We're Fighting Coronavirus With Our Biggest Weapons Off the Table

Tracing becomes difficult when cases increase, and so we have to count on Americans to be safe and take precautions.

Back in mid-April, when it had become clear that total lockdown until the coronavirus disappeared was a recipe for economic suicide, the Trump administration released a road map to reopen state and local economies, gradually and in four phases. As laid out by Dr. Anthony Fauci and Dr. Deborah Birx in an April 16 press conference, the crux of the plan was to creep forward cautiously once there was reason to believe the virus was slowing—reopening low-risk sectors, then waiting to assess whether cases spiked before creeping forward again. If cases did spike, that would show the reopening was going too fast, and the community should take a step back until they settled down.

“There may be some setbacks,” Fauci said. “I mean, let’s face it: This is uncharted water. There may be some setbacks that [mean] we may have to pull back a little. And then go forward.”

A month or more into reopening, these setbacks are cropping up all over the nation. Arizona, Florida, South Carolina, and Texas are among the states where the virus is now spreading much faster than at any previous point in the pandemic. The U.S. experienced its highest single-day caseload yet on Tuesday, and some hospitals in Texas are approaching capacity in their intensive care units.

But while states continue to use the language of phases, few are still making any effort to abide by the White House plan’s stern standards for risk assessment. Some, like Louisiana, Oregon, Kansas, and Maine, have paused plans to reopen still further, while Texas and parts of Idaho have hurriedly slapped restrictions back onto gatherings of large groups of people. But even as caseloads continue to climb, the unspoken consensus most places seems to be that another shutdown is simply off the political table.

The idea that cities and states would be able to turn their economies on and off like a spigot as weekly numbers dictated was overly optimistic from the beginning. Very few businesses can function under those conditions.

“You can’t just keep workers on the side for months, and then open up your business and say ‘come on back,’ and then two weeks later say ‘Oh, we’ve got to close down again, just go home and wait for another month,” Norbert Michel, who directs the Heritage Foundation’s Center for Data Analysis, told The Dispatch. “People are gonna look for other things to do; people are gonna look for other places to go. It’s just not practical. … If you do that a couple times, people are gonna learn, and they’re just not going to reopen.”

But if returning to lockdowns is out of the question, that leaves governments with a seriously diminished toolset when it comes to arresting new breakouts. The other main weapon states and localities have is surveillance—the “test and trace” model of trying to find people who have been exposed to the virus before they can infect others. But this tool becomes considerably less effective once cases are already spreading widely; the officials running these operations are simply snowed under.

Contact tracing “is most effective when you can identify the sentinel case” very quickly, said Dr. Alberto Caban-Martinez, an epidemiologist at the University of Miami who is responsible for much of the university’s own internal tracing operation. That means it’s “really good at the beginning of an event, where it’s more manageable. And then as it continues to grow and you have more people to track, it becomes harder.”

“As the number of people within the community gets more and more infected, you can imagine the workload and the army of people you need to do contact tracing grows, you know, folds higher,” he told The Dispatch. “That’s why you may read some stories where Departments of Health at the county level or at the state level feel a bit overwhelmed with the sheer volume of, you know, response they have to do in order to mitigate the spread of a disease in a geographic area that all of a sudden becomes a hotspot.”

That leaves the individual conscientiousness of Americans themselves—masking, social distancing, and so on—as the primary measure left to inhibit COVID’s ongoing spread. But with the horror stories of New York’s monster outbreak fading into the past—and basic precautions like masks becoming unfortunate flash points of partisanship—there’s plenty of reason to fret about that firewall, too.

“We’re seeing people go back to activities where they all start forgetting that this is really important,” said Dr. Cindy Prins, an epidemiologist at the University of Florida. “We kind of came out cautiously—it’s almost like you come out blinking at the sun—and then all of a sudden you’re like, ‘Woohoo, I’m out!” you know? We’ve just had a lot of people who felt like, when this stay-at-home order stopped, that it meant that coronavirus was gone or something, or was no longer a threat. That is far, far from true, and I think we’re seeing the consequences of that now.”

There are a few silver linings to all this bad news. One is that, while COVID is showing no signs of a hoped-for summer slump, hospitals are at least not having to contend with it, the seasonal flu, and seasonal allergies all simultaneously anymore, making diagnosis easier and hospital beds freer to come by.

Another is that, so far, most new outbreaks are taking place among younger, healthier, less at-risk people: “They’re more adventurous to step out, right?” said Dr. Caban-Martinez. “It’s always our parents are older and wiser, they know better not to go out, even though policies are like go ahead, hang out at a bar or go to the beach or go the park.”

But epidemiologists warn that concentration among the young is unlikely to last. “These cases have skewed a bit younger now, but those are folks who can still potentially infect other people,” Dr. Prins said. “Even if they’re not getting severely ill, you’re not necessarily seeing the same level of hospitalization and death, they can still spread it to vulnerable residents.

As for COVID apathy, it will probably begin to dry up fast if another hotspot starts to look like New York. Hopefully that can still be avoided, but there are some troubling signs that such a moment might not be as far off as we think: Hospitalizations are veering sharply upward in Arizona, and one Miami hospital hit maximum capacity on Tuesday.

And if there’s one thing our ongoing crisis has taught us so far, it’s that it’s far easier to let cases go up than to drag them back down.

Photograph by Alexi Rosenfeld/Getty Images.