It can seem to public health officials that giving an inch means people will take a mile.
In the months since most U.S. states emerged from coronavirus lockdowns, wearing a mask has become a matter of politics more than safety, “pandemic parties” have been broken up in California, New York and Florida, and many states that forged ahead with reopening plans in May have been forced to pause or reverse the orders.
It’s in this fraught climate that public health experts are saying that if other less-extreme measures are not working or being ignored, another round of lockdowns — as politically unpopular as they may be — may be the only way to keep an already-dire situation from spiraling further out of control.
“We understand there’s no appetite for these extreme measures, but we’re on a collision course with destiny right now,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
Pockets of the U.S., like many parts of the world, first enacted stay-at-home orders in March. That helped several countries get their outbreaks under control — but not the U.S., which is now on track to surpass 170,000 deaths. New infections remain alarmingly high in several states.
While the March lockdowns worked initially to drive down infections, the restrictions were lifted too early in many states to keep those numbers down, and new outbreaks have quickly overwhelmed testing and contact tracing abilities. At this point, according to Osterholm, a new round of lockdowns could be the quickest and most effective way to contain the virus’ spread.
The number of new daily cases nationwide appears to be decreasing after hitting a peak of more than 60,000 in late July. But new hot spots are emerging in the Midwest, case counts are stubbornly high in California and much of the South, and coronavirus deaths — which tend to lag a couple of weeks behind spikes in cases — are creeping up in at least 15 states.
And with no sign of a summer lull, experts are warning that the U.S. is running out of time before the coronavirus pandemic collides with the flu season and wintertime, when any sort of outdoor, socially distanced activities will be far less appealing and far more difficult.
But widespread lockdowns have proven to be politically unpopular, largely because of how disruptive they are to local economies.
Dr. Mike Ryan, the World Health Organization's emergencies director, acknowledged the difficult balance between keeping countries and economies open while also stemming new infections.
“The trick is to really focus on and identify clusters of disease, identify any new community transmission and putting in place the kind of localized measures that can contain the virus,” he said Monday in a news briefing. “And try to avoid, if possible, having the sort of countrywide lockdowns that have done so much economic damage before.”
Yet, while stay-at-home orders can be economically painful, they may be the only practical option in places where other, less extreme public health measures are falling short or being ignored altogether.
Osterholm said that reducing infections to less than one new case per 100,000 people per day would make it more manageable to respond to periodic outbreaks and would keep testing and contact tracing measures from being overburdened.
“Right now, trying to do contact tracing with these numbers is like trying to plant petunias in a Category 5 hurricane,” he said.
Ideally, states wouldn’t need full lockdowns and could instead find a middle ground with robust masking policies, social distancing guidelines and bans on indoor gatherings, said Dr. Steven Goodman, a professor of epidemiology and medicine at Stanford University. But, the success of these strategies has varied widely between states.
“We’re having trouble, as a society, finding that middle ground because there’s so much politicization around basic safety measures,” Goodman said. “If we don’t have a comprehensive testing strategy, good contact tracing and all these other means of controlling the virus, then we have to take more extreme, crude and blunt measures.”
All but five states in the U.S. issued some form of stay-at-home order from March to May, but Osterholm said these measures were either not adequately stringent, or were not in place long enough, to drive cases down to a more controllable level. In contrast, countries such as Italy and New Zealand that enacted countrywide lockdowns in the spring have since been able to reopen and have been effective so far at managing local outbreaks when they happen.
“What we did was a slowdown,” Osterholm said. “We went from 100 miles per hour to 60 miles per hour, and then weren’t able to manage the corner ahead of us. What other countries in Europe and Asia did was slow way down to 10 miles per hour and so they were able to manage that corner safely.”
Now, when new outbreaks emerge in those countries, it’s similar to fighting a few hot spots after a forest fire is already under control. What’s happening in the U.S. is instead more akin to battling a massive, raging blaze with a single hose.
The debate over lockdown strategies could also take on new urgency as summer winds down. Both Osterholm and Goodman predict that cases will rise again in the fall, when some schools and colleges across the country resume in-person classes. Certain public health measures will also be more complicated in the winter when temperatures drop.
“We have a window now that is rapidly closing where we could do something,” Goodman said. “In a few weeks, kids may go back to school in some places, the flu season will hit and people will no longer be able to be outside. Once that happens, then all our control measures change dramatically.”
Yet, even if new lockdowns are enacted in some regions of the country, they shouldn’t be seen as a panacea. While strict stay-at-home orders can dramatically reduce the number of new infections, states need to meticulously plan for what to do after restrictions are lifted — something that was not handled as well following the March lockdowns, according to Justin Lessler, an associate professor of infectious disease epidemiology at Johns Hopkins University’s Bloomberg School of Public Health.
“Those of us in the epidemiological community have been saying that lockdowns aren’t a permanent solution — they’re about buying time,” Lessler said. “The problem with the U.S. response has been that it lacks a clear, long-term plan beyond hoping for a vaccine.”