The coronavirus is growing out of control. Deaths will likely increase to 2,000 people a day before the end of the year, and the virus will be with us for much of 2021 and possibly longer. Of the many failures of the outgoing administration’s handling of COVID-19, the most destructive has been its failure to communicate honestly and directly from the start. We can’t get our economy back on track and help millions of Americans emerge from extended crisis until we control the virus.
A safe, effective, and widely available vaccine would be a game changer, but we’re likely many months away from this becoming a reality. The announcement from Pfizer about its vaccine trial is very encouraging, but the vaccine’s safety and efficacy among groups such as the elderly are still unclear. Even with a vaccine that’s fully vetted and ready to go, it will take many months for enough people to receive it to provide population-wide protection. Until then, we need a one-two punch to knock the virus down and then keep it down.
The first action, closing parts of society, needs to be strategic. Timing matters. The initial widespread closure in the spring poisoned the well. Many parts of the country shut down too soon and for too long. By the time COVID-19 came to areas that hadn’t yet needed to close, people were tired of waiting and resisted continued restrictions. An effective closure needs to be nuanced, specific, and tightened and loosened based on real-time data about where the virus is spreading.
Public-health experts learned a lot over the spring and summer. Lockdown and stay at home are not just inaccurate terms; they are unnecessary measures. Outdoor activities are great and largely safe. Schools and child care can, with precautions, stay open unless community spread is extensive. Spread in schools and universities has generally occurred where safety measures such as mask wearing have not been implemented, or in social settings, not academic ones. To keep our kids physically in school, we need to skip after-school pizza parties and other nonessential activities.
Business meetings and work that can be remote should stay so. With modifications and masks, some work sites can open. Delivery, curbside pickup, and safer shopping can keep our economy recovering through the holiday season. We’ve learned what people care about, and getting haircuts and holiday shopping are high on the list, so let’s try to keep salons and retail stores open but make them safer by requiring masks, eliminating crowds, increasing ventilation, and encouraging workers and customers to stay home if they have symptoms. Physical activity is important to health, including mental health, so let’s modify facilities and participation to minimize risk while helping people stay active. Outdoor-recreation classes and individual activities such as walking, running, hiking, and cycling are safe. Well-ventilated gyms—with universal masking (yes, masks with face shields can be worn even while engaging in vigorous physical activity), strict cleaning protocols, and physical distancing—may be able to stay open.
Indoor restaurants, bars, and social gatherings are, sadly, unsafe right now. Low occupancy, increased ventilation, and masking when possible can reduce, but not eliminate, the risk of COVID-19 in these places, especially when the virus is spreading widely. Curfews for restaurants and bars, which officials are implementing in different areas, will help some, but they don’t fully address the fact that any indoor place where people eat, drink, and socialize without masks for extended periods of time is problematic.
Governments should mandate mask wearing in all indoor public places and require business restrictions such as capacity controls and, where necessary, reduced hours or temporary closures. Comprehensive action is particularly important for places where COVID-19 spreads explosively, including meatpacking, agricultural, and other workplaces where distancing is difficult, as well as for congregate housing, including nursing homes, homeless shelters, and correctional facilities. In addition to universal mask wearing, these regulations should include installing physical barriers such as plexiglass shields, upgrading ventilation systems, and increasing space between people.
The responsibility of containing the virus doesn’t just fall on the government. Individuals must also play a role. Thanksgiving could be the perfect storm to accelerate the spread of COVID-19. It would be a good year to skip travel and large Thanksgiving gatherings. If you do get together with others, each pod should limit outside contact for the 14 days before the holiday and minimize risk of exposure during travel. People should reduce the size of gatherings, spend less time indoors together, wear masks when not eating, increase ventilation, and make sure that no one who is feeling sick participates.
Although spring closures were poorly timed and targeted in many parts of the country, our first punch landed in the Northeast, driving down cases to low levels, and reduced viral spread in much of the rest of the country. But our second punch—keeping the virus down—has, so far, missed badly.
Despite lots of effort, current programs to test, trace, and isolate cases have failed to stop the large majority of spread. Tests must come back in hours, not days, and are particularly important among social networks in order to trace webs of transmission and isolate and quarantine people quickly. Outbreaks can be stopped, but only by quick, expert work—and cooperation with public-health measures, which is difficult to secure in an environment of misinformation and mistrust.
Around the world, the best-performing countries provide stipends, social support, and temporary housing to help people who are quarantined. South Korea and Singapore used large isolation facilities for moderately ill patients. Taiwan and Australia offered subsidized hotel accommodations and financial support ($500 and $1,100 per person in each country, respectively) to those ill or exposed. Supporting people with safe and appealing isolation for short periods of time would be a win-win, improving both COVID-19 control and economic stability.
Many clusters of cases come from people who go to work, school, or social get-togethers while ill. No testing, government, or health-care program can control COVID-19 if people continue this behavior. Government and businesses can help. No one should have to choose between feeding their family and keeping their co-workers safe. Paid sick leave reduces the spread of viral disease in workplaces. Instituting it will require collaboration by companies and strategic legal action by the incoming administration and, if possible, Congress. From a public-health standpoint, ensuring paid sick leave is a no-brainer. The devil is in the details of how this is done. In the CARES Act, provisions were limited and complex, so they didn’t help stop the spread of COVID-19 as much as a more effective law could have.
Above all, Americans need to rebuild social cohesion and trust in one another and in our government. What affects one of us can affect all of us. The fundamental scientific error of the push for so-called herd immunity is a failure to recognize this truth. Every infection is a step in the wrong direction, and every infection prevented is a step toward health and economic recovery. Trust will be particularly crucial if and when a safe and effective vaccine is available. But even with a vaccine, the year ahead will be long and difficult.
Because of White House incompetence, 2020 was a wasted year for control of the coronavirus in the United States. Our first punch, strategic closures, was poorly timed and created a lot of unnecessary collateral damage in most of the country. And our second, testing and isolation, flailed badly. It’s up to all of us—not just the incoming administration—to make sure that we get and keep the upper hand in 2021.