Our COVID-19 decisions are self-correcting but at a high price

The peaking of the numbers of new COVID-19 cases in many regions has led some political and business leaders to call for relaxation of social isolation restrictions.  But this pandemic has repeatedly forced us to correct our decision making.

Both China and the US decided initially to downplay the threat but later had to institute lockdowns as tens of thousands became ill. Epidemiologists estimate that implementing social distancing just two weeks earlier might have prevented 90% of U.S. deaths.(1)

Even some countries that managed without complete lockdowns had to reconsider. Singapore appeared to be a model of how to control the virus, but a recent increase in cases required a new lockdown.(2)

Why would resuming normal social and economic activities after a peak pose a risk? A peak followed by a decline in cases occurs because social distancing has made it harder for the COVID-19 virus to spread from infected to uninfected individuals.

However, virtually all Ohioans will still be susceptible to infection even after we pass the peak. Moreover, there will still be large numbers of contagious individuals with active disease in our state. Many of them won’t even realize it because asymptomatic infections are quite common.

Unless done in small increments, relaxing isolation restrictions will result in a surge of new cases and an undoing of the hard work we have done so far.

The smaller number of cases in Ohio’s rural counties and their lower population density may make them candidates for relaxing restrictions sooner. But these case counts could simply reflect smaller populations and limited COVID-19 testing capabilities. Rural communities also do not have enough hospitals and ICU beds to handle substantial increases in patients.

There are four tasks that should be considered in deciding when and how to relax Ohio’s social isolation restrictions.

First, the number of new cases should be declining for at least two weeks (which they are not). Relaxing social restrictions before this happens will make it difficult to determine if any subsequent increases are due to the relaxation or not. As a result, we will not know whether to continue with relaxing social restrictions or reinstitute them.

Second, we need the capability to test all people suspected of having COVID-19 so they can be appropriately treated and isolated to prevent further spread. Even though testing has increased greatly, I used national data to determine that Ohio’s testing rate is currently lower than that of 45 other states.(3)

Third, we need a team of public health staff, health care workers, and trained lay people to identify, quarantine, and provide resources to all the people who have been in contact with infected individuals. A single infected person may have been in contact with 10-20 other people, so contact tracing can only work if the number of new cases is small.

The often cited University of Washington model recommends continuing strict social isolation restrictions until the there are fewer than 12 cases in Ohio.(4) But there are currently several hundred new cases daily in our state.(5) Even a small army of contact tracers would be unable to manage all the contacts for that many COVID-19 patients.  

Fourth, we need to monitor the experience of other states and countries by slightly delaying our own decision to relax restrictions. There is or will soon be a great deal of variation in how other regions are emerging from lockdowns. Some will continue full lockdowns, others will relax specific aspects, and some will relax all restrictions. 

It will take about three weeks to determine the effect of each relaxation decision, which includes time for a population to fully resume previously restricted activities and for any surges to become evident. Slightly delaying our own decision to relax restrictions will give us a chance to learn from and improve upon other regions’ approaches.  

The best way to reopen closed sectors of our economy is to first accomplish these four tasks. Premature reopening will lead to workers getting sick or dying, businesses having to close repeatedly for disinfection, and fearful customers staying away. 

A surge of new cases may even necessitate a new lockdown. A second lockdown will be frustrating for people and businesses who just resumed normal activities and may be less effective as a result.

Until normal economic activity resumes, state and federal policymakers must do more to support the income and health care needs of the millions who are not working, have lost their health insurance, or never had insurance in the first place. Everyone must be able to put food on the table, pay the rent, and get the health care that they need.  

Whatever we decide about continuing social isolation restrictions, COVID-19 will be the final arbiter of whether we made the right call. Incorrect decisions will eventually be fixed but at a great cost in sickened and lost lives.  

REFERENCES

1. B L Jewell and N P Jewell.  The huge cost of waiting to contain the pandemic.  New York Times.  April 14, 2020.
2. A E Carroll.  Lessons from Singapore.  New York Times.  April 14, 2020.
3. State current values.  Available at covidtracking.com
4. Institute for Health Metrics and Evaluation.  COVID-19: What’s new for April 22, 2020.  Available at http://www.healthdata.org/covid/updates
5. Ohio Department of Health.  COVID-19 dashboard.  Available at https://coronavirus.ohio.gov/wps/portal/gov/covid-19/dashboards/current-trends