By: John C. Lesher
It’s mid-May and most of the nation has been locked down for many weeks. It’s time we begin the assessment of what we did right or wrong in our response to the virus. It’s far too early to reach definitive conclusions, but, on the supposition that there could be a second round of this pandemic before we find an effective vaccine, we should start to evaluate the merits of what we’ve done to contain this disease. If it comes back, what prophylactic methods would serve us best: what should we keep as having been of proven effectiveness and what procedures can we discard safely because they were constraints that were of dubious value?
We now are aware of the collateral damage of a lockdown: economic chaos. Given that reality, what appears to have been necessary (and to have worked) and what was overkill? It is easy for me to have a critical eye because I have the benefit of hindsight. Our elected officials had no unerring crystal balls at hand and they made hard choices based on the information and expert advice they were given. They chose--wisely-- to err on the side of caution. I understand and support that, but this is now and we have approximately three months experience with our lockdown. We need to get into military mode and make an objective “after action report.”
A first look should be to question the one-size-fits-all approach to a national lockdown. Some states recorded a death rate from coronavirus not substantively different from that allegedly caused by the seasonal flu we take for granted; others--notably the New York/New Jersey metropolitan area--were devastated. The necessity of equal lockdown treatment in these disparate cases should be evaluated objectively. A second matter to examine is the horrible toll experienced in residences for seniors, but this examination should not be confined to long-term care facilities like nursing homes. As an example, newspaper headlines indicate that some VA hospitals, which have large numbers of senior patients, have had disturbing rates of both infection and death.
A recent article in the New York Times noted that a bit more than a third of all deaths attributed to the pandemic, occurred “at nursing homes and other long-term care facilities for older adults.” These facilities had only 11% of America’s recorded cases. If you could play a statistical mind game and pretend that America’s senior residences and New York City and its suburbs didn’t exist, deaths from the pandemic would be reduced by well more than half. That fantasy obviously can’t be realized, but it does point to a possible approach if we have to go through another round of containment. Instead of universal rules imposed on all geographic areas, businesses and facilities equally, why not try a targeted approach? I am not the first to suggest this: tailor and adapt our remedies to our needs.
Service curtailments, or even shutdowns, in the crowded trains, subways and buses of densely populated urban areas such as New York are fully warranted; so too are cancellations of massive sporting events. Senior residences need lockdowns to the extent legally permitted in order to protect the most vulnerable among us. These are the easily identified targets. However, do we need to close all table service at every restaurant in America, or shutter the thousands of other types of businesses that have a modest flow of in and out traffic during hours of operation? Should we have categorized all businesses, wherever located, by the criteria of “essential” or “non-essential?”
I believe the effort to categorize by the standard of “essential” vs. “non-essential” was valid, but incomplete. That binary choice was the easiest and fastest to make, but in addition to deciding what was and what was not “essential,” we should have looked at business and non-business activities in the context of the probability of contamination and spread of disease. That would include location, frequency of use and an assumed degree of human interaction. Airlines, subways, public beaches and large spectator events by that standard have high interaction and need restrictions on use, but you could argue that closing down a golf course or a public park had no effect on either the spread or the containment of coronavirus. The same is true of many business activities.
The standard just suggested, if applied to business in general, would have resulted in the development of rules of use that might have permitted many businesses to continue in operation, albeit with restrictions. Restaurants and fast food outlets could have remained open for table service with x customers permitted at any one time and with social distancing rules in effect. Millions of employees would have retained their earning capacity. Many states are now beginning a cautious reopening process with similar rules being enforced.
This pandemic will end only after development and widespread use of an effective vaccine. In the meantime, let’s take a detached and austere look at what we’ve done and attempt to measure the effectiveness of how we organized our fight against coronavirus. Maybe we’ll find that the total lockdown was fully warranted, maybe not, but failing to evaluate our actions will only guarantee another painful round of economic uncertainty if the virus visits us again.