In late February, as the data on the coronavirus pandemic continued to unfold, I began making calls to friends and family to prepare them. I told them to get ready to calm down for three months. For many, then, it was difficult to believe that a virus of which we could not see evidence, less understood, would require us to shut down our economy.
I also spoke with C.E.O.s and governors, asking them to close non-essential deals and enact home stay orders to prevent the virus from spreading. Other public health advocates asked for the same – and fortunately government and business leaders responded. His actions saved hundreds of thousands, if not millions, of lives and saved American hospitals from the horrors of rationing care. Shutting down was the right policy at the time.
As circumstances evolved, so did my thinking. We survived the wave of hospitalized cases and suffered immense economic trauma. The complete blockade made sense weeks ago. But the situation is changing and more data about the virus is available to inform our next steps. The choice before us is not to block completely or reopen completely. Many argue that these are the only options.
As a doctor, I firmly believe that the main objective of our reopening strategy should be to maximize the number of lives saved. But virus mitigation can take many forms, ranging from effective to excessive. Extreme forms of mitigation can have diminishing returns. Projections of the number of deaths produced by the current economic disengagement are often politically motivated, but the effects on human life they are real.
At the end of April, the United Nations World Food Program reported that 250 million people could go hungry due to the economic impact of Covid-19. In the United States, local food banks are already congested with record waiting times. There are other serious consequences of the continuity of orders to stay at home and the prolongation of the economic interruption. Deferred health care, mental health problems, domestic violence and one of the biggest public health problems before Covid-19 in the United States – loneliness – are magnified by the shelter at home. The economic and public health damage associated with the shelter has not yet been fully measured.
At the same time, the coronavirus will persist. We must take due care in reopening, so as not to discount human life in the race to prosper. This would worsen the already worrying trends, since Covid-19 disproportionately affects disadvantaged communities dependent on public transport and in congested living conditions. Our path to reopen must protect those at high risk. The current "normal", with its economic anxiety, dizzying unemployment and social isolation, cannot continue – we must work towards a new status quo until mass-produced therapy is available.
So, how is a new and more secure status quo? It looks different in different parts of the country. Not all reopenings are created equal. Areas with continuous outbreaks or growing cases should postpone nonessential activities, and those with a declining case trend should engage in some basic practices.
We need universal masking. China previews a society reopened after a severe wave of the virus. And while the Chinese Communist Party has not been honest about handling the coronavirus, Chinese doctors and citizens have been largely transparent. I recently called some prominent Chinese doctors to ask why they believe the infection is being controlled in most parts of the country. In their clinical judgment, they believe that the main reason is universal masking.
I wore a mask most of my adult life as a surgeon and was skeptical that masks play an important role in fighting this pandemic. Most masks do not have a seal and filter to protect us from coronavirus inhalation. But that is not the only way that they work. Masks reduce the transmission of aerosol droplets to other people and to surfaces that other people can touch. They protect your mouth and nose from other people's droplets and prevent you from touching your nose and mouth.
Spend more time outside. Since April, we have learned a lot about the internal and external transmission of the coronavirus. In the beginning, we closed the parks and asked people to stay inside their homes. But studies since then, they have shown that being outdoors with adequate distance carries a lower risk of contracting the infection than being indoors. These findings have implications for restaurants and other businesses and activities capable of using outside areas. Yoga and other physical activities should be resumed outside when possible. Likewise, instead of having someone in your home for a meal, consider having a meal in the yard or in the park, five feet away.
Business must adapt. A busy consumer sector has already demonstrated how adapting to a virus mitigation approach is feasible. Most supermarkets have operated safely during the pandemic. Many do so by limiting the number of shoppers in a store, requiring masks, spacing alternating lines and registers, installing plexiglass protections, cleaning incessantly and interrupting some services, such as self-service salads. Grocery stores have strict policies so that workers with symptoms do not report to work, and some continue to pay them to avoid creating a financial incentive not to report symptoms. By following distance and hygiene standards, these companies have proven that, even at the height of the pandemic, they can operate without becoming hot spots of contagion. These practices should be expanded to smaller companies. If it is not feasible for a company, such as a cruise ship or arcade, to operate with strict distance, masks and impeccable hygiene, that company must remain closed until it is safe to reopen.
We must prioritize safeguarding nursing homes. Throughout April, several studies using antibody tests, he found that asymptomatic infections are 10 to 20 times more common than those seen previously, decreasing the true case mortality rate. The data also taught us that healthy young Americans have a mortality rate similar to that of seasonal flu. Deaths among young and healthy people are rare. (In fact, the community's immunity against seasonal viruses is usually achieved by younger people who develop antibodies.) one third of all Covid-19 deaths in the United States occurred among nursing home residents. In New Jersey, half of all deaths occurred among long-term care workers or residents. Nursing homes are often understaffed and the last in line when it comes to getting the necessary resources.
Nursing homes should not receive patients from Covid-19 unless the facility has sufficient isolation rooms and protective equipment and tests all staff and residents for coronavirus at least twice a week. In addition, hospitals should be banned from transferring patients from Covid-19 to nursing homes, a common transmission vector that has caused outbreaks in recent weeks.
Protect those at high risk. The data shows that those with pre-existing medical conditions, such as diabetes, lung disease or a weakened immune system, are among the most vulnerable. Based on the degree of risk and the prevalence of the virus in the region, we must advise these high-risk individuals, especially the elderly, to avoid interactions with others until the risk of contagion is extremely low. This approach is in line with the White House's return to work roadmap, which houses high-risk individuals until Phase 3, even though many companies are reopened.
These practices will help to optimize the public's health until there is a therapeutic solution or until the virus changes to a less virulent form. In addition to saving lives now, mastering these strategies will save lives this fall if this virus shows a seasonal pattern similar to other coronaviruses.
At first, we didn't know what we were dealing with. But now that we have better information, we must use a more surgical approach to fight the virus and minimize damage.
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