How many lives will we choose to give up before we get a vaccine?

Public health experts argue for more stringent measures to stop the winter’s surge.

How many lives will we choose to give up before we get a vaccine?
[Photo: Benedikt Geyer/Unsplash]

In Austria, where daily new COVID-19 cases hit a record last week, the country went into lockdown on November 17. Nonessential businesses have temporarily closed. Schools are closed. Everyone is being asked to stay at home whenever possible and to wear masks when they go out.


The record in Austria, on November 13, was 9,586 new cases in a day. In the U.S., which hit its own record of 184,000 new cases the same day—only a slightly lower percentage of cases by population than Austria—there’s no similar plan. That’s true both nationally and in some of the hardest-hit areas.

In El Paso, Texas, where COVID-19 cases have grown so much that the local government converted its convention center into a field hospital and has deployed mobile morgues, the county tried to temporarily shut down nonessential businesses to slow the spread of the disease. The state fought the order in court, and an appeals court agreed that businesses could stay open.

We should not wait until more and more hospitals overflow with sick and dying people before taking the bold actions that we know we’ll probably need to take in order to save lives.”

Matthew Wellington, U.S. Public Interest Research Group

As cases surge nationally, we have a decision to make as a country, argues Matthew Wellington, the public health campaigns director of the Washington, D.C.-based U.S. Public Interest Research Group (PIRG). A recent study calculated that out of 230,000 Americans who died from COVID-19, as many as 210,000 could have lived if the national response had matched what happened in some other countries. Another model suggests that at least 438,000 people in the U.S. may be dead by March of next year, depending on where and how restrictions are relaxed.

How many lives will we decide to save? “We are seeing uncontrolled spread in almost every single state in this country,” Wellington says. “And we should not wait until more and more hospitals overflow with sick and dying people before taking the bold actions that we know we’ll probably need to take in order to save lives.”

Both Pfizer and Moderna may soon get approval from the Food and Drug Administration for emergency use of their new vaccines, which appear to be extremely effective. But the supplies of both vaccines will be limited for months, and until the vaccines are widely available—and Americans are willing to get immunized—the country will need to take other actions to slow the spread of the virus.


In July, a group of public health experts organized by U.S. PIRG advocated for another temporary shutdown, followed by a better system of testing and tracing. In early August, an epidemiologist and economist writing in The New York Times made the argument that since the first U.S. shutdowns ended too early, a temporary shutdown, ideally lasting six weeks, could bring the virus under control until there’s widespread access to vaccines—and by November, students could be back in school and others could be back at work. It didn’t happen.

Some public health experts still believe that more targeted interventions, versus a strict shutdown, could work. Dr. Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security, emphasizes that a shutdown alone won’t have that much of an effect. He argues that the first shutdown failed in part because mass testing and contact tracing weren’t in place afterward to stop the virus from spreading again.

“When you had the stay-at-home orders in the spring, no one—not any state, not the federal government—took the time to actually build a sustainable approach to keeping cases to a level that’s manageable by hospitals,” he says. “They basically squandered that time.”

Something similar happened in Europe, he says, and cases eventually swelled again. Adalja surmises that if large shutdowns happened again now without funding for basic public health infrastructure, “COVID cases would go down, and everybody would breathe a sigh of relief. Then everything else would happen again. And then you’d be asking me the same question in February. The same thing would be happening again.”

Adalja argues that since we now understand more about how the virus spreads and which situations are particularly dangerous, like indoor dining and bars, it’s possible to use more limited, strategic restrictions. Many others agree. “I think the approach should be incremental,” says Saskia Popescu, an assistant professor at George Mason University in Fairfax, Virginia. She says that health officials can target certain areas (New York City, for example, has targeted particular zip codes) and high-risk businesses. Some experts talk about it as a “dimmer switch” approach as opposed to completely shutting everything down.


I don’t want to see us go into lockdown mode. But we’re running out of choices. It’s either that or we let the hospitals fill up. And society can’t run when there’s no room in hospitals, either.”

Michael Mina, Harvard University

Still, it’s possible it may not be enough. Austria tried more limited interventions, but cases still skyrocketed. Similarly, Hawaii tried limited interventions in the summer, but eventually had to move to a temporary shutdown and stay-at-home order. That worked. For a longer shutdown to be most effective, Popescu says, it should last around six weeks, through three transmission cycles of the virus. That can bring the number of cases down far enough that testing and tracing is also much more manageable.

Mass testing could potentially help avoid the need for a large shutdown. (Slovakia, for example, recently stopped exponential growth of the virus by testing the majority of its population and putting anyone who was infected into mandatory quarantine.) Whether or not a shutdown happens, testing will still need to scale up dramatically to stop further viral spread. In some American cities, it currently takes days to get results from a COVID-19 test. The country should invest billions in testing, Wellington says, and should also invest deeply in contact tracing and use the Defense Production Act to spur the manufacturing of more protective equipment like masks for healthcare workers.

Some restrictions—whether targeted or more sweeping—will ultimately help the economy as they reduce cases. “Pretty much every professional economist I know has been saying from the very start of this crisis that that there is no trade-off between fighting the virus and getting the economy back to normal,” says Tom Vogl, an economist at the University of California, San Diego. “In fact, they’re the same goal.”

But any shutdown also has to happen equitably, and the federal government has the resources to provide the right support. “I understand that there are a bunch of small-business owners who would be crushed by further shutdowns,” Vogl says. “And they have lots of employees who work there who would also be crushed. Ultimately, given our federal setup, it comes down to the federal government to support those bars and restaurants. I think actually from very early on in this pandemic, the federal government should have been paying restaurants to stay closed and paying bars to stay closed.” If other businesses have to close temporarily, those workers will also have to get more support so they can stay home.

A shutdown would also need to happen in a coordinated way, unlike the first time. So noted Michael Mina, an assistant professor of epidemiology at Harvard University, on a recent press call. Mina has been arguing for months that testing at a massive scale could help avoid the need for closing businesses.


“We can’t just put people out on the street and say, ‘Sorry, you weren’t able to pay your rent.’ It’s a very, very complex thing,” Mina said. “And it’s why I don’t want to see us go into lockdown mode. But we’re running out of choices. It’s either that or we let the hospitals fill up. And society can’t run when there’s no room in hospitals, either.”

“I think at this point, it’s really when, and not if, we’ll have to take these more drastic measures,” Wellington says. “We just want to do it sooner rather than later, because that’ll save more lives.”

About the author

Adele Peters is a staff writer at Fast Company who focuses on solutions to some of the world's largest problems, from climate change to homelessness. Previously, she worked with GOOD, BioLite, and the Sustainable Products and Solutions program at UC Berkeley, and contributed to the second edition of the bestselling book "Worldchanging: A User's Guide for the 21st Century."