The Next Phase

A mother puts a scrunchie in the hair of her daughter while eating at Bad Daddy’s Burger Bar on the day restaurants and theaters reopened after facing coronavirus restrictions, Smyrna, Ga., April 27, 2020. (Elijah Nouvelage/Reuters)

Parts of the country are starting to reopen, and it’s a good thing.

We took radical measures at the outset of the epidemic to keep the virus from spreading out of control, and indications are that the number of new cases per day has plateaued nationally. Meanwhile, the country’s hardest-hit area, New York City, appears to be through the worst of it. And the nightmare scenario that the lockdowns were meant to avoid, the overwhelming of hospitals in hot spots, has indeed been averted.

The debate over the wisdom of the lockdowns will continue for a very long time. There is still much we don’t know about the disease, including the true death rate. But it is unquestionably more virulent than the seasonal flu. We have had 60,000 fatalities, the same as a bad flu season, in a little more than a month, and that’s with much of the country locked down. Studies of excess deaths in Western counties have established that the fatalities aren’t merely a matter of how COVID-19 deaths have been counted. There have indeed been alarming spikes in mortality — in New York City, deaths might be six times higher than the normal level.

If New York is the epicenter for the disease in the U.S., COVID-19 is not exclusively a New York–area phenomenon. Yes, New York, New Jersey, and Connecticut account for almost half of the country’s roughly 60,000 deaths. But Massachusetts, Louisiana, and Michigan all have per capita deaths on par with European countries such as France and the U.K. As outbreaks in meatpacking plants in the Midwest have shown, the virus easily spreads wherever there are large gatherings of people in close proximity.

That said, it is increasingly clear that the virus particularly thrives in dense urban settings and may even be more deadly there. The infirm are especially vulnerable to the disease, which is why nursing homes, with large groups of infirm people living together, have been so hard hit. A Kaiser Family Foundation report finds that at least 10,378 residents and staff of “long-term care facilities” have died from COVID-19 since the epidemic began. That report counts data from only 23 states, so the true figure is surely far higher.

All of this suggests that, even in this period of severe lockdowns, we were much too late in closing New York and have been too careless with nursing homes. Going forward, homes that seek to transfer infected residents to area hospitals shouldn’t be declined; in New York, they have been. Health and safety regulations shouldn’t be treated as aspirations; Maryland and Florida are admirably stepping up enforcement.

On the other side of the ledger, the lockdowns have been too geographically sweeping. Not only are the states of our union vastly different, so are areas within states. There is no reason for rural areas of New York and Michigan, where many counties have a couple of dozen cases or fewer, to be subject to the same restrictions as New York City and Detroit. Likewise, statewide prohibitions on elective surgeries have, perversely, emptied hospital beds and idled medical workers in places that have had no COVID-19 surge. (The iconic Mayo Clinic has furloughed 30,000 staff members.) These procedures, often for serious illnesses such as cancer, need to resume.

Overall, it’s impossible to exaggerate the economic cost of the lockdowns, which have brought on a steep recession that we will probably spend years digging out of. This is why impatience to reopen is an entirely understandable sentiment, even if it is treated by much of the media as heretical. A balance obviously has to be struck. Much economic activity disappeared when people decided, on their own, to change their habits in response to the epidemic. Consumers won’t come back in full force until they believe the pathogen is under control. But we can’t stay locked down until the virus is entirely vanquished, or we will have destroyed the country to save it.

Fortunately, we have a federal system that allows considerable leeway for states to chart their own policy paths. Texas, Ohio, and Colorado, for example, are all beginning to reopen in stages. We will be able to see what works best. Perhaps Georgia is reopening too fast, too soon. (President Trump, who has blown hot and cold on reopening, rebuked its governor, Brian Kemp.) We will find out. Testing, contact tracing, masks, and prudent distancing all have a role to play in the new normal, but the near-total cessation of economic life in swathes of the country isn’t sustainable.

The best option remains developing a vaccine or therapies, which would allow us to innovate our way out of the public-health crisis. Even in the best-case scenario, though, we won’t have a vaccine before the end of the year. Of potential coronavirus drugs, Gilead Sciences’ remdesivir is the farthest along. A randomized controlled trial of remdesivir conducted by the National Institutes of Health reportedly showed positive results, but the World Health Organization has issued a conflicting report. Until randomized, controlled trials are completed and definitive research is published, we won’t know for sure which treatments work, if any. In the meantime, health officials should coordinate with the private sector to build manufacturing and distribution capacity in case an effective drug does emerge.

This has been a time of great testing for the country, and it is far from over. But we should welcome the resumption of everyday economic life in the places where it’s happening, and hope we can replicate it elsewhere as soon as possible.


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