Now that Utah and many other states appear to have flattened the curve in terms of the level of infections, it is natural to start thinking about what it might take to return to normalcy. Unfortunately, these decisions are vastly more complex than the stay at home orders because there is no “one size fits all” strategy.
Our initial actions can be termed as brute force social distancing, where all residents were told to minimize their activities while essential employees were expected to perform their functions. This was the only realistic option in these first few months given that the woeful lack of testing capability ruled out many of the other options. It also had the advantage that it could be put in place extremely quickly. The current numbers in Utah as well as in other states show that these steps can quickly slow the spread of infections, but brute force social distancing has some major downsides that suggest that it is not the best choice for the next year or more until a vaccine is available.
One is that it greatly slows — but does not eliminate — additional infections, since some infected but asymptomatic persons are unknowingly circulating and transmitting the virus. For example, in Utah, there has been an average of over 100 new infections per day even after the full impact of social distancing guidelines took effect.
The bigger downside is that it is highly damaging to the economy and the well-being of Utah residents. The key weakness of the brute force method is that the vast majority of those who are self-isolating are of no danger to others. However, because we do not know who is infectious, we have to treat infectious and non-infectious people the same, needlessly curtailing all the activity of the non-infectious group.
As of mid-April, just over 3,000 Utahns have tested positive for the virus. Even if we assume that the number of infected Utahns is 10 times higher because those others have not been tested, this would suggest that the total number of infected persons is about 1% of the Utah population. As a result, we have nearly all Utahns curtailing their activities even though less than 1% could actually transmit the virus. The good news is that the leveling off of new cases provides an opportunity to focus on those who need to be isolated and allow other parts of the Utah economy to reopen, and that requires greater attention to testing and contact tracing.
Testing increased rapidly in Utah and in other states during March and early April, but then decreased since fewer people exhibited the symptoms required to be approved for testing. As a result, the number of tests dropped from the first to the second week of April even while the capacity increased, although the number of tests has increased again in the last week.
Consequently, the testing protocols should be updated to ensure any additional capacity is used for workers in critical sectors such as health care and in the highest risk locations such as nursing homes, and then expanded to other essential or high-risk locations. In addition to identifying and reducing potential sources of infection, the results will also provide public health officials valuable information about the level of infection in the broader community.
The other benefit of the leveling off of new cases is that it allows officials to perform contact tracing to a degree that was not possible when case numbers were growing exponentially. As in the case of testing workers and others who do not have symptoms, contact tracing makes it possible to focus the isolation measures on those who pose the greatest risk to others.
These types of steps along with continuing the ‘easy’ practices such as using masks and reducing physical contact such as handshakes will enable more sectors of the economy to open and reduce the hardship on families. Possibly more important is that using these techniques in a few sectors will provide experience that will inform the options for other large sectors such as education, restaurants, and travel that are now operating with severe limitations.
If we abandon the brute force method without replacing it with something better, we will quickly return to a sharp increase in the infections. Brute force social distancing has been costly, but it has given us the breathing room to apply more focused measures such as testing and contact tracing. We owe it to the essential workers who have risked their health and to the myriad Utahns who have curtailed their activities to replace it with something much better.
Loren Yager
Loren Yager, Park City, formerly served as the chief economist of the Government Accountability Office, the investigative arm of Congress.
