The Perfect Strategy to Fight Covid-19 Is … Everything?

The pandemic has changed—and it’s worse than ever.

Cases of Covid-19 are spiking in nearly every state. The statistics are grim. With more than 100,000 new cases and 2,000 deaths every day, hospital intensive care units are filling up everywhere. It’s an entire country of New-Yorks-in-April. And yet Covid skepticism—over how to fight the disease, and sometimes even the reality of the disease itself—remains a hallmark of right-wing politics.

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There’s a light at the end of the tunnel—vaccines may well be available to millions of people before the end of the year. That’s a scientific triumph, to be sure, but meanwhile, we’re still in the tunnel. Manufacturing and distribution challenges mean that it’ll take until at least June 2021 to vaccinate everyone, according to the head of logistics for the government’s vaccine-goosing Operation Warp Speed program. Until then, the same public health measures that slow the spread of the virus—curve-flattening “non-pharmaceutical interventions” like mask-wearing and canceling gatherings—remain the only tools in the toolbox.

So policymakers and leaders have a stark choice: Force everyone, again, to abide by effective but potentially onerous public health measures, or let hundreds of thousands of people die. It’s a tougher choice than it sounds. Anti-“lockdown” rhetoric and a year of stress has ground people down emotionally and nuked the economy. Plus, it’s a basic tenet of public health that abstinence enjoinders and shame don’t work. If curve-bending efforts aren’t politically and socially viable, they’ll fail—and hundreds of thousands of people will die. As Mike Ryan, executive director of the World Health Organization Health Emergencies Programme, said at a press conference last Friday: “Those countries currently in the fight of their lives, you have got to stick with this. You’ve got to try and control this transmission, or your health systems will not be able to cope.”

What you’d really like to know here is which specific interventions give the most bang for the buck, the greatest reduction in disease transmission with the lightest possible touch on the social fabric and the economy. Is it … a mask mandate? Closing bars and restaurants? Closing schools? Temperature checks at building entrances? It would be very, very good to know this, because all of those things have benefits, but also costs. But scientists and public health experts don’t have answers. They know these things work in the aggregate, but not how they overlap and synergize, how behaviors change in response to new rules, and how politics and sociology affect adherence.

That’s why nothing seems to make sense today—indoor dining open, places of worship closed; outdoor playgrounds closed, gyms open; outdoor dining areas open then closed; curfews implemented on bars. In many countries, early measures combined with financial support and rigorous testing, tracing, and isolation programs squashed the disease. The US and Europe did some of the first thing and almost none of the others, dooming those places to a bloody oscillation: Cases spike, lockdowns come, economies and mental health crash, places reopen, cases spike, repeat. And now, well, we are where we are.

In the initial months of the pandemic, everybody blew it. “Ideally, you want interventions that have maximal effectiveness with the least social and economic downside,” says Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University. “That’s the rational way of doing it. But there’s been no rationality around fighting this pandemic, particularly in the United States and Europe.”

Public health experts know, in the broadest terms, what measures will bend the curve, but the science of it is really more of an art. Every country around the world rolled out roughly similar sets of public health interventions to fight Covid-19 in roughly the same order, at roughly the same moments in their encounters with the disease. According to research led by Thomas Hale at the Blavatnik School of Government at Oxford, most countries started communicating to their citizens in February about the potential problems to come, and instituted border controls even before they had confirmed cases. About 25 days later, in mid-March, countries started canceling public events and closing schools, and then closing workplaces five days after that. Four days after that, on average, came stay-at-home orders and public transportation closures—lockdowns.

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