On July 23, COVID-19 cases in the U.S. surged past 4 million—one million more than there were just 16 days earlier. Nearly 150,000 people have died, more than any other country in the world. As cases and deaths grow, an open letter to decision-makers from epidemiologists, emergency room doctors, and other public health experts asks the country to face the obvious: What we’re doing isn’t working, and it’s time to shut down again.
Shutting down businesses in March and April helped flatten the curve, but then many states reopened too quickly. “Many states really reopened very rapidly without really emphasizing any of the behaviors that people needed to engage in to make reopening safe,” says Angela Rasmussen, a virologist and research scientist at the Center of Infection and Immunity at the Columbia University School of Public Health, and one of the scientists to sign the letter, which was published by the U.S. Public Interest Research Group. “People were not necessarily getting the messaging that they needed, which is that, hey, the coronavirus is still here. Just because we got cases down lower doesn’t mean that it’s gone. So we still need to do distancing and wear masks and not go straight back to work or straight back to restaurants and so forth. We just really went back to normal like pretending that everything was the way it was before the pandemic.”
Governments also weren’t ready to reopen. “What we really needed was to have robust testing in place already before reopening, so that we could identify any new cases early on, and break those chains of community transmission,” she says. Instead of using the period of the shutdown to dramatically ramp up testing capacity and hire contact tracers, states didn’t go far enough, and the federal government didn’t provide the necessary leadership.
By the middle of June, the letter notes, more than 117,000 Americans had died; if the U.S. government had responded like the government of Germany, the number of deaths by that point could have been as low as 36,000. If the U.S. had responded like Singapore, South Korea, or Australia, fewer than 2,000 Americans would have died. Those countries did several things right. South Korea, for example, tested people widely early on, so it was possible to stem the spread of the virus. Crucially, people in other countries also followed public health recommendations—and actions such as wearing a mask didn’t become politicized. In the U.S., if things had been done differently, 99% percent of the deaths by June could have been avoided.
Now, Rasmussen says, we need a national strategy to flatten the curve again and to reopen safely. Even in the handful of states where cases seem under control, including New York and Connecticut, the situation could easily change. “If people are still mobile and still traveling places, it would be [easy] to establish community transmission in those states again,” she says. (The letter recommends that policymakers ban any interstate travel that isn’t essential.) “There’s still a lot of debate about serology evidence and who has antibodies and how many people have gotten it. But even in New York, where infection rates were among the highest in the country in the spring, the majority of people still have not had this virus. So that means they’re susceptible.”
If the economy stays open now, “the worst-case scenario is that transmission continues out of control,” she says. “You’ll just continue to see cases increase, and eventually you will see hospitalizations and deaths increase as well.” We’re on track, the letter says, for 200,000 Americans to die because of COVID-19 by November 1.
To make a shutdown feasible, “we need better, more robust stimulus and support for people that will allow them to stay home,” Rasmussen says. Small businesses need more support. Essential workers need more protective equipment and places to quarantine if necessary. A new shutdown would do more economic damage, but the long-term impacts of letting the virus spread are worse; Rasmussen points out that that’s not only because of the impact of lost lives but also because some of those who get sick and survive are facing long-term health problems.
Right now, the letter says, it makes sense to shut down everything that isn’t essential—bars, tattoo parlors, dining inside restaurants—nationally until the curve flattens again. Simultaneously, they say, governments need to work to get adequate testing and tracing in place. And we need coherent national policy. “We can’t rely on individual state governors to take all the responsibility for this,” Rasmussen says. “This is something that’s affecting our entire country. We need to really come together as a country, put political differences aside, and focus on saving as many Americans’ lives and economic futures as possible.”