NRPLUS MEMBER ARTICLE A common refrain in some circles is that many of the preventive measures taken against the coronavirus are doing more damage than the disease itself.
I confess that I’ve wondered about this, too. A New York Times article said that hundreds of millions of people could die in developing countries as a result of “national lockdowns and social distancing measures [that] are drying up work and incomes, and are likely to disrupt agricultural production and supply routes.” Oxford University has warned of an increased number of suicides as a result of the economic fallout, a Reuters article alerted readers to the toll lockdowns have taken on mental health, Time magazine cited a recent spike in domestic-abuse cases, the BBC has warned that countless people are likely to die as a result of skipping out on medical screenings and vaccinations, and Unicef said plainly that the risk of children in developing countries dying from diseases other than COVID-19 now “far outweighs any threat presented by the coronavirus.”
As concerning as all these unintended consequences certainly are, they don’t tell the whole story. “That’s one difficulty of preventive medicine,” Dr. Eduardo Franco of McGill University and its Cancer Epidemiology Unit told me. “You can always interview someone who was presumably harmed” by preventive measures — such as getting vaccinated against a deadly disease — “but you can never interview someone whose disease was averted or life spared” by preventive measures that protected them from an attack in the first place.
We have some idea in this case. Recent studies in the journal Nature concluded that the lockdowns that so much of the world endured in March and April “prevented tens of millions of infections and saved millions of lives.”
Dr. William Hanage, a professor of epidemiology at Harvard University’s School of Public Health, told me that the mistake is pretending that we have a choice in the matter. “We must change the conversation from being a binary choice between a shutdown or no shutdown” to instead accepting the changes that we all must make to “prevent the worst outcomes of the pandemic.” Otherwise, he said, it’s like seeing a “freight train trying to run you down and failing to move out of the way.” Hanage told me he feels the hairs rise on the back of his neck every time he hears someone call for “reopening the economy,” because he “hears within that a desperate wish to return to normal.”
Hanage’s advice is to accept a new normal in which masks and social-distancing measures remain in place everywhere and some businesses remain closed in the cities where infections are rising. (He strongly favors compensating companies that are forced to close temporarily in the face of the pandemic.) Returning to any other kind of normal, Hanage warned, “means a resurgence of the virus” — a reality that has already come to pass as new infections have exploded when states began reopening.
Dr. William Schaffner, a professor of preventive medicine and infectious disease at Vanderbilt University, told me that reopening the economy when we did wasn’t necessarily the problem. The rise in cases came because “we opened carelessly, not carefully,” Schaffner said, adding: “You won’t find three people in my community who favor another stay-at-home lockdown.” But the only way to keep that from occurring is if we take mask-wearing and social-distancing measures seriously: “If we can manage social distancing appropriately, we can do this.”
Franco agreed that “many adults can return to some measure of normalcy provided that social distancing and safety measures are in place, including modified work environments.” Each expert stressed the importance of everyone wearing face coverings in public. “People who claim they want to exercise their right not to wear a mask,” Schaffner pointed out, “are not very different than people who want to exercise their right to run a red light. Problem is, theirs isn’t the only car in the intersection.”
“Think of where we are now like a budget,” Hanage suggested. “If the goal is to avoid another shutdown, that means allowing a certain amount of transmission and deciding where you’re going to allow that transmission to take place and where you cannot.” If we budget poorly, Hanage warned, then another shutdown is unavoidable. “Shutdowns become necessary when health care becomes inundated and is unable to function.”
What’s more, Hanage pointed out to me that many of the unintended consequences linked to preventive measures would probably still have occurred if no such measures had been taken — and might even have been worse. Citing interruptions that have occurred in vaccination programs in developing countries during lockdowns, Hanage stressed that “if the people administering the vaccinations become sick from COVID-19, you cannot keep the program going then either.” The same is true for essential workers in charge of supply chains that are preventing millions of people from starving to death.
Also worth considering are some of the unintended health benefits that have come from preventive measures taken thus far. Each expert cited different examples of benefits they’ve witnessed, including decreased gun violence, a reduction in other communicable diseases, many fewer car accidents, and the long-term health benefits of cleaner air and slowing down overstuffed lifestyles — to say nothing of the numerous studies that show benefits that preventive measures have had on the environment.
And yet, each expert agreed that a more measured approach is appropriate moving forward. “I can say unhesitatingly that the cure will never be worse than the disease,” Schaffner told me plainly, adding, “but we always need to be mindful of the adverse consequences. Our response to the virus is very much the way any doctor prescribes medication — you adjust the dose as needed. We are currently adjusting the dose of the lockdown intervention.” Franco called it a “balance of harms and benefits” in which the experts have “so far been busy measuring the effects of the virus itself, but the same experts are slowly shifting to a more eclectic view of what the consequences [of the shutdowns] are as well.” Hanage stressed that the preventive measures we have taken are “not something we are doing to ourselves; it’s something the virus is doing to us. It’s a horrible situation, and there is no way out that doesn’t come with some major consequences, no matter what you do.”
Another point every expert agreed on was the need for clear leadership. “In order for us to move forward, we need to think of our response to the pandemic as if we’re all playing different instruments in the same orchestra,” Schaffner told me. “For an orchestra to perform as they should, they need just one conductor. America’s conductor needs to be the Centers for Disease Control.”
“If there’s one thing I wish I could convey to our leaders,” Hanage said, “it would be for them to practice a little more humility in the face of nature. This virus is a part of nature, and nature cannot be fooled. The only question that matters is what’s an effective way of dealing with it. We cannot wish this thing away.”