Three weeks after newly identified COVID-19 cases began falling in the United States, The New York Times is acknowledging the downward trend, which it attributes to "effective restrictions." That explanation fits neatly with the paper's reflexive enthusiasm for lockdowns, but it does not fit the data very well.
Consider Arizona, where the seven-day average of daily new cases, according to Worldometer's tallies, rose more than tenfold between Memorial Day and July 7. Alarmed by that increase, Gov. Doug Ducey ordered gyms, bars, movie theaters, and water parks to close on July 23, while indoor dining in restaurants continued at 50 percent of capacity, a cap Ducey imposed on July 11. But the downward trend in new cases, which had fallen by 82 percent from the July 7 peak as of yesterday, began well before the new restrictions could have had a measurable impact (taking into account the typical five-day lag between infection and symptoms that might cause people to seek testing). That suggests other factors are at least partly responsible for the decline.
Newly confirmed cases are also falling in Georgia, which did not respond to this summer's spike with new business restrictions. The seven-day average, which rose fivefold between May 25 and July 29, has fallen by 35 percent since then.
In Texas, the seven-day average of newly identified cases rose tenfold between May 25 and July 15. It has since fallen by nearly half. Gov. Greg Abbott closed bars and reduced the cap on indoor dining from 75 percent to 50 percent of capacity on June 26. Yet cases continued rising for nearly three weeks, longer than the maximum incubation period. The story is similar in Florida, where Gov. Ron DeSantis closed bars the same day as Abbott. The seven-day average of daily new cases peaked three weeks later, when it was nearly 16 times higher than it was on May 25, then fell by two-thirds as of yesterday.
California Gov. Gavin Newsom closed bars, zoos, and museums on July 13, when he also banned indoor dining in restaurants. The seven-day average of daily new cases peaked 12 days later, when it was nearly five times the number on May 25, then fell for two weeks before rising again. The decline resumed in mid-August, and as of yesterday the average was down 42 percent from the July 25 peak. That pattern likewise does not easily fit the hypothesis that new legal restrictions account for most or all of the decline.
California's restrictions, including a total ban on indoor dining, are more severe than the statewide limits in Arizona, Florida, or Texas, which enforce a 50 percent cap. Yet the latter three states have seen bigger declines in confirmed cases, although they also saw bigger increases in June and July.
It is plausible that limiting the options for people to get together, especially indoors in close quarters, would reduce virus transmission. But it is difficult to disentangle the impact of government edicts from the impact of increased voluntary precautions, both of which can be expected in response to spikes in cases.
Just as it is hard to assess the additional contribution of general lockdowns at a time when Americans were already responding to the COVID-19 epidemic by dramatically changing their behavior, it is hard to say how much credit relatively modest legal restrictions should get for reversing the recent surge in cases.
Given the timing of the downward trends in these Sunbelt states, attributing them mostly or entirely to new legal restrictions seems more than a little hasty. The Times alludes to voluntary changes in behavior just once in its story, citing a University of Arizona professor of public health policy who mentioned "news media coverage of the heightened risk" as one factor that helps explain the decline in cases. The implication, which the Times predictably fails to unpack, is that people responded to that "heightened risk" by being more careful—e.g., by limiting social interactions, avoiding crowds, following physical distancing guidelines, and wearing face masks in public places.
What about face mask mandates? Even if businesses were already requiring customers to wear masks, a legal requirement could help reduce disputes about those policies and increase compliance. Yet Newsom mandated masks in California on June 18, more than a month before new cases peaked in that state, while Abbott followed suit in Texas on July 2, nearly two weeks before that state's peak. Neither Arizona, Florida, nor Georgia has a statewide mask requirement, although some local governments in those states have imposed their own mandates.
"Of the states that are driving the decrease" in new cases, the Times says, "all have at least some local mask mandates, and most have paused or reversed statewide reopening policies." That gloss, which dismisses the absence of statewide mask mandates, elides the difference between imposing restrictions and delaying their removal, and ignores the states without new restrictions, makes the Times seem desperate to credit government policies for positive trends that ultimately depend on how people decide to behave.
Granting that legal restrictions have some impact on virus transmission, the extent of those restrictions is still a matter of controversy, given their substantial costs and uncertain benefits. The Times describes a "flattening" of the COVID-19 curve in states where restaurants are still serving customers indoors, for example. Does that mean Newsom went too far by banning indoor dining? Is there an important distinction between bars and restaurants, as DeSantis, Abbott, and Ducey seem to think, or is that premise dangerously mistaken? One thing seems clear from recent COVID-19 trends: The curve can be flattened without general lockdowns, without statewide mask mandates, and even (as in Georgia) without new, post-lockdown restrictions on businesses.
In all of these states, the decline in new cases has been followed by a decline in daily COVID-19 fatalities since earlier this month. Nationwide, according to Worldometer's numbers, the seven-day average of daily new cases, which exceeded 69,000 on July 25, had fallen to about 43,000 as of yesterday. The seven-day average of daily deaths fell from nearly 1,200 on August 4 to fewer than 1,000 yesterday.
Independent data scientist Youyang Gu, who has a good track record of predicting COVID-19 fatalities, is currently projecting a nationwide death toll of about 227,000 by November 1, compared to about 176,000 now.
Is that number lower than it would have been without last spring's lockdowns, and will the ultimate death toll likewise be lower than it otherwise would have been? On that question, the Times seems to be hedging.
In late June, the paper noted that "the shared sacrifice of millions of Americans suspending their lives—with jobs lost, businesses shuttered, daily routines upended—has not been enough to beat back a virus whose staying power around the world is only still being grasped." The implication of that story was that lockdowns were lifted too soon and too quickly. But since the sweeping social and economic restrictions that most states imposed could not feasibly have been sustained until effective vaccines were deployed, it was inevitable that we would eventually face the situation we now confront.
The virus is still here, as everyone knew it would be. And to the extent that lockdowns were effective in reducing transmission, they left a population more vulnerable to infection than it otherwise would have been. In this context, it makes sense to concentrate on protecting Americans in high-risk groups rather than younger, healthier people who face a negligible risk of dying from COVID-19.
Recent data suggest we have had some success on that score. Even as cases spiked this summer, the nationwide crude case fatality rate—deaths as a share of confirmed cases—continued to decline, dropping by nearly 50 percent since mid-May. That trend largely reflects a younger, healthier mix of patients. The key to minimizing the death toll while we wait for a vaccine is preventing new cases among older, frailer people. The debate should focus on the best ways to do that rather than recriminations about what went wrong with lockdowns. And in weighing our options, it would be foolhardy to assume that government policy is all that matters while overlooking the crucial role of the decisions that each of us makes every day.
The report sheds light on two prerequisites—in the absence of a COVID-19 vaccine or a cure—that countries need to have in place to succeed at turning back the virus.
No. 1: Adequate Testing Ability
If there’s no way of knowing who has the virus and can spread it to others, preventing its spread is much more difficult.
Those carrying the virus have to be identified through the use of adequate testing.
That means not only that tests have to be plentiful enough to be used whenever a coronavirus case is suspected, but also that the tests have to be administered correctly. And there must be enough medical resources in a country to process the tests rapidly for the entire course of the pandemic, especially in its early days.
One reason Iceland and South Korea—two countries The Heritage Foundation’s special report covers—were able to escape a wider-scale outbreak, such as the one that currently rages in the United States, is because Iceland and South Korea tested abundantly right off the bat.
Everyone who was suspected of possibly carrying the virus was given a test, and the test results were processed quickly.
In the United States, the prerequisite of having enough testing capability in the early days of the pandemic did not exist because of bureaucratic layers of counterproductive regulations.
One of the main reasons that the United States had difficulty engaging in mass testing early on in the pandemic was that excessive regulation made it very difficult to produce a sufficient number of test kits.
Specifically, the Food and Drug Administration (FDA), which has a lengthy approval process to bring any test to market, initially granted emergency use authorization (EUA) only to the Centers for Disease Control and Prevention (CDC) to develop and perform COVID-19 tests.
Although universities and the private sector were anxious to develop tests early on, the FDA and CDC warned these entities not to perform their own testing without FDA authorization.
Aside from the fact that the first batch of CDC test kits were faulty, the cumbersome process associated with getting FDA authorization prevented the U.S. from having a [usable] supply of tests.
The bureaucratic hurdles that in normal times are costly, time-consuming, and just plain annoying to doctors, hospitals, and other medical professionals can be downright dangerous when they undercut rapid responsiveness in a national emergency and pose risks to public health and safety.
No. 2: Places to Recover
There should be places where infected individuals can go to recover where they are apart from the noninfected population.
Contagious people carrying the virus who are identified through testing need to be able to live apart from the noninfected while they recover from their illness.
Many elderly residents were exposed to the virus when these contagious COVID-19 patients did not leave the facilities, and many thousands of New Yorkers died as a result.
Cuomo later expressed “shock” that 66% of New York hospital admissions related to the virus were those who were adhering to the government order to stay in their own homes and “not venture much outside.”
It shouldn’t have shocked anyone.
Staying in one’s home if no one living there has the virus is one thing, but why would the government and its experts order people to do so when no one knows whether others there are sick with COVID-19 or even when other residents are known to be infected?
It can only be chalked up to one of the all-too-frequent failures of conventional wisdom.
The coronavirus spreads most easily indoors and when contact is made with infected persons for longer than brief meetings. Government mandates to stay home with other people who are contagious only make sense if the goal is to have people catch the virus.
With that in mind, Heritage recommends having facilities known as “isolation centers,” where those who have the virus—but who do not require hospitalization—can go voluntarily and live apart from the uninfected population until they recover.
Excess hotel capacity and other such places may be repurposed as isolation and care facilities. Participation should be voluntary, and policymakers may want to undertake education campaigns to encourage people to use these facilities to protect their families from the pathogen.
The foundering hotel industry could be utilized to designate some hotels as isolation centers, where those whose symptoms are not life-threatening can stay voluntarily until they are no longer shedding virus.
The cruise ship industry also might be interested in participating by allowing some of its docked cruise ships to be used as isolation centers.
The Heritage special report advises the Trump administration and state governors to discuss with private insurance companies—as well as with the Centers for Medicare and Medicaid Services—the idea of reimbursing patient stays in isolation centers, as they already do for many other medical treatments and procedures.
It would be a surprise if the insurance companies pushed back against this idea. After all, preventing more COVID-19 cases would save health insurance companies money by causing fewer medical insurance claims to be filed. And those infecting others in their own homes often infect family members who are on the same health insurance plans as themselves.
The cost of covering one person’s lodging in an isolation center, rather than being on the hook for the COVID-19-related bills of an entire family, is naturally a preferred choice for a private insurance company and saves taxpayer dollars spent on Medicare and Medicaid.
No one wants to infect others in their family with the potentially deadly coronavirus. With isolation centers available, those with COVID-19 would voluntarily use them, and the languishing hotel and cruise ship industries could use the business.
Stemming the pandemic with private sector funds and resources is in the best interests of all.
Conventional wisdom need not be consulted.
