The United States is entering a precarious few weeks in the fight against the coronavirus. New York City’s medical system is on the brink of collapse as the number of patients with the COVID-19 virus requiring intensive care is overwhelming system capacity. While it may be possible to channel scarce resources to the city to increase capacity, that becomes much more difficult if other hot spots such as San Francisco and Seattle follow a similar fate. Then we could be talking about a nationwide collapse of the medical system.
So while it’s understandable that national, state, and local leaders are focused on trying to avoid this dire scenario through aggressive measures that require mass lockdowns and business closures, they must also work on a strategy to open things up once the peak is passed.
There are a few facts to keep in mind. Even if everything goes perfectly, it will take at least 18 months, until fall 2021, for there to be an effective vaccine. Realistically, however, it could be longer. That means policymakers and the public should brace for the reality that the coronavirus will be part of everybody’s lives for the next few years.
The current level of lockdown is unsustainable. The airline, hotel, restaurant, and travel and leisure dependent industries cannot remain closed for years. Schools cannot be shut down indefinitely. Parents are not going to absorb the burden of homeschooling their children forever while struggling to hold down full-time jobs, especially if they must also avoid help from grandparents, playdates, going to playgrounds, and so forth.
Governments can probably count on relatively widespread compliance for a short time, but draconian social distancing is not viable until the widespread availability of a vaccine. Leaders need to take action now so that once the caseload peaks and begins to decline, there is a glide path for people to return to a semblance of normal life.
Given that the ultimate fear is the strain on the medical system, there needs to be a multitiered strategy that attacks the problems of both supply and demand.
On the supply front, there all current shortages caused by the spike in COVID-19 virus cases must be addressed. Masks and other protective gear are scarce, which increases the risk of transmitting the disease to healthcare workers and thus exacerbating the problem of medical staffing. There is also a shortage of ventilators, which allow those with severe versions of the disease to keep breathing, giving them a fighting chance to live. In Italy and China, once medical systems reached their capacity, fatality rates soared. Increase capacity and our system can increase the number of severe cases it can treat before reaching that point.
On the demand side, we must focus on ways to slow the spread of the disease that do not depend on widespread lockdowns.
Scott Gottlieb, President Trump’s former Food and Drug Administration commissioner, has outlined several strategies that could get the U.S. to a point at which there would be some return to normal life. For instance, masks can cut the risk of transmission by half. If all people wore masks when they went out, it would slow the spread of the virus.
South Korea pursued a strategy of widespread testing followed by isolating those who tested positive, and tracking down and notifying their close contacts. Such a strategy would allow the government here to be aware of outbreaks earlier, allowing those with the disease to be confined. Perhaps this would mean schools would close in some hot spots, but life could be more open in other parts of the country.
To make these sorts of alternate approaches possible, we need to be doing things now. It takes time to prepare the technology and put a system in place to do the sort of mass screening strategy that has proved successful for South Korea. And at a time when doctors don’t have a sufficient number or masks, health officials are not in a position to offer guidance that everybody wears masks when leaving the house.
There are, of course, other medical breakthroughs that could make this easier. For instance, if some antiviral drugs were confirmed to be effective at minimizing symptoms. Or, if researchers were able to find a way of testing people to see if they have some form of immunity. That would allow them to go on with their normal lives without being a threat to either catch or transmit the disease. But while we hope for such breakthroughs, it does not negate the need to focus on addressing the logistical challenges mentioned above.
All of these issues need to be treated with urgency. Because if the nation isn’t in a position to return to some semblance of normal life in a well-thought-out way, there are going to be serious problems soon. People whose lives and livelihoods are being ravaged will not stand it for long. They are not going to accept a world in which police break up weddings because they exceed bans on larger gatherings. Absent changes, there will be a huge backlash. The public will try to get back to normal in a haphazard way that risks another spike in cases of the disease. This would lead to a clash with the authorities taking more dramatic actions to maintain order in the face of disobedience. There could be very ugly clashes and great risk to civil liberties. Nobody wants to get to that point.
A better solution for everybody is for leaders to take action now that may allow large parts of the country to return to some form of regular life within a few months, even if it’s a new normal.
