Summer awaits, filled with masks, temperature checks, and the ever-present chance of quarantine. Also many more deaths, say public health experts, as states reopen without enough tests, without enough public health workers, and without knowing exactly where the coronavirus is hiding.
“This summer we will see the face mask become the new normal, now and in years afterward, no handshakes, no hugging, and keeping our distance,” Georgia State University epidemiologist Gerardo Chowell told BuzzFeed News. “Crowds are going to become a thing of the past.”
Since late March, US numbers of COVID-19 cases have marched upward to more than 1.2 million, even as cases elsewhere in the world have entered a period of steady decline. Nevertheless, facing unprecedented economic pressure, 25 states are proceeding with reopening restaurants, businesses, and childcare facilities this month.
Public health experts widely view these moves as a prelude to a disaster, the almost inevitable result of exposing people without any natural immunity to a deadly disease, one readily and silently spread by people often without any symptoms. The outbreaks to come seem likely to reshape the landscape of our daily lives.
“We are nowhere near herd immunity, and when the physical distancing interventions that have slowed transmission loosen, we expect to see a resurgence of cases and deaths,” epidemiologist Caroline Buckee of the Harvard T.H. Chan School of Public Health told BuzzFeed News.
The federal government has provided mixed messages about how exactly to approach reopening the economy without increasing deaths. The Trump administration released general guidelines for state reopenings on April 16. But the administration also reportedly shelved a more stringent CDC guide for local officials to consider when reopening schools, restaurants, summer camps, churches, daycares, and other institutions.
Seizing on the support of his base, Trump has also made vocal declarations against his administration’s own distancing guidelines, tweeting “LIBERATE MICHIGAN!” in mid-April and, this week, assuring states it’s safe to reopen.
That has left individual states to craft their own rules for relaxing social distancing restrictions. Led by a handful of Republican governors opposed to lockdown procedures in states like Georgia and Texas, many have ignored the White House guide’s criteria of 14 days of declining cases before reopening and a declining percentage of positive tests.
States are still widely calling for people to wear cloth masks and for stores and restaurants to allow only half-occupancy to encourage distances between people. It's possible that the slow release of these interventions can prevent the worst-case scenarios, Buckee said, “but it will be very difficult to control once exponential growth takes off again.”
A Columbia University School of Public Health analysis released on Thursday, for example, projected how US daily coronavirus death rates will change through the middle of June, depending on three scenarios for how people behave in coming weeks. In one scenario, US counties continued social distancing to the same level as they had before reopening. In a second, social contacts increased by 10%, reflecting people obeying loosened restrictions in reopened states. In the last scenario, contacts increased by 10% every week in reopened states.
In all of the scenarios, US deaths dip below the current rate of roughly 2,000 deaths a day for the next two weeks. Then they shoot upwards again in the familiar pandemic exponential curve for the loosened states. By June 1, the middle scenario resulted in more than 43,000 new cases and 1,800 deaths per day. An increasing loosening of restrictions every week would lead to median estimates of more than 63,000 new cases and 2,400 deaths per day.
By the middle of June, the projections would reach potentially devastating heights: 3,000 deaths per day in the onetime loosening scenario, and more than 6,000 a day if restrictions continue to loosen.
“The dip is very worrisome, people see lower cases and think there isn’t a problem, so they increase their contacts,” which leads to more deaths weeks later, Columbia’s Sen Pei, a coauthor on the analysis, told BuzzFeed News. “We expect people will change their behavior once they see deaths racing upward again,” he said.
Because of the two- to three-week lag between initial infection and death, combined with a long-running deficit in testing and a perilously slow mobilization of contact tracing to track exposures to new cases, governors are essentially steering by looking in the rearview mirror, driving straight into outbreaks they can’t see ahead. That means deaths and cases will continue to go up, even after the brakes are slammed on again.
“Without testing to closely follow and trace cases, states should not be re-opening in my opinion,” said Buckee.
One of the confusing likelihoods of future outbreaks is the role of good and bad luck, said Pei, where nearby counties pursuing identical policies might see one hit by an outbreak and the other less affected. “There will be an element of randomness we cannot model,” he said. “The best we can tell you is the trajectory will be up where you have more contacts.”
A related wild card in the course of the pandemic in the US is how Americans choose to behave. A state with loose restrictions where people scrupulously stay distant, wear masks, and avoid contact might fare better than one with tight rules that end up being flouted.
"Tennesseans seem to be doing a pretty good job with social distancing," said John Chandler, a general contractor living in Nashville, where a statewide shutdown ended in late April, but guidelines still call for cloth masks and 50% store occupancy. Different stores follow different guidelines though, he told BuzzFeed News on Thursday, with some strictly following guidelines and one employee at a sporting goods store recently discouraging his use of a mask. “I’m thankful for the employees and fellow shoppers who are wearing masks,” he said. "It seems that our success will be in the hands of all of us."
A varied menu of approaches are underway in reopening nations worldwide, all of them essentially experiments in social distancing. Germany is reopening schools for older children, for example, while Denmark is prioritizing younger ones, and the Czech Republic is holding off final exams until later this year. But those reopenings, from Australia to South Korea to Europe, are happening in places where — unlike the US — countries have “bent the curve,” with declining cases, robust testing and tracing, and health care resources available to treat outbreaks without catastrophe. In the US, some states are reopening without those conditions met, largely driven by economic pain and a uniquely American resentment of limits on their personal freedoms.
The stress of the pandemic and the psychological costs of isolation will also be real factors in the decisions people make, Columbia University social psychologist Peter Coleman told BuzzFeed News. Under long-term stress, people tend to become more pronounced in their original outlook or characteristics. Withdrawn people become more withdrawn, and outgoing people become more outgoing. That puts more pressure on extroverts forced to isolate. “Our nation is not comfortable with silence, or stillness,” he said. “We are ‘keep busy’ people. It will take a toll on people, relationships, anxiety.”
In a March interview with BuzzFeed News, Coleman predicted the political divide in attitudes toward distancing that has emerged in the last two months — a split dramatized by front groups for business interests demonstrating in state capitols. A Pew Research Center survey released on Thursday confirmed that while most Americans worry about loosening restrictions too soon, only around half of Republican share this view, as compared to more than 80% of Democrats. Those attitudes — combined with the confusing public health messaging over masks in the spring and President Trump’s refusal to wear one — threaten to erode the norms of social distancing.
Early public health messaging emphasized the need for masks for health care workers, for example. But large outbreaks in the US and increased understanding of asymptomatic cases have made clear that masks can help prevent the wearer from infecting other nearby people. That message has still not been clear enough, Chowell observed.
“It really should just become a standard point of politeness now that we have community spread, and we don’t know who has become infected,” he said.
Regardless, with only an estimated 3% to 4% of the population infected with the virus so far, the basic realities of the disease will drive a lot of the changes in society, Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials, told BuzzFeed News. Until there is a vaccine, he said, reopening is never going to mean a return to life like it was before the pandemic.
“It’s an infectious disease. If you are telecommuting now, you are likely going to keep telecommuting for a year or a year and a half,” Plescia said. “It‘s entirely possible you will contact somebody sick, and the next thing you know, you will be getting a call from public health officials telling you to go into quarantine for 14 days.”
Better summer weather and people seeking an escape from indoors will likely move a lot of commerce outdoors. Some experts such as virologist Vincent Racaniello, professor of microbiology and immunology at Columbia University, have expressed alarm at scenes of overcrowded parks, and towns have fought over shutting down beaches. However fresh air is seen as much safer than closed indoor settings for transmission of the virus, leading other scientists to express support for heading to the park or beach.
Streets in New York, Minneapolis, and elsewhere have been closed to cars to give people more room to exercise outside without coming close to one another, a transformation made easier by a lack of traffic.
“We do know that ventilation is important. And the less time one spends in close proximity to an infected person the less likely transmission is,” epidemiologist William Hanage of Harvard’s T.H. Chan School of Public Health told BuzzFeed News by email.
“Haircuts outside might be sweaty in Georgia and there would still be transmission risk, but less than in a poorly ventilated indoor space. I think a lot of things like this are going to be tried all over the country. People are going to be making very different sorts of contacts even in places that are ‘open.’”
Although heat and humidity are expected to slightly dent the transmissibility of the virus, it can and will readily spread in the vulnerable human population despite summer weather. “It's not going to go away in the summer and we're still gonna have to have these periods of physical distancing,” American Public Health Association President Lisa Carlson told BuzzFeed News.
“It’s not going to be a normal American summer, with concerts, and sporting events, and crowds. Those things are not likely to happen,” said Carlson.
Trusting that the current shortfalls in testing are resolved in coming months — a big assumption to make, given management of the crisis so far — routine testing will become a bigger part of our lives as well. It will likely become standard in healthcare settings for anyone with symptoms or high-risk conditions, and temperature checks are something we might see before entering stores.
Bars, buffets, concerts, and crowded airplanes won’t return anytime soon under most reopening plans, even with more testing. Nursing homes and other settings where residents are at high risk of dying in an outbreak should continue to have highly restricted access, Plescia added.
People with higher-paying jobs who can telecommute will continue to have the luxury of staying home to prevent spread, while people with lower-paying but essential jobs that require more risk will need to keep leaving their homes. “There’s a lot of unfairness we are going to face. Things are going to be harder, less efficient, and less easy,” he said.
“We’re only human and this is going to be an imperfect process, a real challenge. But I don’t see a lot of ways around it.”
The Czech Republic is postponing its final exams until later this year. A previous version of this story referred to the country as Czechoslovakia.