In May, a medical research scientist named Rick Bright, who had just been ousted from the government after filing a whistle-blower complaint about the Trump administration’s coronavirus response, testified before Congress and issued a dire warning. Without rapid federal action, he said, the outbreak would get worse, and soon Americans would suffer “the darkest winter in modern history.”
In the months since Dr. Bright’s testimony, his prediction has come into sharper focus: By Dec. 1, the number of Americans killed by Covid-19, now at about 181,000, may reach nearly 317,000, according to a projection from University of Washington’s Institute for Health Metrics and Evaluation. Further darkening the picture, 32 of 56 economists who spoke to Reuters last month said there was a high or very high risk that the halting job recovery will reverse itself by the end of this year.
As summer draws to a close, what have we learned about the coronavirus that could help us stop the worst from coming to pass in the months ahead? Here’s what public-health experts, economists and journalists are saying.
Wearing masks will save lives
As my colleague Nicholas Kristof wrote last month, declining to wear a mask while near people outside your household is like driving drunk: It puts everyone around you in danger. That consensus did not exist in the early months of the pandemic, when many countries were urging their citizens to wear masks even as the World Health Organization was refusing to recommend their use for fear of insufficient evidence and potential supply shortages. In June, however, after months of confusion and criticism, the WHO endorsed mask wearing, citing “a growing compendium of observational evidence.”
That same month, a meta-analysis of 172 studies published in the medical journal The Lancet found that “wearing face masks protects people” — partially — “against infection.” Masks may even be the key factor in slowing transmission, according to one recent study: “Our analysis reveals that the difference with and without mandated face covering represents the determinant in shaping the trends of the pandemic,” the authors concluded. “Other mitigation measures, such as social distancing implemented in the United States, are insufficient by themselves in protecting the public.”
Over 67,000: That’s how many lives could be saved by December if 95 percent of Americans started wearing masks, according to the University of Washington institute. Right now, though, it estimates, only about 50 percent of Americans are doing so. And as Mr. Kristof wrote, usage lags especially among men, who are more likely to regard masks as “a sign of weakness.” In a count conducted at several spots across New York City at the end of July, Times reporters found that about one in six women were walking around unmasked. For men, that number was nearly one in three.
What makes public and commercial spaces safer — and what doesn’t
Across the country, businesses and officials have responded to the pandemic in the mode of Adrian Monk. In Florida, one town gave a resident permission to spray the streets with hydrogen peroxide. At Equinox, the Whole Foods of gyms, employees clean facilities three times a day and once overnight using “medical-grade, EPA-registered disinfectants” and “next-generation electrostatic hand-held and backpack sprayers.” And in New York City, the subway system is shut down every night for four hours so train cars can be disinfected, a protocol that is expected to cost the Metropolitan Transportation Authority up to $500 million even as it faces insolvency.
Are these “deep cleaning” regimens a wise use of time and resources? Many scientists don’t think so: As Derek Thompson writes in The Atlantic, the coronavirus is spread primarily through the air; becoming infected from a surface — elevator buttons, packages, doorknobs, subway poles — seems quite rare, especially if people practice good hand-washing hygiene. “Covid-19 has reawakened America’s spirit of misdirected anxiety, inspiring businesses and families to obsess over risk-reduction rituals that make us feel safer but don’t actually do much to reduce risk — even as more dangerous activities are still allowed,” he writes. “This is hygiene theater.”
It could be much more productive, Zeynep Tufekci argues in The Atlantic, for business and government to train their attention on the air we breathe. In July, hundreds of scientists signed an open letter urging the WHO to acknowledge that the coronavirus is airborne, meaning that it may spread not only through large respiratory droplets that quickly fall to the floor but also through microscopic particles that hang in the air for long periods.
“If the signatories of the letter to the W.H.O. are correct,” Dr. Tufekci writes, “adding ventilation to our mitigation stack is exactly what we should focus on, doing everything necessary ranging from the more expensive upgrades to our air-quality infrastructure to opening the windows that are right within our reach.”
Six feet of distance? It’s more complicated than that
Since the beginning of the pandemic, keeping six feet away from people outside one’s household has been the quintessential rule of social distancing. But a paper published on Tuesday in The BMJ (formerly The British Medical Journal) argues that the six-foot rule is an oversimplification descended from 19th-century science. Instead of single, fixed distancing rules, the authors propose graded guidelines to better reflect the many factors that determine how dangerous a given setting might be.
What does that mean in practical terms? The general scientific consensus, according to Andrew Joseph, Helen Branswell and Elizabeth Cooney of Stat, is that indoors is riskier than outdoors, large groups are riskier than small groups and prolonged contact is riskier than brief contact. Loud talking, heavy breathing, singing and screaming also raise the risk of viral spread.
The authors of the BMJ study add that a fuller understanding of the slate of risk factors can equip people to better judge not only which situations call for greater precautions, but also which situations allow for greater freedom, potentially enabling a return to normalcy in some areas of social and economic life. As Julia Marcus, a Harvard epidemiologist, told Dr. Tufekci, “when people find lower-risk ways to enjoy their lives, that’s actually a public-health win.”
To lock down or not to lock down?
Five months ago, a debate was playing out among policymakers, public-health experts and pundits over which epidemiological strategy the United States ought to take: Should the country have sacrificed more lives to keep the economy running and to pursue herd immunity, as Sweden did, or should it have kept movement to a minimum to suppress the virus, as other European countries, China and New Zealand did?
Both approaches turned out to have had benefits, and in some cases tragic trade-offs: Sweden, which imposed only modest restrictions, has suffered more deaths per capita than Denmark but fewer than Britain, and it has experienced less economic hardship than either, according to JPMorgan Chase. The stabilization of daily case numbers in Sweden, New York City and Manaus, Brazil, has also prompted some scientists to speculate that the threshold for herd immunity might be significantly lower than previously thought.
But ultimately, the United States never fully leaned into either strategy. That resulted in “a complete disaster,” according to the Harvard epidemiologist Michael Mina: The American economy remains in dire straits, and the number of weekly deaths per capita in the United States is now more than 10 times that in Sweden. “We’re harming the economy, waffling back and forth between what is right, what is wrong with a slow drift of companies closing their doors for good,” Dr. Mina told Greg Ip of The Wall Street Journal.
Dr. Mina has been working with James Stock, a Harvard economist, to model ways of avoiding deaths while minimizing economic damage. “Our modeling strongly suggests that shutting down the economy is neither necessary nor desirable,” Dr. Stock told the Brookings Institution. “It just creates unemployment but doesn’t stop the deaths.” Moving forward, Dr. Stock and Dr. Mina argue the national focus should be on resuming activities with the highest ratio of economic benefit to epidemiological risk.
For example, reopening work places (with safety precautions, like required mask-wearing and ventilation) that can’t operate remotely might make sense, whereas reopening wedding venues and movie theaters might not.
Mr. Ip also points out that nursing homes account for 0.6 percent of the population but 45 percent of the coronavirus fatalities, many of which could have been prevented at little cost had more robust measures been taken to protect residents. At the other end of the age spectrum, safely reopening schools outside of hot spots could do a great deal to ease the economic and psychological strain on working parents and children without necessarily worsening the pandemic.
Many epidemiologists and economists have long argued that widespread, frequent testing is essential for such a hybrid approach, with every $10 spent on tests restoring $1,000 in economic activity, according to the Nobel laureate economist Paul Romer.
Taken together, the strategies we have for resolving the tensions between public and economic health in the coming months may not make for a lot of fun, Dr. Stock told Brookings. “These things are all inconvenient and not very enjoyable,” he said, “but it’s a small price to pay for allowing most people to get back on the job.”
The New York Times
