“Exciting to see our Country starting to open up again!” US President Donald Trump tweeted earlier this week. And the country is, in some parts, reopening. Georgia is opening back up, and Texas Governor Greg Abbott allowed restaurants, movie theatres and malls to start up again with limited capacity (and while Trump initially pushed back on Georgia’s reopening, Abbott was met with presidential praise).
It isn’t only the President who is encouraging state leaders to usher people back to work so that the economy might improve. Those who are lucky enough to be able to work from home are growing impatient with the lockdown and stay-at-home extensions. People miss their families and their friends. They’re tired of staying in their homes (smartphone data shows that people in Washington, DC, for example, are leaving their homes more often, despite there being more, not fewer, cases of Covid-19).
They — we — want to be able to go get haircuts and stroll through museums and sit in a bar drinking a glass of something we didn’t pour for ourselves. A majority of Republicans think it is now safe to go shopping and dine in at a restaurant. And the over 30 million who have filed for unemployment insurance surely want the economy to “reopen” too, that they might get jobs again. That things might go back to normal.
The trouble with this thinking, though, is that things aren’t abnormal because of stay-at-home orders; they’re abnormal because there’s a pandemic, and one that hasn’t gone away. Cases nationwide have plateaued, not declined, and experts say that if the country reopens too fast too soon, and without proper testing and contact tracing in place, things will not only not go back to normal, but longer and more economically detrimental lockdowns could be required.
“I think there’s concern that we’re re-opening quickly and not incrementally as there is still a lot of community transmission and not consistent, continued decreasing transmission across all states,” Saskia Popescu, an infectious disease epidemiologist and infection preventionist, writes in an email to the New Statesman. “Moreover, the lack of widespread testing and challenges in doing contact tracing are concerning as they are critical pieces to ensure a safe reopen.”
And while it’s true that all states are not New York — arguably the region hardest hit in the entire world — it’s also true that other states could become “hot spots” if they throw the doors of their businesses open too quickly.
What, “Well, in our state or in our city, we didn’t have it as bad as New York, so why can’t we go back to normal?” misses, says Jeremy Konyndyk, a senior policy fellow at the Centre for Global Development, is that there are reasons that New York was hit especially hard, one of which is that it was hit relatively early on, and so the virus had reached a certain point in its spread in New York earlier on, too.
“By the time the country began locking down, they had already achieved liftoff and most of the country hadn’t yet.” (Seattle was hit earlier than New York, but they shut down much earlier and more decisively, too.)
“There’s nothing magical about Florida or about Texas or any other red state that has made them less susceptible,” says Konyndyk, who helped lead the US government response to the Ebola crisis in West Africa in the Obama administration. “They began applying these measures before achieving liftoff … but they could still achieve liftoff. And if they reopen recklessly, they will.
“Yes, there is differentiation between states, yes, each state will need to reopen based on local conditions [but there] should be based on a common view of what constitutes readiness.” And, he adds, readiness should include testing, contact tracing and targeted isolation.
But the United States is still not testing as many people as it needs to be. This is partly a supply chain issue.
“The supply chain has played a role in some of the difficulties with scaling the testing and getting it out broadly to communities,” says Lloyd Minor, dean of Stanford University School of Medicine. “The processes involved in detecting require special equipment, replenishable supplies … [there] had to be a massive scale up.”
National clinical labs have had to scale up, and it’s still, even now, taking most national commercial labs several days to return results. Those labs, Minor says, will have to look at establishing satellite facilities or “have much more rapid turnaround”
“Lots of different pieces of the puzzle have to fit together perfectly,” he says..
But there’s a political component, too. Trump has resisted taking responsibility for testing, saying that it should be handled at the state level. And the White House’s new press secretary, Kayleigh McEnany, has in fact said that it would be “nonsensical” for everyone to be tested, as they would then need to be tested again (on the latter point, she is correct).
Even if testing and tracing were at scale, there would still be a careful balancing act required. The Institute for Health Metrics and Evaluation, which has been providing models about the number of deaths that the pandemic will cause, has, as a response to the change in public discourse, added on an epidemiological transmission model to the model of number of deaths. These will soon be released to help policymakers understand the rate at which they can ease restrictions, says Theo Vos, one of IMHE’s senior faculty.
The goal, he explains, is to keep the rate of transmission at one to one. “If R is over 1 — even a fraction, 1.1 — then it inevitably, if that keeps going at that rate, it means over time you’ll get exponential growth.”
Until there is a vaccine, there is some risk involved in reopening. Even if the rate of transmission is one to one or less, Vos says, “You’re still going to pay the price by having new cases and deaths that follow from that. That sounds a bit macabre, but that’s what the real decision making is about.”
However, “if you increase your mobility and you have low testing rates, probability that you’re going to go over one than if you have a very easily available testing set up and have the manpower to do contact tracing.”
And at present, the United States does not. To reopen businesses, then, is quite literally to tell people — particularly the less economically affluent and people of colour, who have been hardest hit by the virus — to go to malls and barbershops and museums and movie theatres and work and shop, while bodies pile up around them.
Testing and contact tracing is what has allowed other countries to slowly reopen and find a new version of normal. To dismiss that and insist that Americans can return to an old normal, Konyndyk says, is “total lunacy”. And that lunacy, he says, “is going to kill and bankrupt a lot of people”.