The Washington PostDemocracy Dies in Darkness

Trump wants ‘the country opened,’ but easing coronavirus restrictions now would be disastrous, experts say

A growing debate pits the health of the U.S. economy against the health of its people

President Trump said he hopes to reopen the economy by Easter during a news conference on March 24. (Video: The Washington Post)
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With President Trump saying he wants “the country opened” by Easter to salvage the U.S. economy, a fierce debate is now raging among policymakers over the necessity of shutting down vast swaths of American society to combat the novel coronavirus.

Health experts point to overwhelming evidence from around the world that closing businesses and schools and minimizing social contact are crucial to avoid exponentially mounting infections. Ending the shutdown now in America would be disastrous, many say, because the country has barely given those restrictions time to work, and because U.S. leaders have not pursued alternative strategies used in other countries to avert the potential deaths of hundreds of thousands.

But in recent days an increasing number of political conservatives have argued that the economic cost is too high. At a town hall broadcast Tuesday, Trump suggested dire consequences if at least some economic sectors aren’t restored.

“You’re going to lose more people by putting a country into a massive recession or depression,” Trump said. “You’re going to have all sorts of things happen, you’re going to have instability. You can’t just come in and say let’s close up the United States of America, the biggest, the most successful country in the world by far."

At the event, Trump amplified a message that has been bubbling among conservative pundits in recent days. Speaking of the economy, he said, “The faster we go back, the better it’s going to be.”

The stance has many worried, including some in the president’s own party. “There will be no normally functioning economy if our hospitals are overwhelmed and thousands of Americans of all ages, including our doctors and nurses, lay dying because we have failed to do what’s necessary to stop the virus,” Rep. Liz Cheney (R-Wyo.), the House’s highest-ranking Republican woman, wrote in a Tuesday tweet.

But the greatest alarm has come from scientists, epidemiologists and health experts who have spent the past three months studying the new coronavirus and have witnessed the destructive, contagious swath it has cut through other countries.

“To be a week into these restrictions and already be talking about abandoning them is irresponsible and dangerous,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security. Removing restrictions now would allow the virus, he said, to “spread widely, rapidly, terribly, and could kill potentially millions in the year ahead with huge social and economic impact.”

While not mentioning the president by name, Bill Gates — who co-founded Microsoft and now leads a global health foundation — rebuked Trump’s approach in a Tuesday interview with TED: “There really is no middle ground, and it’s very tough to say to people: ‘Hey, keep going to restaurants, go buy new houses, ignore that pile of bodies over in the corner. We want you to keep spending because there’s maybe a politician who thinks GDP growth is all that counts.’”

State leaders say the simplistic debate — pitting the health of America’s economy against the health of its citizens — has also laid bare the pressing need for a long-term national strategy from the federal government, which by all public indications does not yet exist.

New York Gov. Andrew M. Cuomo (D) said Monday that Trump’s framing of the situation as a choice between saving businesses or saving lives was unhelpful. “You have to walk and chew gum in life,” Cuomo said. No executive “has the luxury of being one-dimensional.”

To ease current restrictions even slightly without a massive increase in the U.S. death toll, some epidemiological models show, the country must first put in place other strategies — like the large-scale contact tracing of infections being done in South Korea, which local health departments simply do not have the capacity to do.

There would also need to be widespread testing, which remains limited, to understand the scope of the problem and to give economists and epidemiologists data they currently lack to analyze the costs and benefits of such decisions.

Novel alternatives could also prove essential, like blood tests to identify people who have already recovered from infection and gained immunity, because those people could provide a workforce to restart the economy and quarantines could be applied more strategically rather than to every American.

“We don’t have the strategy or tools we need to be talking about ‘relax restrictions,’” said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. “We need to be trying to get them as fast as possible. That’s why you have a federal government.”

Is the cure worse than the problem?

Trump’s argument, laid out at length in a Monday night news conference and at Tuesday’s event, comes down to this: No matter how many people may die because of the coronavirus, millions more face ruin if the economy does not operate. “We cannot let the cure be worse than the problem,” he said.

Already, America’s shift to social distancing has caused widespread layoffs, from restaurants to hotels to the oil industry. Unemployment has health consequences as well as economic consequences, economists have noted. Forecasters on both sides of the debate are trying to weigh these losses against deaths from the coronavirus as well as other medical emergencies that won’t be treated properly if the health-care system becomes overrun with covid-19 patients.

“One of the bottom lines is that we don’t know how long social distancing measures and lockdowns can be maintained without major consequences to the economy, society, and mental health,” John Ioannidis, a medical and epidemiology expert at Stanford University, wrote in an essay last week. “Short-term and long-term consequences are entirely unknown, and billions, not just millions, of lives may be eventually at stake.

“I am deeply concerned that the social, economic and public health consequences of this near total meltdown of normal life … will be long lasting and calamitous, possibly graver than the direct toll of the virus itself,” David L. Katz, director of the True Health Initiative and founding director the Yale-Griffin Prevention Research Center wrote this weekend. “The unemployment, impoverishment and despair likely to result will be public health scourges of the first order.”

Such arguments raise important points about the full impact of the current strategy, said Inglesby, the infectious-disease expert at Johns Hopkins. But those are long-term scenarios, he pointed out. “What social distancing does is buy us time to replenish supplies like masks and ventilators, deal with the immediate crisis in hospitals and come up with additional strategies."

The question in the long run is how to balance competing economic interests and public health needs when basic questions about the pandemic — like how many Americans are infected — are unknown, said Gregg Gonsalves, an epidemiologist at the Yale School of Public Health. “If anybody tells you they have the answer to how to thread this needle, they’re lying to you."

While Trump is debating new federal recommendations that the country reopen, orders to stay at home have largely come from state governors, who may simply ignore Trump. But public health experts say the contradictory messaging would make persuading people to comply — already a difficult job — even harder.

No easy way back to ‘normal’

While business leaders are ashen about the economic meltdown, very few have been willing to take the argument as far as Trump does.

Instead, they have voiced a more nuanced point — that there should at least be a plan for eventually getting workers back into offices.

Lloyd Blankfein, a former chairman and chief executive of Goldman Sachs, said in a phone interview Monday that U.S. leaders should begin work to identify which milestones would allow the economy, perhaps in stages, to move back toward normalcy. “Let’s have a conversation on what the metrics should be,” he said.

“It would be heartening if people were at least contemplating that this will not go on forever,” he added. “But I’m not really hearing that.”

Even in a hypothetical world where the economy was valued above human life, many economists say it wouldn’t necessarily make sense to sacrifice the elderly, abruptly send everyone back to work and allow the virus to run its course. Restarting international flights, for example, wouldn’t mean consumers would buy tickets. And the shock from the spreading infections and mounting deaths would make any sense of normalcy hard to maintain.

“The best way to get control of the economy is to get through this as quickly as possible,” said Edward Kaplan, who teaches economic policy and public health at Yale University. He said that means adhering to social distancing and drastically increasing testing.

Time lag means it’s already worse than it seems

The Washington Post spoke to doctors throughout the country who say shortages of medical equipment and supplies could cost lives. (Video: The Washington Post, Photo: Kolin Pope/The Washington Post)

Epidemiologists say any debate today — on the economy, the effect of restrictions and dwindling hospital capacity — is already behind the curve by two weeks.

“By the time someone arrives at the hospital and is severely ill, you can assume they were infected two to three weeks ago,” said Natalie Dean, a biostatistician at the University of Florida.

That’s why we don’t know to what extent recent lockdowns and shelter-in-place orders have slowed America’s exponential increase in infections.

“As bad as things already seem in New York, for example, if you look at the rising numbers, there’s much worse coming,” said Dean, who is working on coronavirus vaccine evaluations with the World Health Organization. “So to be talking about backing off now feels premature and dangerous. Because of the time lag, the risk of underreacting early on versus overreacting is not proportional.”

There are signs that the U.S. outbreak is outpacing the rate of infections in even the world’s worst-hit countries. Despite limited testing, there are now more new cases per day in America than in any other nation, and the steepness of our upward curve exceeds that of most other countries, including Italy, where more than 6,500 have died.

The real question: Are we doing enough?

Public policy — in America especially — has always been a mixture of health, politics, commerce, competing interests and the question of what is in service of the greater good. (If all policy were based solely on the advice of health experts, for example, cigarettes and sugary sodas would probably be illegal.)

But health experts argue that in this case, the scale is tilted to their side given the scope of the crisis, with worst-case scenarios projecting more than 1 million deaths.

Rather than debating whether to continue restrictions, U.S. leaders should be asking whether enough is being done — because there are alarming indications to the contrary, said K.J. Seung, a doctor and project director for Partners in Health in Boston.

“When you compare what U.S. is doing with countries in Asia that have been successful, we are not doing half the measures they are,” said Seung, who has spent years combating tuberculosis and other infectious diseases in developing countries.

What Americans consider lockdown and quarantine, for example, is leaky by comparison, he said. “You have people still driving around. No one is wearing masks when they go out because there aren’t enough.”

One strategy that enabled China to succeed in containing the virus was its funneling of staff and equipment from other provinces to the outbreak’s epicenter, Wuhan. Because Trump has increasingly pushed responsibility onto governors and mayors, such a centralized, resource-sharing approach appears unlikely in America.

What allowed South Korea to keep parts of its economy functioning and Singapore to keep its schools open was combining social distancing with tools like large-scale contact tracing — retracing a confirmed patient’s movements to find and quarantine those they had contact with. South Korea had already honed this ability during an 2015 outbreak of the deadly MERS coronavirus. Singapore deployed its police force to do the work, drawing on digital footprints in security camera footage and credit card records.

In America, that task has fallen to county health departments — weakened by decades of budget cuts and lacking the staffing and ability to mount such a response.

“But that’s a solvable problem. We should be building that capacity with short-term hires or a volunteer force from all those people now laid off or just stuck at home right now,” said Rivers of Johns Hopkins. “If we want to shift away from quarantines and closures and toward economic recovery, this is the kind of thing we need.”

Building a new workforce on antibodies

Criticizing the lackadaisical response of some countries Monday, the World Health Organization’s head did not name names, but his comments at times seemed squarely aimed at America.

“Asking people to stay at home and other physical distancing measures are an important way of slowing down the spread of the virus and buying time — but they are defensive measures,” said Director General Tedros Adhanom Ghebreyesus. “You can’t win a football game only by defending. You have to attack as well.”

But some offensive strategies that could help ease restrictions and restart the U.S. economy cannot be easily done at a local level and require the leadership of the federal government. They include developing a widespread serological test that could use antibodies to identify the Americans who have already been infected and have recovered.

Those with presumed immunity could then deliver goods, bolster hospitals and restart the economy without worrying about transmitting the virus. Such a strategy has never been used on such a large scale, Rivers said, but during Ebola outbreaks in Africa, survivors were often the ones who provided care, watched over the children of sick patients and buried the dead.

“If we’re serious about restarting the economy and easing restrictions, we need to have strategy for replacing those restrictions,” she said. “It’s doable, but not without a plan.”

Carolyn Y. Johnson and Heather Long contributed to this report.


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