April 21, 2020

Is It Time to Return to “Normal”?

The president is eager to “open up” the economy, and governors—not all of them Republican—are beginning to relax regulations designed to prevent the spread of the coronavirus. Plans to return much of society to “normal” are being made recklessly, without first satisfying the prerequisites either of the World Health Organization or even of the looser requirements articulated by President Trump himself.

I suspect that the president is engaged in his usual magical thinking. Sheltering at home was an extreme measure designed to eliminate coronavirus infections. Now that we’ve largely done that, we can resume life in relative safety. Sick people have been taken to hospitals, from which they will emerge either cured or dead. People resuming their normal lives will have little occasion to encounter foreign carriers—international travel is virtually shut down—and will intuitively avoid the conspicuously ill. What could go wrong?

Well, a lot could go wrong.

We need to think about where infections are coming from. Many hospital workers or workers in nursing homes and similar facilities are being infected by their patients or clients. But infection is an occupational hazard affecting a small segment of the population.

Where are other infections coming from? Who knows? People are developing COVID-19 in states with shelter-at-home orders and in places without such orders. Meatpacking plants are significant sources of virus outbreaks now, and plant workers will infect family members and members of the public at large.

In this country, we have been obsessed with testing those who are sick. If people are sick enough, however, they don’t need a coronavirus test to tell them to go to the hospital. (Hospitals, on the other hand, do need to know who is infected in order to discourage the spread of the virus.) If people are only moderately sick, it is to be hoped that they will, as fas as possible, self-isolate. China took the isolation of such people seriously, even from their families. Sadly, we have not done that.

Problematic are infected and infectious people who are asymptomatic. These people may be sheltering in place in states like my own or walking about in states that have eschewed systematic isolation. They are the people who will create the next wave of COVID-19 cases when restrictions on public movement are lifted, or they may even be creating that wave now.

In reality, we don’t know when infected people are infectious and when they are not. We cannot tell if a person is a threat by sight alone. We don’t know if seemingly recovered people can again become infected or infectious. Only by testing can we identify asymptomatic carriers, and we may even need to test those people repeatedly. Ideally, we should test everyone. If we test a large, representative sample, we can estimate our chances of catching the virus, but we cannot assure our safety. Nowhere in the U.S. is such testing being carried out.

If governors adopt an out-of-sight-out-of-mind attitude toward coronavirus infections and lift restrictions on their residents, the worst will be yet to come, and we may soon learn that the problem is indeed worse than the cure.

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