Officials in the U.S. have undermined hopes of a successful economic reopening because they’ve garbled public messaging, never clearly explaining why strict lockdowns were imposed in the first place. They’ve failed to communicate what the lockdowns are achieving for us, let alone what criteria should be used to lift them.
It’s intuitive to think there must be enormous benefits to something that’s crushing businesses and career dreams, creating long lines at food banks, disrupting education and imposing, for those cooped up alone or with abusive family members, a brutal psychological toll. And yet there was primarily one, relatively limited goal: Preventing transmission from spiking so sharply that hospitals overflow with patients. (As a secondary benefit, the disease should become less deadly over time as doctors improve their ability to treat it.)
Keeping people apart through voluntary social distancing or mandates to stay home can’t defeat the virus; it isn’t going away until a chunk of the population develops immunity. Once lockdowns are lifted, cases will spike here and there. That was always going to be true. But as long as hospitals don’t become overrun, lockdowns may have served their purpose.
The public messaging has been all wrong, says risk communication consultant Peter Sandman. Whether it’s on MSNBC or Fox, viewers are told that lockdowns should be lifted when “it’s safe.”
“That’s unachievable,” says Sandman, who is co-author, along with his collaborator and wife Jody Lanard, of a May 6 report on Covid-19 crisis communication for the Centers for Infections Disease Research and Policy (CIDRAP).
Sandman said many prescient things when I interviewed him about Covid-19 in early February. He had anticipated the behavior of the virus to spread around the globe, and the disruption it would cause. But he didn’t anticipate how badly political and public health leaders would bungle the situation.
“We were aghast” he says, referring to himself and others in the risk communication business, when the U.S. failed to organize testing and contact tracing early. Then leaders resorted to measures that were both draconian and impotent. There were lots of preparedness plans drawn up during previous pandemic scares, and none of them included mass lockdowns.
Preventing v. Postponing Death
The message to “flatten the curve” is catchy, but it may be wrongly implying that this pandemic will rise and fall with a single peak. Epidemiologists say it’s more likely the disease will either expand into a large second peak or rise in intermittent hills for several years. The whole idea of flattening the curve is to distribute the infections over a year (or more) rather than weeks or months. That can save lives by preventing anyone from dying for lack of hospital care.
It’s a nuanced message to get across, to be sure. “Not one in a hundred people understand the distinction between preventing a death and postponing a death,” says Sandman. When the Wuhan was locked down, he says, “We thought it was a horrible Chinese aberration.”
Part of the confusion may stem from the success in China, where the government appeared to “crush” the curve with decisive lockdown measures. There was a lot more going on than just lockdowns, however.
During those shutdowns, there was intense testing and contact tracing to quarantine those most likely to be infected. Infected people were made to go to special facilities, spending a couple of weeks away from family members, heeding evidence that the virus spreads mostly within households. By focusing on where the virus was most likely to be, rather than treating everyone as equally infectious, they were able to drive their infection rate way down.
No state or city in the U.S. has done anywhere near that level of testing, tracing or focused quarantining.
Still, some local lockdowns may have saved lives. They were clearly necessary in New York City, for example, where cases were exploding in March. Sandman says that shouldn’t have been necessary if the U.S. had used its weeks of warning time early in the year to set up testing and contact tracing there, and to prepare the hospitals.
“It was too late in New York but it wasn’t too late in South Dakota,” says Sandman, or in most other parts of the country where there was no evidence of an immediate explosion. That didn’t mean ignoring the problem in such other places. A lack of testing made it hard to rule out new spikes anywhere, but in Sandman’s view, most places would have been better off with voluntary social distancing, cancellation of big events, preparation of hospitals and nursing homes, and focused testing and contact tracing or even contact tracing alone, quarantining contacts of people with flulike symptoms.
Today, politicians in many areas are using these a falling number of infections as a barometer for reopening their economies, though statisticians consider these nearly meaningless. Leaders instinctively want to take credit for ameliorating the public’s suffering, but the deciding factor is now on their shoulders: Do they have a plan to test nursing home and health care workers regularly? Do they have a plan for contact tracing? Is there a way to monitor the virus through random sampling?
Sweden took a more sustainable approach — cancelling big gatherings but otherwise keeping the economy running while attempting to protect those most likely to get severely sick. There were no mandatory lockdowns. Sandman says that’s what he expected here. “Sweden only looks weird and extreme because the rest of the world did something weird and extreme.”
And yet Sweden does have a higher death rate than its neighbors, warns Harvard epidemiology professor Caroline Buckee. A slower spreading disease needs to infect fewer people to reach herd immunity, she says, provided certain assumptions about the length of immunity are correct. Buckee says people should wait to venture out until there are plans for dealing with future spikes, including testing and contact tracing and increasing hospital capacity.
Lockdowns were supposed to be a stopgap to let slow-moving officials get those plans in place, not a long-term solution. Epidemiologists tend to focus on what will save the most lives from a given disease at any cost, but Buckee admits that keeping everyone forced inside their homes until there’s a vaccine is not an option anyone is seriously considering.
Strict shutdown measures are good for protecting public officials from appearing responsible for any deaths. They also, to some degree, shift the blame for continued infections to the public — any increase in cases can be blamed on people’s failure to comply with rules so strict that even epidemiologists and health officials have been caught breaking them.
Those wanting to lift lockdowns aren’t necessarily denying the seriousness of the disease. Our safety can’t be bought by more suffering. At this point we’ve done our part, and public safety depends on what health authorities and politicians have done with the time we bought them. It’s now on them.
Photo: Empty street during lockdown. Bloomberg.
Copyright 2020 Bloomberg.