America's COVID-19 death toll surpassed 250,000 this week, and multiple states hit new records for daily cases, deaths, and hospitalizations. In the Midwest, especially, health-care settings are facing staff and hospital-bed shortages due to an overwhelming influx of coronavirus patients. Experts warn that unless something changes, the situation will only worsen as we head into the winter months. Yet few states appear willing to return to strict lockdowns for fear of tanking their already flagging economies. Instead, we're seeing a patchwork of varying rules across the nation: curfews here, school closures there, mask mandates in most places. Will these measures be enough to control this deadly third wave, or is more drastic action needed?
This week's question is: Should America lock down again?
After the first COVID-19 lockdowns this past spring, bulk data from GPS in Americans' phones showed a curious thing: People began staying home before it was required. In fact, most lockdowns began at or even slightly after the peak of self-imposed travel restrictions.
I'm reminded of that data as the pandemic surges again. If America locks down anew, I anticipate it will accomplish relatively little for public health.
The most important reason, as we saw in the spring, is that when it comes to personal behavior, most people have long since determined what they reasonably can and should do to mitigate the pandemic — or not. Anyone who rejected masks despite the abundance of evidence for their value probably won't reverse themselves so many months in. Likewise those visiting crowded bars or large weddings. The only way a lockdown will change their behavior is if they believe they may get caught and punished.
And speaking of getting caught, many recent orders that might presage locking down (let alone the incoming lockdowns proper) are unenforceable absent truly and unacceptably draconian measures. How do you enforce New York's ban on gatherings of more than 10 people in a private home? Or Pennsylvania's in-home mask mandate whenever someone from outside the household is present? Most enforcement will look more like a response to a noise complaint than jackbooted thugs going house to house on Thanksgiving. That's good, but it also renders these rules functionally null.
Then there's the sheer weariness we all feel in the face of a still-indefinite timeline for this miserable saga's conclusion. And the distrust many officials and public health experts have provoked with hypocrisy personal and/or political. And the reality that many of the new rules just don't make sense. Americans are tired, angry, confused, or all three. Those not already taking whatever precautions are possible for their circumstances likely won't start now.
Honestly, before the Bay Area re-closed indoor dining a few days ago, I'd walk by a restaurant and see someone sitting inside eating — a burrito, wagyu beef, a bowl of bucatini— and wonder: Why? Take it home. Stay home.
A new study out of Stanford was as clear as the crystal glassware at San Francisco's three-Michelin-starred Quince (which spent the summer on a farm and will be wintering on a heated wine country patio): Eating indoors with others poses a grave danger, about four times that of, say, biking indoors with others. Outdoor dining is increasingly unappetizing, too. Portland, Oregon recently took a pause, mandating take-out only. And rumor has it, even sunny Los Angeles — if daily cases surpass 4,000 — may soon follow suit. In the meantime, most elsewhere: If you really must go out for a squash blossom pizza, bring a blanket. Better yet: Buy one from the restaurant in a warm show of support. Like Brooklyn's The Four Horsemen, everyone is bound to be hawking them this season.
True to her bartender roots, Rep. Alexandria Ocasio-Cortez tweeted on Thursday: "To get the virus under control, we need to pay people to stay home." At the very least, pay restaurants. Pass the Restaurants Act, which would offer $120 billion in grants to independent restaurants (and chains with fewer than 20 locations, but it's the small, neighborhood places that nourish both our souls and our cities we should care most about) and help them hang on through winter.
Now that a vaccination is on the horizon, the temptation to put people under lock and key until they can safely come out is understandable. But given that we are still many months, even a year, away from actually vaccinating everyone, lockdowns would be too economically devastating to be the answer.
The fact is, lockdowns or not, most people are already modifying their behavior — foregoing get-togethers, minimizing optional outdoors activities, and generally staying at home. This in itself will lead to economic retrenchment as restaurants once again shut, air travel dries up, and people minimize optional activities that require contact with others. According to a study conducted during the summer lockdowns and co-authored by University of Chicago professor and former Obama economics adviser Austan Goolsbee, government restrictions account for just 12 percent of the decline in consumer mobility in the U.S. This suggests that lockdowns are typically fighting the last war after people have already modified their behaviors to protect themselves and public health.
So what's the economic harm in lockdowns? By banning "nonessential activities" (an arbitrary category), lockdowns prolong the economic pain by removing the flexibility for businesses to innovate to restore consumer confidence. Businesses whose very existence requires jamming people in small spaces — like discos and nightclubs — aren't coming back anytime soon. But restaurants that can build outdoor dining spaces could still survive safely if handed the flexibility to do so.
Lockdowns are a blunt instrument that have to be used very, very sparingly.
Lockdowns work. But they have to be done rigorously and — in the absence of heavy policing — with the willingness of the population. New Zealand, for example, has proven that a nation can band together and stamp out an outbreak.
In regions that use lockdowns to "crush and contain" outbreaks (rather than just flattening the curve to prevent hospitals exceeding capacity), avoiding subsequent lockdowns actually becomes safely achievable. A magnificent demonstration of this appeared this week in The New England Journal of Medicine; a report from Qingdao, China, which had zero cases for weeks, describes how three cases were detected via ongoing surveillance. Authorities threw up 4,090 test sites, conducting over 10 million tests in just a few days. Twelve cases were found in total. The patients were strictly isolated and contact tracing was comprehensive. The city never locked down. Everyone could move freely once a negative test was obtained, as long as masks were in use.
If America locked down again, correctly this time, and had the testing capacity in place, we too could pull off what Qingdao just managed to achieve. The problem is that few seem willing to hunker down for a few weeks in exchange for safety and freedom for a few months. For me, the real question is: Why don't people want lockdowns? If Americans truly understood the danger COVID-19 poses, I believe they would not merely accept lockdown, they'd demand it.
"Prescribing" a lockdown, even if it were to work in theory, would be pointless now because there would be outcry and opposition among a large enough segment of the population so as to render the endeavor futile. After all, medicine only works when you take it.
There is now solid evidence that at least one coronavirus vaccine will be ready for deployment within months, and likely several of them. This means that every infection avoided between now and the time when people can get vaccinated will be avoided permanently.
If we had any sense, America would have locked itself down two months ago. Prior experience in China and now Europe for the second time shows that once the epidemic is this out of control, lockdowns are the only way to slow the spread enough that it can be controlled with more fine-grained measures.
Alas, there is little chance that the federal government is going to do what would be necessary to maintain a full shutdown. Many businesses would need support to keep from going out of business, while workers at those businesses would need help as well, either through boosted unemployment or paying their employer to keep them on staff.
That said, even a partial, semi-voluntary lockdown could achieve a lot. A recent paper demonstrated that a large percentage of infections are coming from indoor superspreader events at restaurants, bars, churches, and so on. Further evidence suggests that many more infections are coming from private indoor gatherings where people are sloppy about precautions or expanding their social circle. If states and cities simply shut down indoor dining and church services (as Philadelphia recently did), people stop doing in-person socializing outside of their direct household, and wear masks whenever they are out in public, we could at least slow the rate of infection.
I know as well as anyone that it's exhausting. But there really is light at the end of the tunnel now. Endure another month of quarantine, and the life you save might be your own.