When the coronavirus began spreading in the U.S. in early spring, governors in hard-hit states took drastic steps to reduce the threat. By shutting down nonessential businesses and schools and ordering people to stay home, they slowed the virus’s spread, but several million people lost jobs.
Since then, we’ve witnessed a series of ad hoc experiments with more targeted approaches. As states started to reopen, they tested different levels of restrictions, such as face-mask mandates and capacity constraints on restaurants. Some closed bars when cases rose again but left other businesses open. Others set restrictions that would be triggered only for hot spots when a county’s positive case numbers passed a certain threshold.
Now, as cooler weather moves more people indoors and daily case numbers rise, states and communities are looking to those successes and failures as they consider future strategies. Could more targeted closures and restrictions be effective, or will a return to statewide stay-at-home orders be needed again?
The nation’s ability to respond to the virus has improved since COVID-19 first reached U.S. cities.
Testing capacity has expanded and results are available faster. That means people who become infected can be isolated faster. Treatment methods have also improved.
However, there is still no vaccine, a lot of questions remain about new therapies, and shortages are predicted for personal protective equipment as flu season approaches.
With colder weather now arriving, the nation faces a greater potential for virus outbreaks to spread.
The upcoming holidays will also mean more inside gatherings and travel. Throughout the pandemic, data has revealed a pattern of increased cases within two weeks of holidays and other events that increase contact and related exposures.
What works?
From the nationally reported and global case data, it seems clear that requirements for social distancing and mask-wearing combined with stay-at-home orders and business closures can effectively reduce virus transmission.
New Jersey and New York initially implemented strict, prolonged measures and were able to keep case rates lower through the summer, while several states that quickly lifted restrictions saw COVID-19 cases surge. But broadly defined shutdowns can have economic drawbacks, so governors are looking for other options.
Two types of more-targeted strategies have been able to help keep the virus’s spread under control: focusing on the type of activity and on the locations where transmission risks are higher.
For example, statewide orders kept bars closed in many states since there is a greater risk when people gather in closed surroundings without masks.
An MIT study in June weighed the risk of crowded conditions that could spread COVID-19 against the economic value for several activities to suggest ways to prioritize business closures. It found that those with the highest risk and lowest economic value included liquor stores, cafes, gyms, museums, theaters, sit-down restaurants and hair salons.
In some cases, decision-making about COVID-19 restrictions has largely been in local hands to respond more quickly and in a tailored way. In most states, school districts have made the bulk of decisions about whether to hold in-person classes for K-12 students or keep their classes online.
Making decisions on restrictions depends on having reliable, up-to-date data about how the virus is spreading in communities.
While thresholds, such as positive test rates, can guide shutdowns, it may be more fruitful to focus on activities and practices that allow economies to stay open as much as possible. Protective measures such as wearing masks in public and avoiding large indoor gatherings can all reduce the virus’s spread.
Communities can learn from the growing evidence and best practices to tailor their own responses and help avoid the domino effects that could send their economies into another shutdown.
Tiffany A. Radcliff is associate dean for research and professor of health policy and management at Texas A&M University. Murray J. Côté is associate professor of health policy and management at Texas A&M. Distributed by The Associated Press.