Millions of working people and small-business owners who cannot earn money while sheltering at home are facing economic ruin. So dozens of states, seeking to ease the pain, are coming out of lockdown.
Most have not met even minimal criteria for doing so safely, and some are reopening even as coronavirus cases rise, inviting disaster. The much-feared “second wave” of infection may not wait until fall, many scientists say, and instead may become a storm of wavelets breaking unpredictably across the country.
The reopenings will proceed nonetheless. The question now, scientists say, is whether the nation can minimize the damage by intelligently adopting new tactics.
Evidence is mounting that masks — if worn in public places, by everyone — are far more effective at stopping transmission than was previously realized. Across the nation, testing remains wholly inadequate, but home-use nasal swabs and saliva tests are on the way that may provide a clearer picture of where the virus is.
Americans are lining up for antibody tests that may reveal who has some immunity. Early (but still controversial) surveys suggest that more Americans may carry antibodies than initially thought.
Employers are moving to design safer workplaces. A modestly effective antiviral treatment has been found. And laboratories around the world are racing toward a vaccine at an unprecedented pace.
But while it may still be possible to blunt the impact of the reopenings, the nation is finding even this goal difficult.
As the weather warms, Americans are already struggling to stay at home or remain 6 feet apart on crowded beaches, hiking trails and park playgrounds.
Many Americans refuse to wear masks, and governors and mayors have waffled over whether to order them to.
Fifty brands of antibody tests are available, but many are inaccurate. Many states are moving too quickly for employers and retailers to make environments safe. And the lockdowns have become entwined in partisan politics, with some libertarian extremists, gun-rights advocates and anti-vaccine activists painting them as an infringement of personal freedoms.
Deaths are already far higher than the 60,000 once predicted by August. Even President Donald Trump has begun to talk of a toll that may reach 100,000, perhaps more.
Some epidemiological models predict three times that many within months — closer to the 240,000 that the White House’s coronavirus task force predicted in March before switching to a new, more optimistic model.
“We’re not reopening based on science,” said Dr. Thomas R. Frieden, a former director of the CDC in the Obama administration. “We’re reopening based on politics, ideology and public pressure. And I think it’s going to end badly.”
All quiet, at first
The effects of the reopenings will not be immediately apparent, and in the absence of widespread testing, it will be hard to know where the country stands in the fight against the virus.
It takes two or three weeks for the newly infected who become severely ill to need hospitalization.
“I do worry that people will stay home enough in the states that open earliest so that we don’t immediately see the second wave, and then other states will draw the wrong lessons,” said Dr. Leana Wen, a former health commissioner of Baltimore.
Social distancing has proved effective at interrupting viral transmission in places where it was embraced. But now even formerly terrified New Yorkers, living at the center of the nation’s outbreak, are clearly wearying of it.
Nationwide, there are still about 25,000 new confirmed cases a day of COVID-19, the illness caused by the coronavirus.
Most reopening criteria say that at a minimum a state should have 14 days of declining cases before it even considers reopening. Almost no state reopening now has met that low standard.
At a minimum, a state must do enough random testing to detect a surge of cases anywhere within its borders. Otherwise, the first unmistakable sign that something is wrong will be the wail of sirens as oxygen-starved patients are taken to a local emergency room.
To spot outbreaks early, a Harvard model advocates scaling up, to 20 million tests a day nationwide.
Adm. Brett P. Giroir, the coronavirus task force’s chief of testing strategy, recently said there was “absolutely no way on earth” that goal could be reached, and that 8 million tests a month, or about 270,000 a day, might be possible by June.
For now, the lofty goal of tracing and testing the contacts of every infected person remains unthinkable. Epidemiological models in the United States and data from China suggest that each case generates about 50 contacts, so the 25,000 new daily cases in the United States generate another 1.3 million contacts to find each day.
Making masks obligatory has strong potential to cut down transmission, according to new evidence not just from Asia, where masks have long been common, but also from the Czech Republic, Germany, Israel and other countries, according to Masks4All, an advocacy group.
The single biggest mistake made in the United States and some European countries that have failed to control their epidemics “is that people aren’t wearing masks,” argued Dr. George F. Gao, the Harvard- and Oxford-trained director of China’s Center for Disease Control.
The issue has become mired in politics: The president won’t wear one, some protesters have compared them to Muslim face veils, and a shopper at a supermarket requiring masks wore a Ku Klux Klan hood.
In the absence of detailed national reopening standards, governors are setting their own, and some allow far closer human contact than others do.
It is or will soon be possible in 19 states to get your hair cut or roots dyed, for example. Many states are letting restaurants reopen with restrictions.
By contrast, Gov. Andrew Cuomo of New York has refused to even set a date for easing restrictions everywhere in the state, although three regions will be allowed to partially reopen Friday.
Florida, Tennessee and Texas are reopening as their cases and deaths are spiking to new highs, which means, experts said, that it is impossible to know when or how high they will peak.
Frustrated Americans often do not realize how lax this country’s strictures are compared with those imposed elsewhere.
In Chinese cities, only a tiny corps of essential workers was allowed to leave home for months.
No city in China was allowed to reopen until it had reached 14 days of zero new cases — a standard that no U.S. city is expected to meet.
If deaths in the United States surged, harsh measures like those could, in theory, be imposed.
The 1918 Spanish flu provides some lessons.
A new analysis of that epidemic from the National Bureau of Economic Research in Cambridge, Massachusetts, concluded that various lockdown measures had “clear success” in lowering death rates. But they ultimately failed to curb overall mortality in most cities because they were lifted prematurely.
“The lesson for the ongoing coronavirus pandemic in 2020 is that, to curtail overall deaths,” wrote the chief author, Robert J. Barro, such interventions “have to be maintained for substantially longer than a few weeks.”
Frieden, the former CDC director, now runs Resolve to Save Lives, the public health advocacy group that has issued detailed reopening guidelines.
“Every day, I look at the two models for approaching this,” he said. “The China model, which is to use the world’s most authoritarian regime and best digital tracking system to hunt down and stop every case and then wait for a vaccine. So far, it’s working.”
By contrast, he said, Sweden is trying to achieve “herd immunity” by letting young, healthy people become infected at what they hope will be slow, steady rates. Primary schools are open, higher ones are closed, everyone is asked to be careful in public, and older adults are asked to stay home.
“And then,” he added, “there’s the American approach, which is: ‘What the hell — I heard something on Fox News. Let’s try it!’ ”
But Sweden is paying a high price, and Frieden rated its success as “still to be determined.”
As of Sunday, its per capita death rate is 319 per million Swedes, which is higher than the figure in the United States, which is 242 deaths per million.
Having 50 states and more territories do competing and uncoordinated experiments in reopening is “daring Mother Nature to kill you or someone you love,” Frieden said. “Mother Nature bats last, and she bats a thousand.”