Response to covid-19 not a one-size-fits for states

David L. Katz, a specialist in preventative medicine and director of Yale University’s Yale-Griffin Prevention Research Center, pondered in the New York Times last month the similarities between military strikes and the states’ varied responses to the covid-19 pandemic.

Military actions, he said, can be done with precision, the kind often referred to as a “surgical strike” that methodically targets a threat and seeks to eradicate it. They can also be diffused responses, which might lead to some military success as well but comes with “inevitable carnage and collateral damage.”

The reason so-called surgical strikes are most often the response of choice is they minimize the required resources and diminish the unintended consequences that are part and parcel of the less-targeted approach.

The political heat on Gov. Asa Hutchinson’s management of Arkansas’ response to covid-19 grew late last week as some residents called for an all-out “shelter in place” order throughout the state. The urgency, in part, was fueled by national reporting that credited a vast majority of states as having adopted such mandates.

That reporting, reflected on a map of the nation showing Arkansas among a handful of states so far without a stay-at-home mandate from the governor, gives people an unrealistic expectation of what a statewide mandate like that would accomplish, Hutchinson said.

He’s been backed up by Dr. Nate Smith, director of the Arkansas Department of Health and the leading medical figure advising the governor on the state’s menu of possible responses.

Hutchinson, in Thursday’s comments, tried to reduce a growing level of tension felt by some residents who have become vocal that a shelter-inplace order is the only acceptable response to what the state faces.

Hutchinson’s stand was undermined a bit Friday morning with comments from the well-respected Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Asked on CNN whether all states should be “on the same page” regarding stayat-home orders, Fauci said he didn’t understand why that’s not happening. At the same time, Fauci declined to get into the discussion about federal vs. state authority.

Hutchinson, asked to respond Friday, said he sympathized with Fauci, who is faced with difficult situations in New York City, Maryland, the West Coast and other major metro locations. But the Centers for Disease Control hasn’t suggested that’s an appropriate or necessary step across the country, Hutchinson said.

What would a stay-at-home order entail? Hutchinson noted that if he issued such an order immediately, more than 700,000 Arkansans would still get out of bed and go to work the next day. That’s because they’re considered essential — grocery store workers, medical professionals, truckers, railroad workers, newspaper reporters, law enforcement, farmers, utility crews, CPAs, etc. Hutchinson estimated a stay-at-home mandate would immediately put another 100,000 out of work, adding to the tens of thousands who have already been laid off.

Smith has stressed that Arkansas’ response is working “at least as well” as actions other states have taken.

Hutchinson shouldn’t accede to well-intentioned but misguided calls for a statewide shelter-in-place order without convincing data that the most stringent kind of constraints will significantly change outcomes.

If public health is the only legitimate factor to consider, shelter-inplace should have been the immediate response to the covid-19 presence in Arkansas. But the governor’s charge is to steer the state through the crisis with attention to the economic recovery, too. The governor’s use of targeted responses (see Saturday’s “Radio nowhere” editorial) attempts to navigate the pandemic with surgical precision, not destroying components of our lives and the state’s economy unnecessarily. Such decisions perhaps would be politically easy to sell and put some worried people a little more at ease, but should 100,000 more people be put out of work if the result is likely no appreciable change in the state’s public health trajectory? Lives matter most. But let’s not pretend livelihoods don’t matter at all. The less our response disrupts Arkansas’ economic foundations, the more quickly the state will be able to recover. In the long term, that may have a more profound impact on Arkansans’ lives for a longer period than this virus will be around.

The governor’s position essentially communicates that he’s going to act, step by step, when he’s convinced either the benefits realized or the damage caused will be worth the disruption. So far, his public health advisers say, the numbers do not gain the state enough public health ground for “shelter in place” to make sense.

Smith said he’d appreciate an opportunity to show Fauci Arkansas’ numbers, which he said shows the state’s targeted response is producing results “at least as well as any other state,” meaning there’s no compelling reason for a shelter-inplace order. Rather, Arkansas should continue to respond to Arkansas conditions.

Smith, on Friday, said the governor has shown openness to any response supported by science and data about what’s happening in Arkansas. That, we suggest, is precisely what should guide Arkansas’ response, not a fearful reaction based on what’s happening elsewhere.

That said, every Arkansans should follow the strong advice to stay home as much as possible and to practice social distancing and heightened personal hygiene (wash those hands with soap and water, scrubbing for at least 20 seconds). Any individual can observe their own shelter-in-place order as stringent as they deem necessary. Most people are observing serious constraints on their lives.

And where Hutchinson has seen trouble, he has acted. He called on the federal government to shut down access to the Buffalo National River, which had become a destination for people looking to be outdoors. But the crowds made social distancing difficult and the flow of out-of-state visitors added to concerns that they might be spreading the virus. The National Park Service closed the Buffalo River last week in response.

Hutchinson has also ended overnight uses of state parks and closed some, such as Pinnacle Mountain State Park near Little Rock, that showed a tendency to become overcrowded even with day-use only. He’s closed schools statewide, and he has shut down all sorts of businesses that require people to operate in close quarters.

Mississippi Gov. Tate Reeves last week issued a stay-at-home order for his state, so far harder hit than Arkansas. But he acknowledged such orders are not sustainable for long periods — people will not observe them indefinitely. What that suggests to us is that their use must be judicious and timed so that they have the biggest impact at a critical moment.

Nobody, especially Hutchinson, is saying a stay-at-home mandate is an impossibility. The answer for Arkansas so far is “not now,” and hopefully it won’t be needed.

We think that’s informed wisdom.