One month ago, I asked epidemiologist Tara Smith if she was worried about states loosening their stay-at-home orders, despite most not meeting the government’s criteria for doing so.
“I am really fearful that by June 1 or June 15, after we’ve seen a couple weeks to a month of [state reopenings], that our cases are going to be climbing,” said Smith, a professor at the Kent State University College of Public Health.
Well, here we are. It’s June 12, and Covid-19 hospitalizations are rising in Arizona, the Carolinas, Utah, Arkansas, Texas, Tennessee, and perhaps Florida. Those states are also seeing higher numbers of positive Covid-19 tests, as well as increases in the percentage of tests that come back positive. This indicates that the higher case counts aren’t simply due to more widespread testing finding milder cases.
Call it a reopening backfire. But really: No expert thought that reopening this quickly was going to work in the first place.
“This is totally predictable”
Many states opened up in early May, hoping the economy would recover while a winning battle against Covid-19 continued apace.
Unfortunately, it’s now clear that in the areas where the virus has come roaring back, few gains against it were made in the last month.
“We managed to disrupt our economy [and] skyrocket unemployment, and we didn’t control the damn virus,” said Jeff Shaman, an infectious disease modeler at Columbia University.
States reported ~20k new cases again today.— The COVID Tracking Project (@COVID19Tracking) June 11, 2020
The 7-day average of new cases has been between 20-23k cases for nearly a month. But the outbreak has shifted south and west. pic.twitter.com/Rk6zPi1mV0
“This is totally predictable, and there have been many warnings,” Sarah Cobey, an infectious disease modeler at the University of Chicago, said. “We’re seeing undeniable signals that prevalence is truly increasing in many states.”
Simply put, reopenings have led to more infections because more people are coming into contact with each other while there’s still a lot of virus around. Mask use is inconsistent, and even when they’re worn properly, masks are not 100 percent effective at preventing transmission.
Most concerning, Cobey said, is the increased hospitalization rates in these states — a reminder that the virus can be very severe and deadly for some, and that deaths could also start climbing soon. “It’s a lagging signal, so what it’s really telling us is how transmission rates were changing closer to two weeks ago,” Cobey added. “This implies that unless behavior — the primary driver of transmission — has changed in the meantime, the situation will continue to worsen for another few weeks.”
It’s too soon to know what impact the mass protests against police brutality will have on the pandemic. (Many protesters know the risks and have thoughtful reasons for participating anyway.) The spikes we’re seeing now result from actions and decisions that likely predate them.
How bad might things get in Arizona and other states? We don’t know yet. It might not be a disaster. These states could avoid the worst-case scenario of hospitals being overwhelmed and keep the epidemic curve from spiking to uncontrolled levels. Still, more cases likely means more deaths — some of which could have potentially been avoided.
Overall, though, the trends are not moving in a good direction, and we have yet to see the full Covid-19 consequences of reopening.
Not every place that’s reopening is seeing spikes. Scientists aren’t sure why.
Ending or loosening lockdowns hasn’t led to Covid-19 spikes everywhere.
Georgia was one of the first states to reopen businesses, like barber shops, on April 30. Since then, its Covid-19 cases have more or less remained flat.
“Why didn’t Georgia go through the roof? And the answer is, ‘We don’t know,’” Shaman said. The pandemic is “a real patchwork” in America, he added.
Similarly, Smith said she is “a bit surprised that Ohio is doing as well as we are since reopening.” Maskless armed protesters showed up at the Ohio Statehouse for three weeks to demand that the governor allow businesses to reopen. “We don’t have all the data right now to determine why some [areas] have increased and others have not,” she said. It could depend more on how individuals behave — for instance, whether they’re wearing masks — than on any broad policy the state may enact.
Scientists are still unraveling what makes the difference between a sprawling outbreak in one city and a more manageable one in another. Some factors are policy, demographics, structural inequality and racism, and individual behavior. And some of it is just luck.
It’s important to remember: Though scientists can’t precisely predict which areas will be hit hardest by Covid-19, they do understand the conditions under which the virus thrives. And so they can predict, broadly, when social distancing isn’t replaced with another safeguard, cases will increase.
The main ingredient that leads to increased cases is more people being in close contact with one another out in public. “I believe the increases we’re seeing in places like Arizona are likely the results of easing social-distancing restrictions too soon,” Eleanor Murray, a Boston University epidemiologist, said.
These new spikes in cases appear to be occurring in places that have largely avoided the worst coronavirus outbreaks so far. But it’s important to remember that even hard-hit places like New York could still see new waves of infections. There are still so, so many people out there who are not immune to the virus.
Is this a “second wave”?
In the US, overall cases have been dropping slowly. But a lot of that is due to the initial huge crisis in New York subsiding, obscuring the emergence of new hot spots.
What’s happening now in Arizona and elsewhere is the continuation of the first wave, or the first wave in those areas.
Nationally there’s no “second wave.” There’s one long wave. We’ve been in a plateau of around 20,000 cases and 1,000 deaths a day, largely among minority and vulnerable populations. Reopening will cause spikes, but calling them a second wave denies the reality of what’s going on. pic.twitter.com/ivutKKYgF9— James Hamblin (@jameshamblin) June 11, 2020
But “waves” might be the wrong metaphor to describe what’s going on.
Instead, I imagine a bunch of nuclear reactors spread out across the country. Control rods have been taken out in many of these reactors without being replaced by new controls, and the reaction grows. This disaster is maybe more like Chernobyl and less like a tsunami. It’s our actions — both collective and individual — that determine the results.
Ultimately, there’s no quick, snappy metaphor that really gets at the complexity of how the virus spreads. But at the same time, the story is simple: When you don’t do enough to stop people with no immunity from getting infected, transmissions occur.
Experts never said that eternal lockdowns were the only choice we had to combat the pandemic. They argued that once areas got the initial case spikes under control through widespread social distancing (with new cases decreasing over at least a two-week span), a new phase of control should begin with widespread testing and contact tracing. The initial lockdown period avoided the worst possible scenario, but the US didn’t use that time to prepare for managing the pandemic in the future. And now we’ve wasted the weeks that have passed since reopening.
“As prevalence rises, the demands on contact tracing increase too, because there are more cases to track,” Cobey said. “At some point it becomes more practical for governments to institute blanket interventions to reduce prevalence.”
That is, we may have no choice but to enter lockdowns again. The scary thought: What if states or businesses aren’t willing to do it? How many people will die? How many hospital systems will be overwhelmed?
Too many communities and states “are acting like we’re done with it,” Shaman said of the pandemic. “And we’re nowhere near done with this.”