Editor’s Note: Every Wednesday, James Hamblin takes questions from readers about health-related curiosities, concerns, and obsessions. Have one? Email him at [email protected].
Dear Dr. Hamblin,
I’m an American living in Germany, and I’ve been following how some people in the United States have opposed lockdowns due to fears about “shutting down the economy.” It seems to me that even to those who believe the economy is what matters most, having a complete national lockdown for a few weeks is economically better than what the U.S. is going through now. Should the U.S. have done that? And is it too late?
Perhaps the least enviable status of any country during the pandemic is indefinite limbo—in which economic and physical suffering remain high, and no end is in sight.
It happens when a country has an outbreak, haphazardly and incompletely shuts down, and then attempts to reopen without changing much of what allowed the virus to spread in the first place. The country is divided over the false binary of financial and health security. The reopening is not enough to ensure economic prosperity, but the restrictions are also not enough to contain the virus and prevent needless death.
This is where the U.S. finds itself right now. Most of us are still making compromises in daily life, severely limiting our social interactions. At the same time, many businesses are struggling, in part because they are only partly open. Limitations on the number of people who can enter a store or sit down at a restaurant allow for businesses to continue operating, but with less revenue. Yet, as they are open, governments justify easing up on safety nets meant to help them get through the pandemic. Consumers are still going out less and spending less than usual, and unemployment remains higher now than at any point since 2011.
But despite all these sacrifices, the U.S. also has nearly 40,000 new coronavirus cases a day, far more than many other industrialized countries. The virus continues spreading so widely and insidiously that some hot spots are impossible to discern while they can still be contained. A preliminary analysis of one August biker rally in Sturgis, South Dakota, for example, suggested that the gathering may have led to some 266,000 infections and at least $12 billion in health costs. Given limited data and testing, it’s difficult to know precisely. In much of the country, contact tracing is essentially used to construct maps after an outbreak. It is a palliative measure rather than a preventive strategy.
In an attempt to end the limbo, some experts have proposed that a “second shutdown”—for part or even all of the United States—could save money and lives. Though far from the only way forward, this would mean reattempting what we didn’t manage to do in the spring: Lockdowns that are precisely implemented and coordinated, in which nonessential businesses are closed and people are ordered to shelter in place. Instead, we had a patchwork of shutdowns determined by cities and states as they saw fit (or didn’t). A “second shutdown” would not mean that the entire country is under the same directives, but it would mean that everyone is operating from the same playbook.
As case counts once again creep up, a “second shutdown” might be the pandemic equivalent of calling tech support and describing an elaborate problem with your computer only to hear in response: Have you tried turning it off and turning it back on again? The goal would be to essentially wipe the slate (nearly) clean. Hypothetically, if everyone were truly, absolutely sheltered in place for several weeks, the case count would drop to zero. The closest real-world example would be China, or to a lesser extent, places like Germany, where shutdowns have led to major drops in caseloads.
The shutdown would end when we are able to implement widespread testing and tracing to contain cases before they turn into outbreaks. The value of such a measure is entirely contingent on the quality of the plan for how to emerge from it. The plan cannot be to hope that that virus goes away and then to simply go back to what we were doing before.
A more successful shutdown wouldn’t likely mean closing down the whole country at this point. That would be a dire move, and feel especially unnecessary in a place such as New York City, which was once the global epicenter of the outbreak, but after months of intense measures, now seems to have contained the virus. But if cases keep going up elsewhere, an effective shutdown may affect swaths of the country for several weeks at a time. That would require federal, state, and city governments to work in tandem, and Americans to trust them. It would require financial reassurances that businesses and their workers could survive the shutdown. It would require ensuring that Americans have health-care coverage should they test positive, so there would be no incentive to avoid testing and reporting cases.
Because of failures on each of these things, the U.S. was unable to coordinate an emergency response between states and cities and prevent the virus from taking hold everywhere. Some places entirely shut down while others continued to hold mass gatherings. Even though the federal government spent trillions of dollars supporting businesses and people who lost their jobs, its actions were temporary, and didn’t go far enough: From March to April, unemployment rose from 4 percent to more than 14 percent, the biggest jump since the Great Depression. Even if a better-orchestrated series of shutdowns might ultimately save us money and lives, the political and emotional will to do it again are unlikely, especially so close to an election.
But shutting down doesn’t have to be as economically damaging as it was to the U.S. Countries such as Denmark were able to do so without the same massive jump in unemployment by ensuring that people stayed financially secure. In theory, a shutdown should cost a country a lot of money in the short term, but cost less than limbo in the long run, which prolongs our return to anything resembling normalcy. The U.S. didn’t operate under this framework in the spring. A more deliberate process could have discrete promises about how long the shutdown would last, and exactly what kinds of support could be counted on, from day one. It could even involve a week or two of advance notice.
At a fundamental level, what stands in the way of such a move is the American tendency to see shutdowns as breaches of personal liberty. Individuals would have to be willing and able to isolate themselves after high-risk contacts, to resist our innate temptation to flout restrictions, and to submit to tracing and monitoring at a level that Americans don’t seem likely to tolerate in the same way that other citizens have. But the current state of half-shutdown limbo is also not exactly freedom either, and every way to break out of it will involve an idea of freedom that is collective rather than individual. A shutdown is a bitter pill at any time, for everyone. We are all weary of isolation and uncertainty. Going through another round of shutdowns would feel too excruciating for many to consider.
Even if it might be a prudent path forward, a large-scale shutdown is not inevitable in the U.S., nor is it likely. Instead, by every indication, we will choose to persist in limbo. Still today, nine months into the pandemic, after losing some 190,000 lives, our overall approach is to do more of the same. When we are already fatigued and economically shattered, leaders have every incentive to tell people that the end is right around the corner. Our limbo only ensures that it is not.
“Paging Dr. Hamblin” is for informational purposes only, does not constitute medical advice, and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. By submitting a letter, you are agreeing to let The Atlantic use it—in part or in full—and we may edit it for length and/or clarity.