Coronavirus: Why Early Reopening Could Spell Disaster
As states reopen early they're seeing a jump in Covid-19 cases; experts explain why this could prolong the pandemic and depress the economy even further. Here's the best way to protect yourself and your loved ones.
By now, you’re probably all too familiar with the terms “flattening the curve,” “community spread,” “PPE,” and “social distancing,” thanks to the Covid-19 pandemic. Its widespread effects have left many of us scrambling and wondering what’s next.
Even the Centers for Disease Control (CDC) and the World Health Organization (WHO)—which have been instrumental in leading the charge nationwide and globally to attempt to slow the spread of the novel coronavirus—have been left guessing: Health agencies had to do an about-face on cloth face masks, for example, and then there was the back-and-forth on the use of the antimalarial drug hydroxychloroquine for Covid-19—it’s a bad idea, by the way.
More than anything, we all want to move past this dark and scary time. But despite the urge to resume normalcy and restart the economy, experts worry that early reopenings could have exactly the opposite effect, leading to not only more Covid-19 cases and deaths, but they might actually damage the economy further and delay true recovery.
Why states want to reopen
As the United States is reaching its fifth month into the Covid-19 pandemic, states are setting their own schedule for reopening and learning as they go along. Here in Iowa, where I’m based, Gov. Kim Reynolds allowed nearly all businesses to open at 100 percent capacity on Friday, June 12—even as positive cases held steady and daily deaths statewide hovered between five and 10, about where we were for the latter half of April. Iowa is now inching closer to 26,000 confirmed positive cases and 700 reported deaths statewide from Covid-19. (Read about how I’m almost positive I had coronavirus.) The general guidance for reopening is to keep people separate by at least six feet of physical distance; if that’s not possible, wear a face mask.
The reasons for reopening are plain: For a five-week span during peak coronavirus lockdown, Iowa had seen more unemployment claims filed repeatedly than it had since the Great Depression, according to The Des Moines Register. The latest Bureau of Labor Statistics data shows that Iowa’s unemployment rate fell from a peak of 11 percent in April to 10 percent in May, the month when most businesses were able to open at 50 percent capacity.
Closing schools and businesses helped Covid-19 cases plateau
“Several areas of the United States enforced shut-downs or stay-at-home orders at the beginning of the pandemic. Reducing the number of new cases or ‘flattening the curve’ was important to prevent overwhelming local health systems that were not equipped to handle an acute surge in patient volume. By closing schools and businesses and urging people to stay at home and social distance, it allowed the case numbers in several areas of the country to plateau,” explains Jill Weatherhead, MD, an assistant professor of adult and pediatric infectious diseases at Baylor College of Medicine in Houston.
This allowed hospitals the time to develop protocols for patient care, increase testing capacity to get a better handle on where hotspots exist, and restore the supply of PPE, like N95 masks. The fact that hospitals are more prepared to handle what’s ahead has helped state governments decide to ease shelter-in-place or stay-at-home orders.
In May, the U.S. Bureau of Labor Statistics reported that the country gained 2.5 million jobs as restrictions began to ease and businesses reopened. Since the crest of nationwide unemployment, new unemployment claims have decreased 78 percent, per June 2020 Wallet Hub data. While the recovery has been tied to states that had lower case rates and deaths (such as Rhode Island and Idaho), even hard-hit places like New Jersey (about 170,000 cases and nearly 13,000 deaths) and is seeing an employment recovery that is among the best in the nation.
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The downside of early reopening
Unfortunately, as restrictions ease, several states are seeing an increase in positive cases and hospitalizations, particularly in the South and West (Texas, Arizona, and the Carolinas are currently experiencing increases in Covid-19 cases.)
Whether this is a “second wave” of cases caused by reopening or a continuation of the first one that never really calmed down is not yet clear.
“The data tells us that 20 percent of Covid-19 cases can develop to be moderate to severe. Covid-19 is just as dangerous and deadly as it was in the beginning, and when people become infected, it’s likely that they will get just as sick as they did before,” says Sandra Kesh, MD, the deputy medical director and infectious disease specialist at Westmed Medical Group in Westchester, New York. Dr. Kesh explains, “the positive thing is that coronavirus is on people’s radar a lot more now so intervention may happen earlier for patients who develop symptoms. Because we still do not have a proven treatment or vaccine, people are just as likely to get a severe infection as they were in February.” (Here are the 12 coronavirus symptoms you should watch for.)
The actual sources of new infections
While some have tried to peg this increase in positive cases to recent protests against racial discrimination and police brutality, Dr. Kesh and Dr. Weatherhead agree that the demonstrations are far less likely to spread the virus than, say, sweating in a room full of other people indoors at a gym or attending a religious gathering and singing next to strangers, sans-mask.
“Large mass gatherings where people are in close contact, particularly indoors, are going to facilitate the spread of the virus. Outdoor gatherings will likely have less effect on transmission, particularly if people are able to wear facial coverings, social distance, and wash hands frequently,” says Dr. Weatherhead. Furthermore, she says, the rise in Covid-19 cases occurred before the protests. “However, in early May, when cases were still plateaued and not decreasing, phased easing of restrictions began and have returned to near-normal daily function in certain regions. As people reduce social distancing, the case numbers are now rising again,” Dr. Weatherhead explains.
More testing doesn’t explain the rise in Covid-19 cases
Over the past few days, some government officials have claimed that the increase in Covid-19 cases in the United States is actually just the result of more testing being done. “There are some places that have increased their testing and as a result are finding more positive cases. But the reality is that there most likely is more spread of the coronavirus,” Dr. Kesh explains. “As you saw with New York, Washington, and California, they clamped down quickly and saw the number of cases go down. If you don’t shut things down—or keep them shut until cases decrease—it’s hard to know when the peak will be and how long or slow the decline will be. That’s the concern around all of this.”
The community spread of the Covid-19, or person-to-person transmission, never decreased in most areas of the United States, Dr. Weatherhead says. Instead, it plateaued. “So, as activities return to ‘normal’ and people are in more contact with others, the cases will continue to rise. The increasing hospitalization rates that we’re seeing wouldn’t be affected by testing accessibility,” she says.
Reopening early could be much worse for the economy
Dr. Kesh predicts a yo-yo for many states that reopened early, which may lead to challenges for the economy down the road. “I think we will see a lot of tightening and loosening of restrictions in response to the disease curve for the foreseeable future,” Dr. Kesh says, or at least until there is a vaccine. If hospitalizations become so high that hospital systems are overwhelmed and do not have the resources to care for patients then policies should be in place to re-enact restrictions, Dr. Weatherhead concurs.
Some economic predictions suggest that reclosing due to climbing infection rates and deaths will depress economies even more than if states had taken a more measured approach, according to a paper in progress from the National Bureau of Economic Research. While the early reopening can give a brief economic boost, if states or counties are forced to reclose, they are more likely to end up in a prolonged recession, the authors wrote, going on to say that: “Prematurely abandoning containment brings about a temporary rise in consumption but no long-lasting economic benefits… tragically, abandonment [of lockdown measures] leads to a substantial rise in the total number of deaths caused by the epidemic.” The authors point to evidence indicating that a resurgence of Covid-19 could leave people even less willing to work and shop—and for a longer period of time than if governments followed a more contained and gradual reopening.
How to reopen responsibly
Singapore, South Korea, and other countries have made use of technology and speedy, more wide-ranging lockdowns to slow the spread of Covid-19. A May 2020 study published in the Iranian Journal of Medical Sciences found that as a result, they were able to reduce the rate of spread and lower Covid-19 case counts through “stringent monitoring approaches and mass quarantine.” These monitoring approaches, such as contact tracing using phone GPS or surveillance camera footage at places like restaurants, allowed the government to be able to contact all who had come within transmission range of those who had received a positive diagnosis. All of this brings a lot of privacy and ethical issues to the surface, but it appears that locking down early and strictly seems to help the residents—and the economy—to bounce back quicker.
Here in the states, Dr. Kesh points to what’s happening now in the Southwest compared with the Northeast. “Arizona saw a 200 percent increase in cases over 14 days in early June. New York did a lot of work to get people to do social distancing and saw their ‘curve’ come down,” Dr. Kesh says. “My fear is this decrease in one area will give people false confidence to go back out and the curve will start to go in the wrong direction again,” since restrictions and reopenings are on a state-by-state basis.
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Tips for staying safe as states reopen
Regardless of when, why, or how your state is reopening, the way you proceed can have a big impact on your health—and your neighbors. So while I love supporting my local restaurants, I’m sticking to restaurants that observe social distancing at outdoor tables—patio dining—or carryout picnic dinners rather than dining indoors rubbing elbows with strangers.
“Everyone can play a role in reducing transmission of the virus and reducing hospitalizations and death from the virus. Despite loosening restrictions, life cannot go back to ‘normal.’ Weigh the risks and benefits of doing your previous activities and still continue to stay home as much as possible,” Dr. Weatherhead says. Wear a face mask and keep six feet (10 to 15 is even better) between you and others when in public, she suggests.
“Social distancing absolutely works and it needs to be a shared effort on the part of everyone. Wearing masks protects others more than it protects you. If you see people not following those guidelines, help to educate them. You have to all be in it,” Dr. Kesh says.
Everyone needs to stick to frequent hand-washing, disinfecting surfaces that people touch frequently (doorknobs, stair railings), and remembering that just because we’re tired of this virus doesn’t mean we can wish it away. “These are decisions that each individual can make on a daily basis to save lives,” Dr. Weatherhead says. While the health of the economy and livelihoods are important, of course, lives are even more so.
- Centers for Disease Control and Prevention: "Use of Cloth Face Coverings to Help Slow the Spread of COVID-19"
- World Health Organization: "Q&A : Hydroxychloroquine and COVID-19"
- Iowa Department of Public Health: "COVID-19 in Iowa"
- The Des Moines Register: "Iowa Weekly Unemployment Claims Continue String of Job Losses Unseen Since Great Depression"
- U.S. Bureau of Labor Statistics: "Iowa Economy at a Glance"
- U.S. Bureau of Labor Statistics: "Frequently asked questions: The impact of the coronavirus (COVID-19) pandemic on The Employment Situation for May 2020"
- Wallet Hub: "States Whose Unemployment Claims Are Recovering the Quickest"
- National Bureau of Economic Research: "The Macroeconomics of Epidemics"
- CDC: "Cases in the U.S."
- COVID-19 Health Data Projections: "United States of America"
- New Jersey Chamber of Commerce: "Pandemic Update for N.J. Businesses"
- The Covid Tracking Project
- Sandra Kesh, MD, deputy medical director and infectious disease specialist at Westmed Medical Group in Westchester, New York
- Jill Weatherhead, MD, assistant professor of adult and pediatric infectious diseases at Baylor College of Medicine in Houston
- Brian Katzowitz, health communication specialist at the CDC
- The Hill: "Trump on coronavirus: 'If we stop testing right now, we'd have very few cases, if any'"
- Iranian Journal of Medical Sciences: "International Public Health Responses to COVID-19 Outbreak: A Rapid Review"
- The Brookings Institution: "How Surveillance Technology Powered South Korea's COVID-19 Response"
- CDC: "Cleaning and Disinfecting Your Facility"