Are More Lockdowns Inevitable Or Can Other Measures Stop The Surge?

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25 Ноя 2020, 01:45

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Some states have imposed lockdowns to slow the spread of coronavirus, while others are issuing more limited restrictions. California is among states that are trying curfews to curb transmission.

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Health care workers treat patient who tested positive for coronavirus in the emergency room at Providence Holy Cross Medical Center in Los Angeles, Thursday, Nov. 19, 2020. California is imposing an overnight curfew on most residents as the most populous state tries to head off a surge in coronavirus.

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With new infections rising all over the country, states are struggling to slow the spread and testing can barely keep up. People line up outside a Covid-19 testing site in New York on November 11, 2020.

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«For places in the Midwest and the Upper Plains where the virus is sort of everywhere, it’s going to be very hard to use testing to target our interventions,» Gonsalves says.

Lacking local data, communities can learn from research and the experience of their neighbors. Here’s what research and experts say about the effectiveness of common restrictions and mandates.

Mask mandates: There’s unanimous support for these among researchers. It’s clear that such mandates curb the growth of the virus, and even some governors, such as Iowa’s and North Dakota’s, who spent much of the pandemic refusing to issue one, have relented as their hospitals near crisis. More than a dozen states still don’t have universal face mask mandates.

Curfews: Experts have mixed views on these. In states like New York and Massachusetts, late-night curfews are aimed at the most high-risk settings, including restaurants and bars. Much of California is now under a curfew between 10 pm and 5 am. State health officials said that will cut down on nighttime social activities, when people let their guard down and may spread the virus.

Ohio’s curfew baffled some public health experts: «I haven’t met a single public health official who thinks these types of curfews/10pm shutdowns will be particularly helpful,» tweeted Tara C. Smith, a professor of epidemiology at Kent State University, in reaction to Ohio’s curfew.

This kind of curfew may help bring down cases in the short-term, says Indiana University’s Ana Bento, but would need to be in place long-term to truly decrease transmission.

Limits on gatherings. Research shows superspreading events play an outsized role in the transmission of the coronavirus, including weddings, funerals, choir practices and other similar communal events. Some states, especially those that have resisted closing businesses, have enacted measures limiting the size of such gatherings or banning them outright.

And some have left in exceptions that appear to contradict their other policies. Indiana has exempted religious services from its rule on crowd limits, even though multiple outbreaks have been linked to places of worship.

Closing (or limiting capacity) at restaurants and bars. This appears to be the «single, most effective social distancing order,» according to preliminary research from Harvard and Google.

Another study found that reopening full-service restaurants was «particularly risky,» along with fitness centers and places of worship. Using cell phone location data from the Chicago area, the researchers showed that capping maximum occupancy at 20% in these most high risk settings could cut down new predicted infections by 80%.

But some experts say limiting the numbers of people is probably not enough when people are indoors, where the risk of catching the virus goes up substantially.

«We should certainly shut down restaurants and bars first before anything else,» says Don Milton, «Not just cutting back, but shutting them down.»

Closing down K-12 schools. This is a particularly contentious measure. Recent research suggests that schools are not leading to large outbreaks as initially feared and may be able to stay open safely, but there are still substantial risks if there is rampant community spread. After keeping schools open for a fraction of students, New York City has again halted in-person learning because the city has surpassed a COVID positivity rate of 3% — a threshold agreed upon by the teachers union when schools restarted.

Perils of the scattershot approach

For all these restrictions, says Bento, there could be «race to contact» when the policies are relaxed and people are eager to start interacting again.

«While these work short-term, if they aren’t implemented for a long enough time to truly decrease transmission, once they are relaxed there will be a rebound of cases,» she says.

With the virus spreading at record speed, it’s still far from clear that even data-driven, tailored approaches will work, given the enormous reach of the virus and the coming holiday travel season.

Ultimately it’s like there’s a fire raging, but you’re only able to douse the spot fires and wait for help.

«We are putting out fires as they happen,» says Bento. «This is not a long term solution.»

She and other experts say what’s really needed is widely accessible rapid testing, a robust system of contact tracing and eventually the vaccine.

There is progress on some of these fronts, but the pandemic is moving at a breathtaking pace and the health care system is already starting to buckle under the growing number of patients.

Some public health experts say the U.S. may not be able to afford to wait for those interventions to be ramped up.

«I do think a shelter-in-place order is probably what we really need right now,» says Columbia University epidemiologist Jeffrey Shaman.

NPR’s Nurith Aizenman contributed to this report.