The argument that harsh restrictions on business and social interaction during the COVID-19 pandemic will do more harm than good has real power. Unemployment is projected to rise to 30 percent in a few months, and an economic contraction in the second quarter of 15 percent or more has been forecast.
President Trump’s wish to open up the country by Easter and avoid a nationwide shelter-at-home policy is understandable. After all, a COVID-19-induced recession will cause its own serious health problems — depression; suicides; the damage stress will cause to those with heart disease, diabetes and other conditions, not to mention the effects of growing poverty.
Yet it is likely that one million Americans currently are infected with coronavirus, and if that number doubles every six days, 100 million Americans will have COVID-19 by the early May. If 1 percent of those infected die, there would still be a million deaths. That’s the equivalent of what 10 Hiroshima bombs would do, or nearly double the number of annual cancer deaths.
Many of the people infected are 70 and older, and it might be possible to make extra efforts to shelter and protect them. But without shelter-in-place rules, we could expect almost 400,000 people under 70 to die, with about 135,000 between the ages of 30 and 59.
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I’ve helped make the case before that a strong, fast, federal effort to speed the distribution of testing, protective gear, intensive care equipment and training, to coordinate and plan a national response, could sharply limit the spread of COVID-19.
The federal government has done little, but if it acts now a similarly strong national response may allow America to open up sooner — in June, not by Easter — and do it more safely. Here’s how:
Stop the virus. A nationwide shelter-in-place or quarantine should take place for the next eight to 10 weeks. According to Chinese data, this would mean the number of COVID-19 cases would peak in four weeks or so and then decline over the next four to six weeks. So, as hard as it will be, everybody but crucial workers will have to remain inside until roughly June 1st.
Make reasonable exceptions. In counties with few cases of COVID-19 and the ability to test and trace infected people’s contacts, normal life could go on as long as people believed to be infected are quarantined and those who are known to be infected are rapidly isolated.
Mobilize public health resources. During the eight weeks of shelter-in-place, the federal government needs to produce and distribute enough tests so state and local health officials can check as many people as possible, even those without symptoms, and determine the true extent of infections. We should also push the Food and Drug Administration for rapid approval of blood tests to determine who has antibodies to coronavirus, and is thus immune, and then deploy millions of them.
State and local health department then need to deploy thousands of teams to trace contacts of all new COVID-19 cases using cellphone data, social media data, and data from thermometer tests and the like. We also need to get infected people to inform their own contacts. It will be easier to lift the national quarantine if we isolate new cases, find and test all their contacts, and isolate any of them who may be infected.
The national quarantine would give hospitals time to stock up on supplies and equipment, find more beds and room to treat people, get better organized and give clinical staff a respite to recuperate for the next onslaught of COVID-19 care. Without these measures, any COVID-19 resurgence would be far harsher, and economically damaging.
Begin a mass education program. While many Americans have been more careful about washing their hands, keeping six feet away from other people, and staying indoors as much as possible, these new behaviors have not been adopted in every part of the country. We need a stronger campaign to educate Americans about these habits so that the average number of people any infected person might spread the virus to would drop below one, from about 2.4 today.
Create a COVID-19 certification system. States should use blood tests to certify people who have had COVID-19, are immune and are no longer contagious. These people could then work in hospitals or other areas where being risk-free would be a benefit.
Slowly open the economy and social activities. If these steps are taken, we should slowly open up parts of the economy in June, while requiring those 70 and older, or others at high risk, to continue to shelter in place, perhaps in isolation. Lifting restrictions could start with children and young adults, who are far less likely to get seriously ill and die. We might open up summer school on a voluntary basis and camps. Parents should be allowed to assess the risk that their children could become infected with the coronavirus and bring it home. Teachers and administrators would also have to be able to opt in, knowing they could acquire COVID-19. Colleges and universities might open up for summer sessions, with faculty and staff opting in, or not, with knowledge of the risks they are taking. Following South Korea and Taiwan, America should deploy testing and contact tracing aggressively during this opening to limit any potential outbreak.
Open the economy more fully. If the initial opening works, we should allow people in offices to go back to work in places without significant COVID-19 infections have died down. Businesses need to require workers to follow rules on physical distancing with fellow workers and customers, and to tell employees to isolate themselves if they believe they are infected. To permit physical distancing, we’d need occupancy of restaurants, bars and stores to be at half the legal limit.
We would then open museums and other venues to small numbers of people, although it would be necessary to still prohibit mass gatherings where physical distancing is not possible — sporting events, large conferences, Fourth of July celebrations and tourist sites like Disney World. When possible, stores and restaurants could be managed and staffed by people certified to have had COVID-19 and be unable to spread it. If there are no flare-ups, more venues could be opened. During this gradual opening, public health teams would continue to perform contact tracing and enforce isolation. Meanwhile, scientists will continue furious efforts to create a vaccine that prevents infection, or medicines that treat the disease.
This is not a perfect solution. It is a middle course that can save lives and save the economy. Indeed, a recent analysis of the 1918 influenza pandemic concluded that cities that put in place public health measures like physical distancing tended to have both low mortality and high economic growth. Undoubtedly, some people will still become infected and die, but far fewer than if we arbitrarily set Easter as a date to open the economy without any concern that hundreds of thousands of people could die as a result.
With a controlled reopening of the economy around June, the new $2 trillion stimulus could have a real effect and the health of the nation would be protected. It would require the full commitment and attention of the federal government. Is that possible?
Ezekiel J. Emanuel
Ezekiel J. Emanuel, M.D., is vice provost of global initiatives and a professor at the University of Pennsylvania.
