Public health policy expert Dr. Anand Parekh warns that the “new normal” will likely include a recurring pattern of implementing and lifting social distancing interventions.
Although the United States is still battling the first wave of the Covid-19 pandemic, every state has announced or taken steps to reduce social distancing interventions. However, our elected officials won’t be able to markedly reduce the anxiety many Americans have of Covid-19 simply through proclamations (a recent poll found that two-thirds of Americans felt nervous, depressed, lonely or hopeless for at least one day in the last week). Only policies that actually suppress the virus will enhance the safety of Americans so that we can confidently proceed to a “new normal” in this country.
Over the month of April, the U.S. was able to flatten the curve thanks to the American public adhering to social distancing interventions (e.g., cancellations of large gatherings, school closures, telework). Mobility data confirm that physical distancing led to reductions in contact rates anywhere from 40% to 70% across all fifty states. However, mobility rates have increased over the last several weeks due to the stated intentions and actions of our nation’s leaders to reopen the economy.
The desire to reopen is not unreasonable. Over 36 million Americans have filed unemployment claims while many others are struggling to afford food and housing, and calls to suicide hotlines have risen astronomically. However, at least one influential model from the University of Washington nearly doubled its nationwide projection for Covid-19 deaths over the next several months largely because of state reopening plans. Previously, the model had assumed that states would continue enforcing comprehensive social distancing interventions through May, thus putting the country in a more favorable position for the summer.
By trading the month of June for May, particularly given that U.S. Covid-19 testing and contact tracing infrastructure is still insufficient, the country is at risk of an increase in transmission of the virus that could lead to an uptick of cases and hospitalizations in June. This could start another wave of the pandemic and potentially lead to reinstituting social distancing interventions.
A recent Pew Research Center poll indicates that 68% of Americans (most Democrats and nearly half of Republicans) are concerned that restrictions on public activity imposed by state governments in response to Covid-19 will be lifted too quickly. This is likely because few states have met the White House’s gating criteria, or other more specific, evidence-based quantitative metrics necessary for reopening safely.
Ideally, each state would first demonstrate sufficient testing capacity to identify and isolate cases. While testing has expanded across the U.S, several states still have too high a percent of positive tests, one metric of adequate testing capacity. Sufficient testing is critical in our ability to gauge the second criteria for opening, which is a decreased trend in confirmed cases for two to three weeks.
Third, the healthcare system should be under capacity with sufficient personal protective equipment and critical medical material. Fourth, there should be ample contact tracing capacity (30 contact tracers per 100,000 people) to stop chains of transmission.
Once states start to open up, they should begin with sectors that have a low risk of transmission and space out openings by two weeks. This would start with outdoor employers and construction, followed by manufacturing and retail at low capacities. Starting with businesses that have high contact intensity such as restaurants, movie theaters, gyms, salons, and barbershops are not entities that should be opening first.
It’s important to remember that a public health crisis led to the economic downturn. If we bring the pandemic under control, the economy will start to come back. In the meantime, we need to continue supporting effective policies that mitigate the economic consequences of social distancing interventions. This includes unemployment benefits, small business loans, food and housing assistance, paid leave and childcare assistance, and increased access to behavioral health services.
Responding to and recovering from the Covid-19 pandemic will be a marathon, not a sprint. It’s likely that over the next year or two, the nation will face additional waves due to changes in human behavior, seasonality and other factors. Implementing and lifting social distancing interventions will become a recurring pattern. It’s quite likely that everything about the “new normal” will look different – work, school, travel, family vacations. With time and perseverance, we will adjust.
But the first order of business for the nation is ending this first wave of the pandemic. Continuing to follow public health and science is how we suppress the virus, inspire confidence, reduce fear, and reach a “new normal” when we can start to resume at least some aspects of our lives.