Lockdown

When will social distancing end? The 3 major risks of reopening too soon

According to a health economist, we’re “playing with fire.”

Alexi Rosenfeld

Across the country, every state has, in some capacity, started reopening public life and lifting social distancing restrictions. Even as some communities face rising Covid-19 case counts, people are venturing out for their first shopping trip or concert post-lockdown. Others stay home weighing the risks.

It’s an arduous choice for policymakers and the public: how to test the waters, resume some semblance of normal life, and cautiously lift restrictions without causing catastrophic spikes of sickness and death.

Because Covid-19 symptoms typically take days or weeks to appear, we don't yet know how these localized experiments will play out. But the data shows social distancing policies have helped curb the spread of Covid-19. Rushing to lift them — without ensuring testing, contact tracing, and hospital capacities — could be dangerous.

Restarting the economy and public life isn't as easy as flipping a switch — nor should it be, experts tell Inverse. It's a slow build that requires incremental, cautious calculation, not an all-or-nothing approach.

"You have to remember that the virus hasn't gone anywhere," Amesh Adalja, an infectious disease expert and senior scholar at the Johns Hopkins University Center for Health Security, tells Inverse. "This is going to be something that we have to live with."

Experts say reopening too soon could lead to three major risks:

  1. Exponential, unmanageable spread that overwhelms health systems.
  2. Reinstated restrictions to manage these spikes.
  3. A longer, costlier course of the pandemic.

"If you're opening the door to a dark and maybe dangerous room, you don't just throw the door open and race in and see what happens," Charles Courtemanche, a health economist at the University of Kentucky, tells Inverse. "You crack the door open, peek around the corner, listen for some noise, and then maybe you crack it open another inch."

The guiding principle for reopening should be hospital capacity, Adalja says.

"If hospital capacity is not compromised, then it's really going to be down to individual decision making and risk tolerance for what people want to and want not to engage in," he explains.

Is social distancing working? — In a recent study published in the journal Health Affairs, Courtemanche and a team of researchers studied how effective social distancing policies have been at curbing the spread of Covid-19 so far. They wanted to know if the Covid-19 crisis has been "overblown" and if social distancing policies were warranted to manage the pandemic.

The team analyzed four types of social distancing policies: school closures, large event bans (typically over 50 people), the closing of entertainment venues like bars, gyms, and restaurants, and shelter-in-place orders. They captured the impact of these measures by examining the growth rate of confirmed Covid-19 cases across United States counties between March 1, 2020 and April 27, 2020.

What they found was striking: Social distancing policies, especially the stricter restrictions, helped flatten the curve by reducing the rate of case growth to 9 percent over three weeks in place. The daily growth rate without these policies would have been around 16 percent.

Lighter restrictions alone, like school closures and bans on large gatherings, "didn't really work," Courtemanche explains. Stronger measures — like entertainment venue closures and shelter-in-place orders — did.

"It was still worth it."

Had zero social distancing restrictions been put in place, cases may have been 35 times higher by the end of April than they were in reality, the team reports.

"The cost of the social distancing restrictions are obvious," Courtemanche explains, noting the United States' astronomical unemployment numbers and trillions being spent in stimulus funds. The disruption to people's lives, he acknowledges, is hard to even "put a price tag on."

However, the benefits are clear — albeit harder to see without statistical analysis. That's because when pubic health precautions are effective, bad outcomes don't materialize. In turn, precautions are critiqued as overreactions.

"What we're finding is that, yes, we realize the costs were massive, but the costs of the alternative were worse," Courtemanche says. "Despite the massive economic and social costs, our results really imply that the public health situation would indeed have been so severe that it was still worth it."

Another cost-benefit analysis published in April found social distancing's benefit of lives saved far outweighs its economic toll in the United States. County by county comparisons between Illinois and Iowa suggests Iowa's lack of stay-at-home order may have contributed to excess Covid-19 cases.

"What the public health experts feared probably would have happened if we hadn't done these things," Courtemanche says.

How can states reopen safely?

Although evidence suggests self-isolation is one of our best tools to fight Covid-19, Courtemanche argues that staying in lockdown indefinitely is unsustainable, and frankly, impossible. Re-engaging in pre-pandemic activities — while maintaining social distance and public health precautions — is crucial for people's mental, physical, and financial health, he says.

"You don't just say indefinite lockdowns and ignore the cost of those lockdowns," Courtemanche explains. "At the same time you realize, you are playing with fire."

As of May 19, 46 states have started staggered reopening plans. Most states failed to meet the White House guidelines — a “downward trajectory” of cases over a 14-day period — before reopening.

None of these plans are zero-risk.

“When you do decrease social distancing restrictions, by simple biology, you are going to have more cases,” Adalja explains. “The question always becomes, ‘Will those cases occur at a clip that's too fast for the healthcare system to absorb?’”

Researchers at Columbia University predict a rebound of Covid-19 incidence and death in late May stemming from loosened restrictions. Internal projections from the Trump administration obtained by the New York Times also predict the daily death toll from Covid-19 will rise to 3,000 on June 1 — a 70 percent increase from May 4. As of the time of writing, an estimated 92,149 Americans have died from the disease.

"There is a lagged impact and if it's going to be a disaster, we really wouldn't know that yet," Courtemanche says. "We wouldn't know it until it was too late to prevent it."

But Adalja notes that social distancing policies weren't necessarily meant to decrease the number of cases or deaths from Covid-19. It was to spread them out over a longer period of time to stay below hospital capacity.

A state, city, or region's pace of reopening depends on how hard they've been hit by Covid-19 and the level of health resources that equip them to handle surges in cases — like ICU bed space, mechanical ventilators, and PPE. What makes sense for Brooklyn is starkly different than what's right for Louisville.

Courtemanche says that the data supports taking slow, incremental steps when reopening a region. At each step, it's essential to evaluate whether any spikes have emerged, he explains. Spacing these steps out far enough should show if policies have "gone too far."

Adalja's also argues a cautious approach, based primarily on health resources.

"Social distancing was about hospital capacity issues and if you've solved the hospital capacity problem, then it comes down to individual choice," he argues. "It's going to be different for every person."

A runner wears a mask in Central Park on May 3.Alexi Rosenfeld

Weighing the risks and benefits— Community by community, people are cutting back on social distancing at different speeds. Weekly foot traffic to retail locations is on the rise, hitting 192 million visits across the US, Reuters reports. But activity is still about 40 percent lower than it was this time last year.

Still, Adalja notes that lifted orders and reopened stores shouldn't keep people from continuing to socially distance if they still want to. Both he and Courtemanche stress that just because an area is "reopening" it doesn't mean everything is going back to normal.

"Nothing is reopening without some sort of additional measures and guidelines," Courtemanche says. "There's no state in the country that's literally just flipping a switch and going back to January. That would be an unmitigated disaster."

Ultimately, as government restrictions and public health guidance evolve, each individual must make a personal risk calculation. They'll consider what they deem essential, their personal hierarchy of values, risk tolerance, and their risk factors for disease, Adalja explains. "I don't think that you can be overly prescriptive in this," he says.

It can be helpful to focus on all the things you can do, not the things you can't. Some activities are safer than others — jogging outside or going for a swim, are less risky than going to a bar or the office. Someone who is immunocompromised needs to be more careful than someone who's not.

"It's clear that this pandemic definitely impacted every person," Adalja says. "The fact that every time you step out the door, you have to think about this virus, is something that's going to impact people's behavior."

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