When will it be safe?

There is increasing pressure to resume social and economic activity soon to limit the economic damage from the coronavirus. Suggestions to reopen are emerging that are not informed by thoughtful analysis or public-health expertise.

Determining when it will be safe to go out again is the flip side of the question of when social distancing should start. If there are multiple cases for which the source case cannot be identified, indicating that infection is spreading widely, people need to shelter in place. Otherwise, there will be explosive spread as occurred in China and Italy, and is occurring in New York.

Our health-care system needs to be ready to treat large numbers of mildly ill patients, provide safe and effective intensive care for those who would die without it, and maintain care for the millions who need to continue treatment for chronic conditions. And all that needs to be done while protecting our front-line health-care workers.

Note that China is months into the outbreak and responded much more robustly than the United States, but is only now reopening much of its economy. When it will be safe to come out again depends on how well the country uses this time to prepare health-care and public health systems for a possible surge in cases when activity resumes.

The Trump administration squandered the lead time provided by Chinese disease control efforts and its own travel ban. We can’t afford to make that mistake again.

Determining what gets restarted first should depend on what would have the biggest benefit for society. We urgently need to understand whether children spread this infection. If they don’t commonly do so, schools may be able to reopen, carefully. This would require enabling staff and students who are medically vulnerable to participate by distance.

Among the most concerning flaws of this administration’s response has been the virtual absence of our lead public health agency, the Centers for Disease Control and Prevention, from the decision table and the podium. This is dangerous.

For example, the CDC issued practical and nuanced guidance about school closings. Without any scientific justification or explanation, the White House overruled that guidance 72 hours later. As a result, many school districts closed that probably didn’t need to, causing avoidable social, economic and educational dislocation.

How the virus spreads and how prepared health-care and public-health systems are to fight it will vary by state and community. The only reliable approach to decide what, when and how to safely reopen is to base decisions on data and evidence-driven principles as they apply to each community and state. More than the economy will be hurt if we get this wrong.