Issue Seven: Grand Opening, Grand Closing
4.26.20 | The delicate and dangerous process of emerging from quarantine
Hello,
As the official death toll from the novel coronavirus pandemic soared past 50,000 in the U.S. this week, some believed the worst to be over. But restarting social life will be a delicate and complicated process in which a lot can go wrong. Even under the rosiest estimates fewer than 20 percent of Americans have been infected with the virus so far, meaning most of us are still vulnerable. What’s more, there’s no definitive evidence that being infected confers long-lasting immunity from Covid-19.
The road ahead will likely be defined by periodic easing and tightening of physical distancing as the pandemic continues to smolder and flare. Implementing this as a matter of public health policy will require a level of trust in public officials and scientists that has long been tenuous, has been further damaged by the uneven federal performance to the pandemic, and is coming under concerted assault as political activists seek to gain advantage by drawing the pandemic fight into polarized partisan discourse.
In this issue: grand openings and grand closings.
In this issue
Link Roundup
Trust, and Living With the Virus
// Link Roundup
The Second Wave: Epidemiologists have been warning since the start of the pandemic about the possibility of a second wave in the fall and winter that could be even more challenging. Now CDC director Robert Redfield too has voiced those concerns just as the White House is making sunny projections about an end to the pandemic. One cause for concern: the first Covid wave hit just as flu season was petering out. The second wave could coincide with the 2021 flu season, straining hospitals past their breaking points.
— “CDC Director Warns Second Wave of Coronavirus Is Likely To Be Even More Devastating.” Lena H. Sun, The Washington Post.Dropping our guard against other pathogens…: As people avoid hospitals and doctor’s offices, vaccine rates for other communicable diseases are falling, leaving people vulnerable: “during the week of April 5, the administration of measles, mumps and rubella shots dropped by 50 percent; diphtheria and whooping cough shots by 42 percent; and HPV vaccines by 73 percent.” Doctor’s offices are adapting, administering drive-through vaccinations for example. Widespread vaccination against flu in the fall will be critical.
— “Vaccine Rates Drop Dangerously as Parents Avoid Doctor’s Visits.” Jan Hoffman, The New York Times.…and non-communicable diseases: People also seem to be avoiding hospitals to treat heart problems, stroke, and appendicitis.
— “‘Where are all our patients?’: Covid Phobia Is Keeping People With Serious Heart Symptoms Away From ERs.” Usha Lee McFarling, STAT News.Some states are easing suppression orders, almost certainly too early. “The vast majority of Americans are still believed to be uninfected, making them like dry kindling on a forest floor. Barring a vaccine or treatment, the virus will keep burning until it runs out of fuel. … ‘The math is unfortunately pretty simple. It’s not a matter of whether infections will increase but by how much,’ said Jeffrey Shaman, a leading epidemiologist at Columbia University.”
— “States Rushing To Reopen Are Likely Making A Deadly Error, Coronavirus Models And Experts Warn.” William Wan, Carolyn Y. Johnson and Joel Achenbach, The Washington Post.Georgia in particular is in danger of recommending people resume normal life just as the spread of the virus is approaching a peak in the state’s population.
— “Why Georgia Isn’t Ready to Reopen, in Charts.” Nathaniel Lash and Gus Wezerek, The New York Times.An asymmetric curve: One reason governors might be tempted to reopen their states too early is a belief that rates of infection will fall as quickly as they rose. That belief is fatally mistaken. Data shows that even under heavy suppression orders the epidemic curve of Covid-19 tends to be asymmetric, with a long and fat tail. Easing movement restrictions too soon “‘is like thinking you can cut your parachute off at 2,000 feet because it slowed you down,’ said Carl Bergstrom, a biology professor at the University of Washington.”
— “It’s Too Soon to Reopen States. The Coronavirus Is Not Under Control.” Aaron E. Carroll, The New York Times.Meat packing plants may be driving infections in rural communities as the pandemic spreads out of cities. Working conditions in the industry are notoriously unhealthy, creating an unusually favorable environment for the spread of the virus between workers. These workers then spread the virus to the wider community. “Rates of infection around these plants are higher than those of 75% of other U.S. counties,” an analysis found. A lawsuit filed this week against a plant in Missouri claims the plant is a public nuisance because it prevents workers from protecting themselves against coronavirus: “workers are typically required to stand almost shoulder to shoulder, must often go hours without being able to clean or sanitize their hands, and have difficulty taking sick leave.” Under current conditions, “workers say they have encountered another health complication: reluctance to cover their mouths while coughing or to clean their faces after sneezing, because this can cause them to miss a piece of meat as it goes by, creating a risk of disciplinary action.”
— “Coronavirus At Meatpacking Plants Worse Than First Thought, USA TODAY Investigation Finds.” Kyle Bagenstose, Sky Chadde and Matt Wynn, USA TODAY.
— “Missouri Pork Plant Workers Say They Can’t Cover Mouths to Cough.” Noam Scheiber and Michael Corkery, The New York Times.Strange complications: The virus that causes Covid-19 is producing an array of unexpected complications, sudden crashes, haywire immune responses, blood clotting and strokes in patients.
— “A Mysterious Blood-Clotting Complication Is Killing Coronavirus Patients.” Ariana Eunjung Cha, The Washington Post.
— “Young And Middle-Aged People, Barely Sick With Covid-19, Are Dying of Strokes.” Ariana Eunjung Cha, The Washington Post.
— “Why Some People Get Sicker Than Others.” James Hamblin, The Atlantic.A view from the hospital: Hashem Zikry, an E.R. doctor at Elmhurst Hospital, on what it’s been like to work the pandemic:
“‘It’s become very clear to me what a socioeconomic disease this is,’ Zikry told me. ‘People hear that term “essential workers.” Short-order cooks, doormen, cleaners, deli workers—that is the patient population here. Other people were at home, but my patients were still working. A few weeks ago, when they were told to socially isolate, they still had to go back to an apartment with ten other people. Now they are in our cardiac room dying.’ Zikry, whom I have spoken to regularly in the past month, has extraordinary resilience and good humor; on this day, he sounded despondent. ‘After my shift, I went for a run in Central Park, and I see these two women out in, like, full hazmat suits, basically, and gloves, screaming at people to keep six feet away while they’re power walking. And I’m thinking, You know what, you’re not the ones who are at risk.’”
— “A New Doctor Faces the Coronavirus in Queens.” Rivka Galchen, The New Yorker.
You catch the virus from people, not packages: An expert roundup of all the things from which you shouldn’t worry about catching Covid — your newspaper, your packages, your shoes, your clothing (unless you’re a hospital worker) etc.
— “Is the Virus on My Clothes? My Shoes? My Hair? My Newspaper?” Tara Parker-Pope, The New York Times.The ghosts of pandemics past: A moving roundup of memories from people who survived previous pandemics, from the 1918 flu, to Polio, to SARS, to H1N1.
— “How I Knew It Was Over.” Ruth Graham, Slate.What it’s like to work in a grocery store during the pandemic: This moving short documentary follows a worker at a New York City grocery store.
// Trust, and Living With the Virus
The most interesting thing I heard this week was this interview with Dr. Michael Osterholm, an infectious disease expert at the University of Minnesota. We’re well past the hope of containing or eradicating the virus that causes Covid-19. It’s in our communities, it’s circulating widely around the globe, and it will continue to pop up in waves for the foreseeable future.
Since we can’t get rid of it any time soon, Osterholm says, the question is now how to live with the virus as a fact of social life. It’s clearly unsustainable to keep economic and social activity as suppressed as they have been, with unemployment at historic highs and cascades of unpaid bills, debts, and taxes threatening to overwhelm even those parts of society that are still operating under some degree of normalcy.
At the same time the widespread testing most experts say is necessary to contain the virus may not even be possible in the U.S., given coming shortages of the resources needed to conduct the tests. Widespread contact tracing might not be possible either, given the difficulty of training people to do it well, along with unanswered questions about what to do with people who have been in contact with a known carrier. Simply sending people home to self-isolate isn’t a good idea, since we know the virus transmits easily to people in the same household. We can’t legally require large numbers of people to be quarantined away from home, and don’t necessarily have the resources to isolate huge numbers of people voluntarily, given how broadly prevalent the virus has become.
So it may be the best we can do to simply try to keep the pandemic burning through society slowly enough for hospitals to handle the caseload, easing up and cracking down on economic and social activity as the rate of infection dips and rises.
There are risks to this approach. The margin for error is small, given that the virus spreads exponentially in communities and that many people seem to spread the pathogen without showing symptoms. We might not be able to calibrate restrictions quickly and accurately enough for them to be effective.
What’s more, for calibrated openings and closings to work, people have to trust the people saying when it’s safe to emerge and when it’s time to go back into hibernation. The good news here is that these decisions will mostly be made at the state and local level, and people have far, far more trust in local officials than in the federal government on this issue, according to one recent series of polls:
Currently, according to the same poll, most people are willing to stick through a longer period of sheltering in place and are more worried about opening too soon rather than too late — this includes majorities of democrats, independents, and republicans alike (polling by the Kaiser Family Foundation gets similar findings):
But how long can this trust last in the face of multiple waves of re-openings and closings, some of which could go disastrously wrong? And how long before coordinated protests to undermine Democratic governors and general partisan sniping metastasize into generalized distrust of public health orders?
Unfortunately, the only way we’re going to find out is by watching the next few weeks unfold.