Anthony S. Fauci, the nation’s top infectious-disease expert, has warned of “needless suffering and death” if reopening occurs prematurely. No state has met the White House’s own reopening criteria, yet more than 40 of them have loosened or are loosening social distancing restrictions. So here’s the question I would have asked the witnesses at Tuesday’s Senate coronavirus hearing: Have we formally retreated from a goal of containing covid-19 to one of harm reduction?
At the beginning of the outbreak, the United States had a chance to contain the novel virus by identifying each person bringing the infection into the country and stopping it before it spread in the community. We failed, with a lack of testing largely to blame. Instead of individual-level containment, which would have had minimal effect on the economy, we had to employ societal-level lockdowns to slow the explosive spread of the virus and buy us time until we developed the capacity to rein it in. The idea was that restrictions would be lifted once we reduced the number of infections far enough and built up the public health infrastructure needed to find new positive cases, trace contacts and quarantine those exposed.
Unfortunately, due to a late start, inconsistent state actions and a lack of federal direction, most states have yet to see a consistent decline in cases, much less reduced them to low enough levels for this to work. No state has achieved sufficient testing and contact tracing. Reopening under these circumstances means we are giving up on containing covid-19.
What’s next, then? The administration has yet to use these words, but it appears that we’re adopting a strategy that I recognize from other aspects of public health: harm reduction.
Harm reduction was initially developed as a public health approach to reduce the negative consequences of drug use. It recognizes that while stopping drug use is the desired outcome, many people won’t be able to do that. For those individuals, needle-exchange programs can reduce their risk of acquiring HIV and hepatitis and transmitting these infections to others. Such programs do not promote or condone drug use, as some critics contend. Rather, they face the reality that if a behavior with harmful consequences is going to happen regardless, steps should be taken to reduce the risk for both individuals and others around them. Think, too, of safe-sex campaigns, or motorcycle helmet laws.
And this seems to me where we are with covid-19: We’re no longer trying to eliminate the virus. Instead, we are accepting that Americans will have to live with it.
If that’s the case, then our efforts should pivot from justifying why reopening is a good idea to figuring out how best to reduce the harm it is certain to cause. If employees have to go to work, let’s at least come up with evidence-based practices that help them do so more safely. Should workplaces all get regular deep cleaning, close off any communal areas and meet new standards for ventilation? Can employees be mandated to wear masks, work six feet apart and keep a contact diary?
We know that covid-19 is most likely to be transmitted when a lot of people are in an enclosed area for a prolonged period. I would not have advised that hair salons and gyms open for business, but since they have in some states, we should aim to stop the highest-risk practices — prolonged treatments and crowded indoor fitness classes, for example. If people are going to get together in large groups despite the danger, we should at least advise that they do so outdoors, for shorter periods of time, and avoid practices with a higher likelihood of disease transmission, like sharing utensils and group contact sports.
A switch to harm reduction doesn’t mean the Trump administration is off the hook on testing and tracing. Regular, rapid testing will make it much safer for employees and students to return to work and school. Of course, there is also a fundamental difference between this new iteration of societal harm reduction and what I know as the standard public health practice of individual harm reduction — this disease risk is being forced upon the many Americans who would not have chosen it for themselves and their loved ones. That’s a real tragedy.
The Opinions section is looking for stories of how the coronavirus has affected people of all walks of life. Write to us.
I wish the United States had taken a different path. We could have contained the virus earlier, and we still had a chance to do it until we reopened against the guidance of public health experts — including the Trump administration’s own top doctors. But now that we are where we are, we should at least be honest and call our new strategy what it is. It’s our best hope left for saving lives.
Watch the latest Opinions video:
Alexandra Petri: Welcome to our safe-to-go-back-to-work panel. You may notice we are not safely back to work.
The Post’s View: The coronavirus spreads in close quarters. That should factor into reopening decisions.
Coronavirus: What you need to know
End of the public health emergency: The Biden administration ended the public health emergency for the coronavirus pandemic on May 11, just days after WHO said it would no longer classify the coronavirus pandemic as a public health emergency. Here’s what the end of the covid public health emergency means for you.
Tracking covid cases, deaths: Covid-19 was the fourth leading cause of death in the United States last year with covid deaths dropping 47 percent between 2021 and 2022. See the latest covid numbers in the U.S. and across the world.
The latest on coronavirus boosters: The FDA cleared the way for people who are at least 65 or immune-compromised to receive a second updated booster shot for the coronavirus. Here’s who should get the second covid booster and when.
New covid variant: A new coronavirus subvariant, XBB. 1.16, has been designated as a “variant under monitoring” by the World Health Organization. The latest omicron offshoot is particularly prevalent in India. Here’s what you need to know about Arcturus.
Would we shut down again? What will the United States do the next time a deadly virus comes knocking on the door?
For the latest news, sign up for our free newsletter.