioner Scott Gottlieb, for instance, tweeted, “If the concern is that asymptomatic or mildly symptomatic younger Americans (millennials) are continuing to spread #Coronavirus because they don’t heed warnings, you could require anyone between certain ages to wear a procedure mask when they go out.” To be clear, he was not referring to the more scarce N95 masks that are needed for doctors.
(I should note at this point that there seems to be some confusion about the changing guidance on the wearing of masks that’s really just a matter of the situation having evolved in the past few weeks. The point was that masks should be seen as a way of preventing you from infecting other people. A few weeks ago, when there were a relatively small number of cases, the odds that any individual was infected was fairly low. But now with cases in all 50 states and outbreaks in some large cities like New York and Seattle, there’s a greater chance that somebody young is infected and doesn’t know it.)
To this point, early stumbles, especially a lack of adequate testing, have hampered the U.S. response. But hopefully, the dramatic social distancing strategy we have adopted will bear fruit, and at some point the cases will peak without bringing down our medical system.
If we could get to the point where we could essentially reset the clock in the summer, we’d be in a much better position to combat a potential resurgence in the fall. Testing should be readily available by then, allowing us to identify and isolate hotspots early in a way we could not the first time around. Public awareness of hygiene practices will be greater. We’ll have more time to ramp up production of ventilators, masks, and other medical equipment to increase the capacity of our medical system. With some luck, some of the drugs being tested will prove effective in reducing the severity of the disease.
Now, some of these ideas I’ve floated may not be practical or effective. New requirements may cut into the margins of businesses to the point at which they are no longer profitable even if they aren’t totally shut down, for instance. All ideas would obviously need to be vetted. But the general point is that we have to start discussing a social distancing strategy that takes into account that governments will not be able to count on mass compliance for very long.
