The U.S. Is in a Pandemic Freefall. Why Isn’t There a Federal Lockdown?
By: Dana G Smith
Tags: Public Health, Covid 19, Health, Science, Coronavirus

The U.S. Is in a Pandemic Freefall. Why Isn’t There a Federal Lockdown?

Message from experts is ‘you’re on your own’

A health care worker talks to a person waiting in their car at a coronavirus testing site at Ascarate Park on October 31, 2020 in El Paso, Texas. Photo: Cengiz Yar/Stringer/Getty Images

The United States is in a state of pandemic freefall, and we’ve already used up our parachute.

Coronavirus cases are surging uncontrollably with rates higher than they’ve ever been. Nearly every day last week broke the previous day’s record, with more than 170,000 people testing positive for the virus on Friday alone. Hospitalizations are also increasing, surpassing numbers from the spring and summer peaks with no indication of slowing down. And after hospitalizations come deaths, rising for five straight weeks and on track to reach their highest number since July any day now.

Countries in Europe, including France, Germany, and the U.K., re-enacted nationwide restrictions in October for case numbers a fraction of the United States’. But despite the dire state the U.S. is in, experts say you shouldn’t expect a national lockdown any time soon, or potentially ever again. There have been some local exceptions made recently — Oregon, New Mexico, Michigan, Washington, and Chicago started temporary, targeted stay-at-home orders — but these will likely be the exception, not the norm.

The reason is primarily economic. In March, the federal government passed the CARES Act, which offered $2 trillion to individuals and businesses to offset the economic impact of the pandemic. But efforts to renew the bill have stalled in the Senate for months, and hope for a new stimulus package during the last months of the Trump administration is shrinking. Without that support, the financial consequences of another round of stay-at-home orders could be dire.

“People can’t just be expected to stay home indefinitely and not be able to support themselves or feed themselves or their families.”

“It’s really hard to ask people to [shelter in place] without support from the federal government to help people get through it,” says Angela Rasmussen, PhD, an affiliate member of the Georgetown Center for Global Health Science and Security. “What we would need for a nationwide lockdown is full support for small businesses. […] We definitely need a moratorium on evictions, but potentially also rent relief. And we need to expand unemployment and access to health insurance.”

“People can’t just be expected to stay home indefinitely and not be able to support themselves or feed themselves or their families,” she adds.

It’s not an on-off switch, it’s a dimmer

Without financial support from the federal government, state governors have to weigh the economic ramifications of a lockdown with the public health toll of a virus spreading out of control, although it should be said there will be no normal economy — or normal life — until the pandemic is under control.

Instead of taking an all or nothing approach, Céline Gounder, MD, a clinical assistant professor at the New York University Grossman School of Medicine and a member of President-elect Joe Biden’s coronavirus advisory board, recommends enacting targeted restrictions on high-risk businesses, such as indoor dining, bars, and gyms. A recent study using cell phone data to track people’s activities, matched with local coronavirus case information, showed that restaurants were by far the riskiest place for contracting SARS-CoV-2, followed by gyms, coffee shops, and hotels.

“I really don’t like the expression ‘lockdown.’ I think that that is misleading and makes it seem like this is a binary decision or an on-off switch,” Gounder says. “It’s really a dimmer switch or dial where we’re talking about tightening up or loosening up depending on what’s happening in a particular community.”

Like Rasmussen, Gounder says that support has to be made available to people whose businesses would be affected by new restrictions. “Do we need to put a pause on indoor dining at this moment? Yes, I think it is absolutely critical that we be doing that in much of the country,” she says. “Should we be figuring out ways to support small business owners, including restaurant owners, during this period? Yes, that’s also part of the puzzle. How do we support people working in those restaurants so that they’re not bearing the brunt of the burden?”

“Everybody picks on indoor dining, but I think in the epidemiology now, it’s more indoor dining in your home, not indoor dining in a restaurant, where people are getting infected.”

Message from experts is ‘You’re on your own!’

There is also mounting evidence that a large proportion of the new cases are coming not from public venues but from private get-togethers in people’s homes. As a result, other public health experts are saying that personal responsibility needs to play a larger role in controlling this third wave of the pandemic.

“Everybody picks on indoor dining, but I think in the epidemiology now, it’s more indoor dining in your home, not indoor dining in a restaurant, where people are getting infected,” says Amesh Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security. “That becomes much more challenging because there’s not any way that public health can reach into people’s homes in that manner.”

Instead of waiting to be told not to go out, people need to be more vigilant about their personal protection now. That includes all the recommendations public health officials have been repeating since the beginning of the pandemic: wear masks, avoid crowds, stay outside, pay attention to ventilation, wash your hands, and disinfect high-touch surfaces. It also means forgoing indoor events with people from outside your household, like Thanksgiving.

“I think that we are looking at a situation where people are just going to have to do the best they can,” says Rasmussen. “In the absence of a coherent federal response, all we can really do is continue to encourage people to take those measures in their own lives as they are able to.”

“Personal responsibility and the voluntary compliance with pandemic measures is not very high in the United States compared to other places,” Adalja adds. “The only thing that’s really on the table now is stronger public health communication to get people to be able to start behaving as if we’re in a pandemic.”