Leana S. Wen is an emergency physician and visiting professor at George Washington University Milken Institute School of Public Health. Previously, she served as Baltimore’s health commissioner.
Most states are reopening to some degree this week, even as public-health experts warn that it’s too soon. Proponents of early reopening use some variation of six arguments. Here is what’s wrong with each of them:
Instead of preventing covid-19, we should let people infect each other to achieve herd immunity. Herd immunity occurs when enough people in a community generally 60 percent to 80 percent develop antibodies to an illness, either through vaccination or recovery. Banking on herd immunity without a vaccine is a dangerous proposition: It’s unclear whether people acquire immunity after contracting covid-19. Even if those who recover become immune, an infection rate of 60 percent would mean nearly 200 million infected Americans. Millions could die.
Most cases of covid-19 are mild. We can keep older people at home and allow young, healthy people to go back to school and work. This is wrong for multiple reasons. Older people aren’t the only ones contracting covid-19. One in 5 patients requiring hospitalization in the United States are ages 20 to 44, the Centers for Disease Control and Prevention found in March. Infected people in their 30s and 40s are dying of strokes.
Even if young people are not as likely as older individuals to become severely ill, they can be asymptomatic carriers who spread the virus. Growing evidence suggests that children with mild or no symptoms can be highly contagious carriers. In New York, 66 percent of hospitalized covid-19 patients appear to have been sheltering at home. This suggests they probably contracted the virus from someone close who had exposure to others.
People are getting sick and dying from other illnesses in greater numbers than covid-19. It’s true that emergency department visits for other illnesses are decreasing and that patients are eschewing medical treatment because they fear risking infection. Chronic medical conditions require care. Mental health is also affected by social isolation. Allowing the coronavirus to spread without restrictions would lead to hospital overcrowding, further inhibiting patients from obtaining necessary care.
Controlling the pandemic, by contrast, would create confidence and increase people’s willingness to seek care for other conditions. Meanwhile, mental health needs to be a priority not only to help people experiencing isolation but also to treat the trauma and grief of those who have lost loved ones.
It’s worth the sacrifice if some people die so that the country has a functioning economy. This is a false choice; there are ways to safely reopen, and consumer confidence depends on the reassurance of public health protections.
Another flaw with this argument is that those making it are committing others to a sacrifice they did not choose. Covid-19 has disproportionately affected people of color, who are more likely to be essential workers, as well as to have chronic health conditions that make them more susceptible to severe illness. Minorities and working-class Americans of all ethnicities unable to shelter at home will continue to bear the brunt of infections, illness and death. Individual liberty cannot take precedence over the health and well-being of the less privileged.
We’ve been in lockdown for more than a month and cases aren’t declining; social distancing doesn’t work. Actually, social distancing has worked in places where measures were applied early and consistently. The two states with earliest known community transmission, California and Washington, avoided surges. New York was able to “flatten” its curve, and the number of cases at this epicenter is declining.
U.S. case numbers have not declined as much as case numbers in other countries because we have not applied the aggressive measures that some Asian and European countries have. At best, the United States has had a piecemeal approach. Some states never issued stay-at-home orders. Social distancing was intended to buy time to prepare hospitals and scale up capacity to test, trace and isolate coronavirus infections. Hospitals are better prepared than they were two months ago, but the country still lacks the resources for mass testing and contact tracing/isolation on the scale needed to tamp down infections. New Zealand and other countries have been successful when they combined social distancing with public health measures. U.S. inaction has limited the benefits we could have realized.
We can’t keep the country in lockdown until a vaccine is developed, which could take years. No one is arguing to extend stay-at-home orders for years. But reopening criteria set out by the White House’s own coronavirus task force have not been met. Removing restrictions too soon would have predictably grim results.
In reopening against public-health guidance, officials and others across the country have effectively decided to give up on trying to contain the coronavirus. This is a dangerous decision that is certain to lead to many preventable deaths. Let’s stop using misleading arguments to justify it.