A couple of weeks ago, I wrote a column arguing that while a stay-at-home order might be justified as an initial response to an immediate and poorly understood public-health threat, it wasn’t “sustainable” for more than a few weeks.
“The draconian response to COVID-19 has imposed grave economic and social consequences on North Carolinians,” I wrote. “They won’t shelter in place for months. They can’t. And they’ll become increasingly impatient with leaders who offer them platitudes instead of a practical plan for moving forward.”
The piece generated more than the usual amount of snark and hate mail. I was being “ignorant” and “reckless” and “irresponsible.” My opinion was motivated by “extreme partisanship,” because Gov. Roy Cooper is a Democrat, the allegation being that I’d “roll over” to the same policy if North Carolina’s governor were Republican.
Hmm. At an April 15 press conference, Cooper had this to say: “The stay-at-home orders are working, but we know our current situation is not sustainable in the long run.” Check.
In my original piece, I pointed out that the case for a lockdown was not to keep North Carolinians from becoming infected with COVID-19 and thus shorten the duration of the pandemic. Rather, its stated purpose was to “flatten the curve” — that is, explicitly to lengthen the duration of the pandemic so that the infection spread more slowly and the peak need for hospital beds, supplies, and intensive care did not exceed the available capacity.
If the peak need for medical care stays above capacity for long, there will be an excess of avoidable deaths, as we have seen in the hardest-hit places in Europe and, in our country, during the early stages of the outbreak in the New York metropolitan area. Patients who might otherwise have survived COVID or other illnesses and injuries, but instead did not receive timely and adequate care, ended up passing away.
Avoiding that outcome was why several research teams scrambled to come up with COVID models. Their main purpose was to predict the peaks and compare them against the capacity of the health-care system. In March, those models offered gloomy forecasts — that even with stay-at-home orders in place, states such as North Carolina would likely peak above capacity for a period of time.
As soon became evident, however, the models were too pessimistic. Drawing on preliminary data (the best available at the time, perhaps), the models assumed a ratio of hospitalizations to COVID-19 deaths than turned out to be incorrect for most places, including North Carolina. Rather than seeing their bed counts and ICU admissions surge over the top, our hospitals are operating far below capacity. Indeed, hospitals and other medical providers are suffering crippling revenue losses because they don’t have enough patients.
It is time to begin a prudent reopening of North Carolina’s economy. It isn’t going to happen all at once. It will follow something like the three phases the Trump administration’s task force laid out on April 16 — with workplaces, stores, schools, and restaurants following different schedules, with differing levels of mandated distancing and widespread use of voluntary distancing.
No, reopening can’t wait on a vaccine. That is likely a year or two away. Reopening can’t wait on near-universal DNA testing for the virus, or therapies proven to be unquestionably effective in clinical trials, or flawless test-and-trace systems that can prevent any potential outbreak. Those are likely many months away.
A prudent reopening can include increasing levels of regular testing, however, such as blood tests for antibodies and temperature checks at workplaces. A prudent reopening can include immediate quarantines of the sick and ongoing social-distancing rules for those at greatest risk of severe illness or fatality (the elderly constitute 84% of COVID-19 deaths in North Carolina, for example, while those under 50 account for 5%).
The strongest argument for a prudent reopening — indeed, the inescapable argument for it — is that it is consistent with a free and functional society. It is sustainable. Staying at home for months is not.