I had just finished reading Mario Loyola’s very sensible column on public versus private choices in dealing with the pandemic when I saw this story out of New York. New York took a body blow from COVID-19, and is still suffering losses, but the energy that has always characterized that great city is beginning to return, as New Yorkers make the private choices of which Loyola wrote.
It all reminded me of an axiom of pandemic response that, until the day before yesterday, public-health experts felt free to acknowledge without being considered heartless: that general quarantine or shutdown measures are at best a clumsy and inefficient tool with rapidly diminishing benefits and rapidly increasing costs.
I’ve spent a considerable part of the last 12 years warning the government about the importance of preparing for a global pandemic. As part of that work, I’ve often discussed with public-health authorities the various steps they could take to control a pandemic once it broke out. They have never been enthusiastic about the idea of quarantining or confining the general population, as opposed to those who are actually sick. In fact, they typically dismissed such measures as counterproductive.
There are a lot of reasons for that besides the economic deprivation that obviously accompanies any severe shock to the economy. For one thing, such measures disrupt the lives of the health-care workers on whom the system depends for medical management of the pandemic. For another, shutting down social interaction means shutting down large parts of the health-care system as well, and that means people can’t get the medical care necessary for their general health or to manage a chronic illness unrelated to the pandemic.
Another problem with extreme measures is that they divert the attention of authorities from focusing on the most urgent threats posed by the disease. Two months ago a pandemic expert — a longtime friend whom I respect greatly — told me that his biggest fear was that COVID-19 would get into nursing homes. That fear has been realized, in part because in many places inadequate steps were taken to protect that population. One of the reasons for that failure may have been that authorities were distracted by the difficulties of maintaining restrictions over the whole population.
It’s hard to focus on the really urgent aspects of pandemic response when, for example, government resources are being diverted to count the number of cars parked at a law office.
Finally, extreme social-distancing measures are very difficult to enforce even for a short time, and harder still to enforce after the visible need for them begins to disappear. Once the urgent necessity recedes, people start to circulate whether the government likes it or not, which then tends to create the worst of all worlds: The quarantine measures are not obeyed well enough to significantly reduce disease transmission, but their very presence continues to stifle the economy, cause social dysfunction, and reduce the credibility of the public authorities who try to enforce them.
That’s starting to happen now, and it is increasing public discontent across the spectrum. The more risk-positive part of the population is angry that the extreme measures are still in place, and the more risk-averse people are angry that the measures aren’t being enforced. There is a real and growing possibility that continuing the de jure shutdown will end up alienating just about everybody.
I want to be very clear that I am not saying the extreme measures were unwise. I supported them when they were taken, and I believe they produced many benefits; and even if we eventually conclude they were not necessary, or not necessary to the extent they were imposed, the leaders who imposed them made the best decisions they could in the fog of uncertainty that pandemics always produce.
What I am saying is that those measures belonged to the initial phase of pandemic response, which is, basically, over. The balance of risk has changed substantially over the last two months. The government now knows, to the extent we know anything about COVID-19, that a large part of the population is at extremely low risk and that many people have already had and recovered from the disease and therefore have a large measure of immunity going forward. It also knows that the danger that hospitals will be overwhelmed by severe cases, while still present, is much less than was feared in March.
The public knows all that too, and even in the hardest-hit places, is beginning to insist on returning to the normal pace of human activity. Trying to stop it would be like trying to stop a river from flowing. Going forward, the government should focus on empowering, informing, and encouraging the general public while assisting the high-risk demographics who remain isolated. That’s the best and most balanced strategy, and in reality the only viable strategy, for minimizing the total harm that the virus will cause over the life of the pandemic.