We are still months, if not years, away from a vaccine that will protect people. Furthermore, once the vaccine is safely developed and has passed through rigorous testing, coordinated a global vaccination program will be the largest public health project in the history of humankind.
Until that vaccine is developed, shutting down economies is the most effective way of stopping the spread. Countries and states that shut down their economies quickly had fewer deaths because of the pandemic, while those that waited saw more deaths.
When restaurants were only operating on a takeout basis, wait staff lose their jobs. When people could no longer go to a spa to get a massage or other non-medical procedure, the workers get furloughed. The upside is that the workers and customers are much safer, but the toll has been enormous.
Millions of workers have been furloughed, meaning that they are temporarily unemployed but expect to return to work when their workplaces reopen. But many workplaces have already been unable to survive the shutdown and will have to close permanently.
Current levels of unemployment are higher than at any point in American history since the Great Depression of the 1930s. The federal government has authorized billions of dollars in funding for unemployment payments and relief payments to help keep the economy afloat.
However, an extended period of such high unemployment, as we are currently seeing, will have economic reverberations that will last years. Many states are concerned about the long-term effect of so many people being out of work, and the governors and legislators are eager to reopen their economies.
Most people who have not been furloughed or laid off are now working from home. Though they are fortunate to have a job, many have the responsibility of caring for children home from school.
Schools across the country closed in March since schools are exceptional places for pathogens to spread. To stem the spread, children were sent home. While many schools provided online lessons, parents became full-time caregivers and had to become fully responsible for their children’s education.
There is no understating the impact of children all across the country being out of school for so long. High school and college seniors did not get to have graduation ceremonies. Many missed critical periods of learning that were necessary to prepare them for the next grade level.
When children return to school, they will almost certainly be behind. Teachers will be spending time helping the students make up what they missed during the time that they were home. Making up the learning will be the natural part. Helping so many children deal with a collective trauma will be the hard part.
Schools across the country (and all across the world) will probably reopen on a modified basis in the fall to make the problem worse. Class sizes will be significantly smaller to allow for social distancing so that schools do not have to shut down again.
To accommodate smaller class sizes, many schools are contemplating having students attend every other day or every other week. It means that children will be doing hybrid learning online, and some of it in the classroom. Nevertheless, there are additional consequences for schools not fully reopening.
Working parents across the country have had to deal with the staggering weight of not having childcare. Many essential workers – grocery store workers, sanitation workers, bus drivers, and healthcare professionals – have had to continue working without adequate childcare.
Other parents, who are working from home, have been struggling to get their work done while also homeschooling their children. The burden has been immense, and working parents are unsure of their situation if their children cannot return to school full time in the fall.
With high levels of unemployment, essential workers not having access to childcare, children out of school, and public spaces being open only on a modified basis, economies have been stretched as far as they can go.
Governments have been working to help those affected by the economic fallout, by offering relief payments, preventing foreclosures and evictions, and providing other assistance. But freezing the economy in place, which has been the strategy for many governors, can only do so much to offset the long-term repercussions of the economic shutdown.
Parents who have not had the responsibility of caring for their children 24/7 are exasperated (and more appreciative of their children’s teachers than they have ever been). People who have been stuck at home with each other for months are finding their relationships strained.
Many have been growing restless. To make matters worse, there has been no shortage of conspiracy theories to fan into flames public unrest over economic shutdown. Even those who do not fall for conspiracy theories just want to get back to work and move on with their lives.
In May, states began taking the first steps to reopen their economies after being closed, some for six weeks or longer. Some states, such as New York (which saw the worst outbreak and had the highest number of deaths), are more timid and cautious.
Others, such as Georgia and Florida, have reopened beaches and other public places with few to no requirements on methods such as social distancing and wearing a mask, both of which have been proven to contain the spread of the pandemic.
There’s a well-founded concern that some states have been too rash in their efforts to reopen their economies and that they’re opening the doors to a second wave. If people can attend mass gatherings once again, then one infected person, even if he or she is asymptomatic, will spread the illness to many people present.
Those people will then spread it to their families and others that they come into contact with. Pretty soon, a second wave will hit, and hospitals will be overwhelmed with patients that need ventilators.
Understanding the way that a virus spreads is critical in developing methods to contain it. While HIV, the virus that causes AIDS, presented a substantial public health emergency in the 1980s and 1990s, it does not spread nearly as quickly as this one.
HIV spreads through bodily fluids that move from one infected person to another person. This particular one, however, is airborne. It spreads through the water droplets in coughs or sneezes of infected people, even if they are asymptomatic, and can infect dozens of people nearby.
When people are in close contact with each other, they are at a much higher risk of contracting it. Even if they do not become sick, they will likely spread it to their friends, family members, and other people they come into contact with during that time.
Social distancing, especially in public places, is the best way to prevent contracting the virus and spreading it. People need to wear masks when they are around other people; if everyone out in public wears a mask, then people only have a 1.5% chance of contracting the illness.
Workers whose jobs require them to be in close contact with their colleagues are at particular risk for contracting it, especially when they do not have PPE (personal protective equipment) to shield them. Meat-packing plants are a prime example of workplaces that require close contact.
Meat-packing plants throughout the country have seen high levels of outbreaks and deaths among workers. For workers to be able to do their jobs safely, they need access to PPE as well as the ability to distance themselves from their colleagues socially.
In April 2020, the Smithfield meat-packing plant in South Dakota made the news because hundreds of its workers became infected. Nearly half of all cases in South Dakota were workers at the Smithfield plant who contracted the virus at work.
Tragically, some of the Smithfield workers died after becoming infected. The only way to prevent outbreaks, such as this one, is to provide workers with access to the PPE that they need and ensure that they can remain six feet apart from their colleagues.
These kinds of measures are unfeasible in many places, and in others, they have not yet been implemented. PPE has been in short supply since hospitals have been in desperate need of it to protect front-line healthcare workers. Most people outside of healthcare have been relying on homemade cloth masks to protect them.
But some workplaces have not yet implemented policies that would provide adequate protection for employees. For example, the Smithfield plant did not provide proper cleaning and sanitation and did not enable employees to distance themselves socially. Amazon warehouses and many other workplaces have faced similar criticisms.
Workers who cannot safely return to work, desperate as they may be to get back to their jobs, stand a high risk of contracting a potentially deadly disease. If one person is infected, then that one person could infect many other people. Remember that the virus is airborne – it could potentially travel through the building’s ventilation.
Employers have a legal obligation to implement adequate safety protocols to protect workers, but if these protocols are not effective in protecting workers in the current crisis, then returning to work could be deadly.
Right now, there is no government-level standard for precisely what workplaces need to do to reopen safely. Some states are requiring that businesses submit workplace-reopening plans, which detail the measures that employers are taking to protect workers and customers.
However, other states are not. And for economies to reopen, people have to have the ability to return to work safely. Requiring workers and customers to wear masks and allowing for social distancing are the two most important things that businesses can do.
For workers to return to their jobs, many need access to reliable childcare. And in many places, that will not be an option for months, if not years. Furthermore, everyone will need assurances that they can return to their jobs safely.
Without providing adequate safety precautions, there will almost certainly be a second wave as soon as economies reopen. The catastrophe that hit New York City will happen in cities all over the country as hospitals become overcrowded.
Providing PPE and requiring people to socially distance themselves have effectively contained the spread of the virus. However, Gates thinks that there is one thing that is even more important: testing people.
For example, South Korea contained its outbreak very quickly by implementing a drastic testing regimen that enabled public health officials to trace every epidemic source. They were then able to isolate people who were asymptomatic before they infected other people. As a result, South Korea has had very few fatalities.
But in the United States, testing has become a political weapon people have been throwing at each other. And to make matters worse, the early tests that the CDC approved gave many false negatives. Many people who had the virus and took a test were told that they were fine.
Since May, states have been on their own about testing. Some have implemented rigorous testing programs by providing free tests for people at clinics throughout the states. These states have been more effective at containing the spread. But other areas have done little to test their residents.
How well a state has fared so far in the current crisis depends on how quickly it shut down its economy and its comprehensive testing program. Some states shut down their economies very rapidly and have tested a high proportion of their populations.
Other states have not. Some states never even implemented a full shutdown, and the virus spread quietly among people who were asymptomatic before hospitals became full of people on ventilators. For children to be able to return to school and workers to return to their jobs, rigorous testing needs to be in place.
A test can identify if the person being tested is infected, but this level of testing is not sufficient in a public health emergency such as the current one. Someone who took a test that came back negative could become infected 10 minutes later.
The robust testing that needs to be in place is what South Korea had in its early days of prevention: being able to trace outbreaks to the source. It means that public health workers need to be able to identify all of the people that a positive person came into contact with and test them. This plan will require enormous resources and personnel, and the US has not deployed that at a systemic level.
6. Gates Believes Reopening Needs To Happen In Stages
To prevent a catastrophic second wave, the reopening that happens needs to be gradual, in stages. That means that states need to implement plans that require businesses to submit reopening plans to ensure workplaces are safe before reopening. Gates revealed his plan that involves many aspects including these stages.
Small gatherings, rather than unlimited gatherings of people on beaches or in shopping malls, should be allowed once the state has flattened the curve. Only as the states’ plans to reopen a new wave of businesses and allow for more interaction between people have shown not to create a new wave should more reopenings happen.
As economies reopen, the reality is that there will be new outbreaks. And again, this is why testing is so essential: tracing these new outbreaks to the source so that they can become contained before the outbreak becomes uncontrollable.
Being prepared to deal with new outbreaks also means that hospitals are supplied with enough PPE and ventilators to prevent another near-collapse, such as what happened in New York in March and April. Moreover, new outbreaks mean that economies may have to close again, at least temporarily.
The alternative to gradual reopenings that occur only with robust testing that can trace outbreaks to the source is a new wave of infections that will overwhelm and possibly collapse the healthcare system.
The goal of reopening needs to be to preserve human life by protecting people – especially those who are most vulnerable – from the possibility of infection. While the economic fallout is certainly disastrous, the human toll of a massive loss of life will be immense.
The Bill and Melinda Gates Foundation has been leading the way in developing a vaccine that could immunize the world to the virus that has paralyzed it. Institutions all over the world – including universities, hospitals, and pharmaceutical companies – have been collaborating. Gates is spearheading that effort.
Continuing the research and development plans that are working towards a vaccine should be a priority for governments. However, relying on a vaccine to come in the future is not an adequate plan for reopening economies, as there is no guarantee of a vaccine or when it will be available.
The shortest timeframe that has been proposed for a vaccine is 12 to 18 months. That means that one will not be available until the summer of 2021, so shutdowns may continue well into next year. It is a reality that we all need to be prepared to deal with immediately.
Many public health experts are concerned that a vaccine may not come for years, or may not come at all. If this is the case and it is here with us to stay, then we need to be prepared for our lives to change dramatically, permanently.
While waiting for a vaccine, the most important thing that states can do is implement rigorous testing programs that will trace infections to the source to contain outbreaks. Employees will need to be tested before they can come back to work.
When those employees return to work, they will need both childcare and the assurance that they can work safely. So states all across the country have a long way to go before their economies can safely reopen without risking another wave of infections, which could be much more deadly than the first one.