Are We Finally Turning the Corner?

T here’s some good news on the coronavirus front. We’re not out of the woods, but maybe we’re no longer headed deeper in.

The CDC’s director says we’re “nearing the peak.” Daily death counts, after climbing for some time, seem to have leveled off at around 2,000, though these data are often revised as more deaths are reported. The much-watched University of Washington model says we’re a few days past the peaks of deaths and hospital usage. Estimates of the virus’s “reproductive number” in the U.S. (from the London School of Hygiene & Tropical Medicine) are headed toward one, the magical threshold beneath which the problem starts to decline rather than spreading further.

Nothing much can change immediately, because holding steady isn’t great: It’s a sign that the severe measures we’ve put into effect are controlling the virus, not beating it. In the coming week or two, though, we’ll hopefully see deaths decline and the reproductive number go below one. And that means it’s time to start thinking of the next steps.

That situation will put us at a crossroads. There’s a lot of uncertainty about how many COVID-19 cases are asymptomatic and never detected, but with only 550,000 or so known cases in a population of 330 million, we can be pretty confident that a very low percentage of the country has survived the virus and gained some immunity. This means that if we simply go back to life as it was before, the virus will start spreading again.

But at the same time, the calculus changes. The longer we try to force the country to stay cooped up, the more damage we do to the economy, the more resistance the lockdowns will provoke, and the worse the cost-benefit calculations will start to look. And subsequent waves of the epidemic might be weaker than the first one, both because some share of the population will probably be immune and because immunity will be concentrated among the people with the most social contacts.

My admittedly subjective guess is that mass lockdowns can last at most about month longer, until mid May. If cases and deaths indeed start to decline rapidly, Americans are not going to stay home unemployed while the hospitals are empty and medical staff are furloughed for lack of work. We have to start opening up soon, and we have to do it intelligently. There are numerous plans to do so — Ezra Klein has a good rundown over at Vox — but they all rely on a fairly straightforward selection of tools. My view is that we should aggressively pursue all of them at once, both federally and at the state level, until it’s clear which are delivering the most bang for the buck:

1. Open selectively, and use additional lockdowns only as a last resort. This one is pretty obvious. If a given area hasn’t gotten its problem under control, it can’t reopen, and highly vulnerable individuals should still stay home when an area first reopens. Scott Gottlieb suggests that a decline in case loads for 14 days, plus adequate hospital capacity, are a practical threshold. On the other side of things, areas that have hardly been affected should be freed up as quickly as possible. And of course, if reopening leads to a fresh explosion of death, new lockdowns in the affected areas might be the only option.
2. Test, test, test. There are many things we can do with tests besides just checking people who are showing symptoms of the disease or who came into contact with known cases. We can conduct surveillance throughout the country to see where new outbreaks are popping up. We can test people and clear them to work if they’re okay. Etc. But we can’t do any of this well without a lot more tests than we have right now. There are reasons that testing capacity has been slow to build up, but frankly, screw that: We’re the United States of America, dammit, and we excel at making stuff. Let’s ramp up capacity as quickly as possible, make the needed investments, and dangle huge incentives in front of everyone who is able to help. Don’t take no for an answer. Depending on where we end up, we might be able to pursue any number of testing-based strategies.
3. Creepy phone apps. Everyone hates (but not enough to turn off our cellphones) the fact that Google and Apple track our every movement. But the tech giants are teaming up to put those capabilities to good use. Phone apps could keep track of which users come in contact with one another, and when someone reports an infection, the app could notify everyone they’ve been near. Mandating the use of this technology should be out of the question, except perhaps for known cases, but at the same time these apps should be strongly encouraged once they come online. The more we can focus testing and quarantines on people who are actually at risk, the less we have to rely on indiscriminately placing everyone in the country under house arrest.
4. Keep your breath to yourself. Seriously: If you’re going to public places where you’ll repeatedly walk within six feet of other people, cover your face, period. You don’t need a fancy mask to do that. A dish towel, bandana, scarf, or other piece of clothing will do wonders by itself. (The higher the thread count, the better.) Businesses, including nonessential ones when they reopen, should — among other steps to stop the virus from spreading in the workplace — require employees as well as customers to stop openly breathing all over one another.
5. Push for treatments and eventually a vaccine. There’s a lot of work ongoing here, and none of it has come together as quickly as one might hope. But if we can treat severe cases, the risks of opening up will be a lot lower, and the sooner we get a vaccine, the better (though that will probably be in a year or two).

I don’t know about you all, but I’m getting impatient locked up with three kids under the age of six, and I don’t want the virus to start spreading again and force us back to Square 1, either. It’s time to unleash American ingenuity on all fronts at once.