It may seem to public health officials that giving an inch means people will take a mile.
In the months since most U.S. states emerged from coronavirus lockon, wearing a mask has become a matter of policy over security, “pandemic parties” have broken out in California, New York and Florida, and many states that ‘ t advance with rescheduling plans in May are forced to pause or reverse the orders.
It is in this beautiful climate that public health experts say that if other less-extreme measures do not work or are ignored, another round of lockdowns – as politically unpopular as they may be – may be the only way to keep an already dire situation at bay. of spiral further out of control.
“We understand that there is no appetite for these extreme measures, but we are currently pursuing a collision course with destiny,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
U.S. pockets, like many parts of the world, first introduced home-stay orders in March. That helped several countries get their outbreaks under control – but not the US, which is now on track to top 170,000 dead. New infections remain alarmingly high in several states.
While the March lockdowns initially worked to drive infections, restrictions in many states were lifted too early to maintain these numbers, and new outbreaks have overwhelmed rapid testing and contact detection capabilities. At this point, according to Osterholm, a new round of lockdowns could be the fastest and most effective way to contain the spread of the virus.
The number of new daily cases nationwide seems to be declining after reaching a peak of more than 60,000 at the end of July. But new hot spots are emerging in the Midwest, business counts are exorbitantly high in California and much of the South, and coronavirus deaths – which follow a few weeks behind spikes in cases – are creeping up in at least 15 states.
And with no sign of a lukewarm summer, experts warn that the US is running in time before the coronavirus pandemic clashes with the flu season and winter season, as any kind of outdoor, socially distant activities will be much less appealing and much more difficult.
But widespread lockdowns have proven politically unpopular, in large part because of how disruptive they are to local economies.
Dr Mike Ryan, the director of the World Health Organization’s emergency organizations, acknowledged the difficult balance between countries and economies while keeping new infections at bay.
“The trick is to really focus on and identify clusters of disease, identify each new communication transmission and implement the kind of localized measures that the virus can contain,” he said in a news release on Monday. “And try, if possible, to prevent the kind of nationwide lockdowns that have done so much economic damage in the past.”
However, while orders to stay at home can be economically painful, they may be the only practical option in places where other, less extreme public health measures are lacking or completely ignored.
Osterholm said reducing infections to less than one new case per 100,000 people per day would make it more manageable to respond to periodic outbreaks and testing and contact detection measures would remain exaggerated.
“Currently trying to establish contact with these numbers is like trying to plant petunias in a Category 5 hurricane,” he said.
Ideally, states would not need full lockdowns and could instead find a middle ground with robust masking policies, social distancing guidelines and bans on indoor meetings, said Dr. Steven Goodman, a professor of epidemiology and medicine at Stanford University. But, the success of these strategies has varied greatly between states.
“We as a society have trouble finding this middle ground because there is so much politicization about basic security measures,” Goodman said. “If we do not have a comprehensive testing strategy, good contact tracking and all these other means to control the virus, then we need to take more extreme, raw and blunt measures.”
All but five U.S. states have issued some form of stay-at-home measure from March to May, but Osterholm said those measures were not strict enough, or were not in place long enough to take matters to a more controllable level. to drive. In contrast, countries such as Italy and New Zealand, which introduced nationwide lockdowns in the spring, have since reopened and have so far been effective in managing local outbreaks as they occur.
“What we did was a delay,” Osterholm said. “We went from 100 miles per hour to 60 miles per hour, and then could not manage the angle for us. What other countries in Europe and Asia were doing was slow to 10 miles per hour and so they could manage that angle safely. ”
Now, when new outbreaks occur in those countries, it is tantamount to fighting a few hot spots after a forest fire is already under control. What happens in the US is instead more akin to fighting a massive, raging blaze with one snake.
“We now have a window that is closing fast where we can do something.”
The debate over lockdown strategies could also assume new urgency as summer winds subside. Both Osterholm and Goodman predict that cases will resurface in the fall, when some schools and colleges across the country begin classes again. Certain public health measures will also be more complicated in winter as temperatures drop.
“We now have a window that is closing fast where we can do something,” Goodman said. “In a few weeks, children will be able to go back to school in some places, the flu season will reach and people will no longer be able to be outside. Once this happens, all of our control measures change dramatically. “
However, even if new lockdowns are introduced in some regions of the country, they should not be seen as a panacea. While strict door-to-door orders can dramatically reduce the number of new infections, states need to carefully plan for what to do after removals – something that was not handled well after the March lockdowns, according to Justin Lessler, an associate Professor of Epidemiology of Infection at Johns Hopkins University’s Bloomberg School of Public Health.
“Those of us in the epidemiological community have said that lockdowns are not a permanent solution – they are about buying time,” Lessler said. “The problem with the U.S. response has been that it lacks a clear long-term plan beyond hoping for a fax.”
