Magazine May 4, 2020, Issue

Coronavirus Lockdowns: Going the Distance

A healthcare worker outside of Maimonides Medical Center during the coronavirus outbreak, Brooklyn, N.Y., April 13, 2020 (Andrew Kelly/Reuters)
The restrictions were necessary, and they still are

It is reasonable to wonder whether we have been overreacting to the pandemic. The basic rationale for social distancing — reducing the rate at which people come into contact, to arrest the spread of the coronavirus contagion — is easy to explain. But the inconstant and sometimes dishonest advice from experts, and the fuzziness of the models that seem to be influencing government decisions, has eroded confidence in the wisdom of current policies. Following the recommendations of public-health authorities, Americans have made huge sacrifices for an indefinite period of time. While a majority agrees that the current measures are necessary, there is understandable impatience. That impatience has fed demand for heterodox theories that would permit a rapid reopening of the economy.

It is true that shutting down the economy is a bad strategy. But given the alternatives, it was the least bad strategy available at the time it was implemented. In many places, and especially in New York City, it was adopted later than it should have been. The premature abandonment of that strategy could be catastrophic — not least in its economic effects.

The debate over shutdowns has been bogged down by some conceptual errors. On April 8, the Institute for Health Metrics and Evaluation model used by the White House revised its average projection of the death toll in the U.S. down to approximately 60,000. Opponents of shutdowns asked: If the death toll of this virus turns out to be that of a bad flu season, will draconian measures really have been justified? But comparing the costs of shutdowns with the toll the virus has taken on public health is fallacious, since the shutdowns are extremely likely to have reduced that toll substantially. When considering marginal costs, it is the cost per death averted that matters. And unlike the case with flu, there is no vaccine for COVID-19, which, the evidence suggests, is more of a burden for hospitals and more likely to inflict serious harm or death. The experiences of New York and northern Italy show that COVID-19 can overwhelm medical systems in a way the flu does not.

The debate has also foundered on questions about whether it is morally acceptable to trade lives for dollars, and about the details of cost–benefit analyses. These analyses often go awry. Excluding serious but nonfatal health effects from the calculation biases us toward greater complacency about the pandemic. Excluding lost option rights, on the other hand, biases us toward complacency about the costs of lockdown.

It is also important to remember that social distancing was adopted in a decentralized fashion. Before governors ordered residents to stay home, many school districts had already closed down, restaurant patronage had plummeted, and major sports leagues had postponed their seasons. Air traffic, though allowed as an essential service, has collapsed. A working paper from the National Bureau of Economic Research suggests that the economy began contracting before the first shelter-in-place order was issued. It follows that neither the economic costs of social distancing nor its health benefits can all be attributed to government orders. It follows as well that the public-health problem itself, not just the reaction to it, is an economic problem.

Which is the main practical objection to easing the shutdown to help the economy: The much-debated tradeoff does not always exist. A public-health crisis entails economic costs. (There are also, of course, public-health costs to the economic crisis, such as the increased risk of suicides. But research tends to find, perhaps counterintuitively, that mortality is pro-cyclical: that it rises and falls with the economy.)

By mid March, when the first stay-at-home orders were issued and the White House adopted its “slow the spread” message, few alternatives were available for us other than widespread social distancing. This is in no small part the fault of the Chinese government, which in December suppressed information on the virus, and of the obedient World Health Organization, which ignored a December 31 query from Taiwan about human-to-human transmission and publicized Chinese denials of its occurrence. Only on January 20 did a government scientist admit that the virus could spread in that way; only on January 23 did it lock down Wuhan. Had Chinese authorities intervened three weeks earlier, a University of Southampton study finds, cases in the country would have been reduced by 95 percent — and so it might well not have become a global threat.

The U.S. made mistakes that foreclosed alternatives, too, the anemic production and rollout of tests chief among them. A defect in CDC test kits slowed their manufacture and rendered many of them unusable while FDA regulations prevented private actors from offsetting the shortfall. By the time outbreaks began in March, there were far too few tests for the “test and trace” strategy that some East Asian countries have successfully implemented to be feasible here. There is plenty of blame to go around for this embarrassing failure of American state capacity.

The Trump administration has received some of that blame. Yet some criticisms of it don’t withstand scrutiny. It is a myth that the National Security Council directorate responsible for handling pandemics was eliminated: It was folded into a new directorate that oversaw biodefense, global health, and arms control, as part of an ordinary reorganization of the NSC, and the New York Times reports that it was gathering intelligence on the virus by early January. It is also a myth that the CDC’s funding was cut: Congress increased it.

Other criticisms President Trump has earned. From the beginning of the outbreak to well after the culminating point, he was more focused on denying the threat of the virus than on countering it. His insistence through much of February that the virus would magically disappear almost certainly discouraged some people from social distancing, undermining the strategy he eventually implemented. His January 31 decision to restrict travel from China has not been as helpful as advertised, both because of loopholes and because any time it bought was squandered by his denial. His capriciousness may have contributed to the coordination problems in the administration. It is difficult to say precisely how much of a difference he has made — any president would have made mistakes in responding to such an unusual danger — but it is clear that the difference has been negative.

In any case, we were left with little besides the strategy that our society eventually adopted. The common suggestion that we simply isolate the elderly and immunocompromised while encouraging younger low-risk people to behave normally in hopes they will develop herd immunity falls apart under scrutiny. As columnist Megan McArdle points out, millions of young Americans live in multigenerational households and millions of older people depend on help from younger ones. These considerations may explain why the U.K., which briefly considered this strategy, quickly abandoned it. The Chinese alternative of dystopian surveillance and domestic-travel restrictions, meanwhile, could not have been implemented in the U.S. even if we had desired it. Sweden has not imposed quarantines, but even its government is ratcheting up restrictions as the growth of cases and deaths continues to outpace that in its Scandinavian neighbors.

Our response has involved underreaction and overreaction. The virus won’t simply “go away,” but park closures may not have been necessary, and banning drive-in church services certainly wasn’t. In broad outline, however, from late February onward our society has made the right call, given the situation we found ourselves in.

The question on everyone’s mind is when we can ease, or outright end, the restrictions. A premature reopening would have substantial costs. It could lead to more outbreaks, forcing us to impose longer additional lockdowns, and therefore even more economic pain, than otherwise necessary. The tail risks of jumping the gun are sobering: Runaway infections among public officials could jeopardize law enforcement and the maintenance of necessary infrastructure. And the benefits are uncertain, as there are several obstacles to a “V-shaped” economic recovery besides domestic restrictions. Consumers, fearful of future outbreaks, won’t be as confident as they were during the cyclical peak. Falling global demand is a headwind that won’t abate simply because the U.S. decides restaurants can reopen. Notwithstanding its comparatively lax response, Sweden projects that its GDP will contract by 3.4 percent this year.

All of this means that reopening should be the goal of our next steps, not the next step itself. The best attempt to set forth the conditions under which we can reopen and to think through the contingencies of reopening was made by former FDA commissioner Scott Gottlieb and other experts, in a paper released by the American Enterprise Institute (where one of us is a fellow). Social distancing can be relaxed, they conclude, if there is a sustained, two-week-plus decline in cases, hospitals are prepared to deal with future outbreaks, and the capacity exists to rapidly test everyone on demand.

As social-distancing measures are relaxed, the chance of new outbreaks rises. Officials will need to learn as much as possible about the virus to prevent these outbreaks from overwhelming hospitals. In the absence of on-demand testing — which, as Gottlieb noted recently, remains an aspiration — data from serology tests can provide information on the rates of exposure and immunity in a given area. Such tests will also yield more data about the share of cases that are asymptomatic and have gone undetected, allowing researchers to make inferences about the virus’s infectiousness and severity. Answers to these and other questions (how do climate, air quality, and population density affect its spread?) have been frustratingly elusive. Regional disparities in the severity of outbreaks mean that the transition from widespread social distancing should happen at different times in different places.

Containing future outbreaks without lapsing back into mass closures will require people who have come into contact with positive cases to self-isolate. As Brent Skorup points out in a Mercatus Center report, the use of anonymized, aggregated cellphone data to distinguish between high- and low-risk areas could be useful to public-health authorities. More-granular information would be more useful, but at a greater risk to privacy. Apple and Google are collaborating on a program to trace the physical contacts of participants. Exceptions should be granted to any possible antitrust rules implicated by the partnership, but the privacy issues it raises are serious.

Production, privacy, and coordination issues would hinder the implementation of a test-and-trace strategy such as Gottlieb’s. Even if it is successfully implemented, it will not forestall all future outbreaks of the virus, as South Korea and Singapore are currently discovering. States and cities may need to shift back and forth between limited openings and mass closures in the coming months. Of course, that possibility creates tremendous uncertainty, which the government should mitigate by providing reliable backstops for businesses and workers. Senator Josh Hawley (R., Mo.) has a plan to issue tax rebates to businesses to cover a substantial portion of payroll. The proposal deserves serious consideration. Another round of direct cash transfers to individuals might also prevent hardship while indirectly aiding those businesses that can resume operations. Given that the government is crushing economic activity in the first place, its intervention is justified in a way it wouldn’t be in ordinary times. There is no moral hazard during a pandemic.

All of these, Gottlieb says, will be temporary measures. Innovations in the drug industry — therapeutic treatments and, hopefully, a vaccine — are the permanent way out. Therapeutics can help alleviate the burden on hospitals, and there are several different treatments, from antiviral drugs to old-fashioned plasma therapy, undergoing study. Not all of these will work, and not all are scalable. Every effort should be made to discover whether a drug is effective. But lifting social-distancing restrictions on the untested assumption that a drug will work, only to find after further testing that it doesn’t work or has unacceptable side effects, would be an entirely avoidable mistake. A vaccine, of course, would spell the end of the pandemic, but candidates will not become available for several months. Here too there is likely to be pressure to rush promising candidates, but speed and efficacy need not be at odds.

Our country has enormous strengths in dealing with the challenge of the coronavirus, but it is one that poses distinctive difficulties for us. We are an individualistic, government-skeptical country that doesn’t meekly obey expert edicts. Those instincts often serve us well but cannot all the time. We have to figure out a way to get out of this situation, rather than trying to wish it away.

This article appears as “Going the Distance” in the May 4, 2020, print edition of National Review.

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