A made-in-America end to lockdown
The U.S. has embarked on a massive, unplanned natural experiment
Jeffrey Shaman was exasperated. “It’s frustrating. It’s very, very frustrating,” he said on the phone this week. The Columbia University infectious disease expert had been saying the same things about how to stop the spread of the coronavirus for weeks — and the message hasn’t sunk in.
“And it’s, you know, people’s lives we’re experimenting with.”
This was the week the United States embarked on what is essentially a massive, unplanned natural experiment, as dozens of states lifted or eased stay-athome orders imposed during the COVID-19 lockdown.
Some reopenings, like those in Georgia and Texas, are liberal (including movie theatres, for instance), and taking place as caseloads of the virus continue to rise. Others are more restrictive. Very few states have met the expert guidelines released by the federal government.
“We’re gonna learn a lot. These are all experiments,” said Ashish Jha, director of Harvard University’s Global Health Institute.
Jha was among four infectious disease experts I spoke with who agreed that the varied — and possibly reckless — way reopenings are being managed state to state would provide information on the spread of the virus. They also seemed to agree the usefulness of the data would be somewhat limited.
“I think there is clearly a natural experiment taking place right now, but it is definitely not one that is going to be easy to analyze,” said Jon Zelner, an epidemiologist from the University of Michigan. The number of variables — such as geography, population, infrastructure and health care — will make effective comparisons hard. “That doesn’t mean there is nothing to learn here,” Zelner said, “but I think the learning will probably be around patterns that are not deeply nuanced.”
Dionne Aleman, director of the Medical Operations Research Lab at the University of Toronto, says the amount of travel between states further confounds things.
She also says that, if you planned this as an experiment, it would be deeply unethical.
“We should not celebrate information gained by intentionally putting members of the population at risk, whether through lax mitigation measures or removing those measures for the sake of the economy despite high and growing infection numbers,” Aleman said.
All four feared dramatic increases in deaths and coronavirus cases as a result of premature reopening. “There’s a balancing act between learning and being reckless,” Jha said.
He nevertheless thinks the results will provide new information, and he’s hoping to be surprised. “I’m deeply worried about what’s going to happen in a lot of these places. I’m, at the same time, hoping that I am wrong to worry,” he said.
“There’s still enough about the virus we don’t know that I think — again, I think the prudent thing is to follow the science. But our science will get better because of this.”
Whether better science will lead to better policy is a different question. Part of what frustrates Shaman is that South Korea’s widespread testing and contact tracing have clearly yielded good results over months — an example the U.S. has so far failed to follow.
“We’ve been saying, I’ve personally been saying it for about a month, ‘Everybody, look at what the South Koreans have done. They have accomplished a lot,’ ” Shaman said. Starting with its first case on the same day as the U.S. did, South Korea managed to keep cases down and suffer less economic disruption than the U.S.
Shaman says a “lack of federal leadership” from the outset means the U.S. is not in a position to do such testing and tracing. He said Korea has tested 60 people for every case it has identified, where in the U.S. the ratio is only 6-1. “That’s critical. There’s a lot to learn from it,” he said. The U.S. has not taken the lesson.
Zelner says effective contact tracing depends on achieving a far lower caseload than the U.S. is seeing now.
“In New Zealand, this is an effective strategy right now and, in other places that have successfully reduced their number of daily cases to a handful, the effort of contact tracing is likely to be well spent,” he said. “But I don’t think we need an experiment to tell us that it isn’t going to work well to open up when there are still thousands upon thousands of new cases reported every day with many more likely unreported.”
The point of social distancing, Zelner notes, was to get caseloads low enough that treatment, testing and tracing could be effective. States are pursuing an end to social distancing before that’s reasonably possible.
Jha identified one reason U.S. leaders might not have learned from South Korea’s example: “One fundamental of public policy in every context that I have ever seen is the belief that the experience of others doesn’t necessarily apply to you.”
He’s seen this everywhere, even among Dutch people claiming the example of Germany just a few kilometres away will not apply to them. “And so there is this broad sense of, ‘Oh, yeah, sure that’s South Korea, but what does that have do to with the United States? America is different.’ ”
There’s a possibility that results gathered from across the United States might resonate differently. “I think at some point, it will become harder and harder to take the thinking that the virus affects other people, not me,” Jha said.
Shaman said he’s grown cynical as he repeats himself while watching the crisis unfold, mismanaged by “a complete clown in the White House who is illequipped to actually do work” and misinformation spread by the media outlets that cheer him on. He isn’t certain new local evidence from this experiment will have any great effect.
“I think we will see a return to growth in these states that have done this. And I don’t know — you tell me what kind of reckoning it’s going to have. Will we learn? That is the question. Or will we just keep being in our spin bubble?
“Maybe we’ll finally learn, but I don’t think so.”