The Lockdown Dilemma

By Michael Brendan Dougherty

Friday, May 01, 2020

From the beginning of the COVID-19 crisis, it has been obvious that the fates of public health and the economy were tied together. Weeks before formalized “lockdown” policies began appearing, as news about the danger of the coronavirus spread, economic activity dramatically slowed. And it obviously won’t speed up again until the public in general has confidence that going back out into the world is as relatively safe as it was before.

So now we face a serious dilemma. It goes something like this: We don’t have enough money to stay idle, but we don’t have enough confidence in testing to go out and spend again. The COVID-19 social contract was cobbled together at alarming speed. Everyone quickly adopted three assumptions: First, that the government would compensate — and, as much as possible, make whole — those men and women who, for the sake of public health, lost income, business, or their livelihoods; second, that we would in due course build the kind of mass testing-and-contact-tracing system that would allow us to isolate the sick, rather than locking down everybody; and third, that we would adopt clear benchmark conditions for re-opening, and clear, universal guidelines on masks, handshakes, hygiene, and the like to be followed until we had a vaccine.

None of those assumptions has held up. Congress accepted and arguably exacerbated the mass unemployment the pandemic immediately left in its wake. Its limits on “paycheck protection” loans and other small-business aid turned its relief program into a lottery. Talk of increasing test capacity to millions per day has turned out to be just that — talk. Guidelines for re-opening at the state level have proposed hopelessly vague metrics. And federal guidelines, while more sound upon examination, have not been publicized.

Perhaps it was inevitable that all those hopes would be dashed.

Elsewhere, even our successes have come with unanticipated downsides. The lockdown policies were justified by the imperative of “flattening the curve.” That meant slowing the transmission of the disease to avoid the catastrophic medical-system collapses that sent death rates into truly scary territory in Wuhan, China and Northern Italy. And for the most part, we’ve done this. New York needed fewer ventilators than estimated. The naval-ship hospital has already left city’s waters. The curve is flattened so much that stories of New York emergency rooms filling to the brim have been crowded out by stories of hospitals that are eerily empty. People fearful of contracting the virus have delayed seeking medical attention for other problems. With elective surgeries cancelled, hospitals are actually laying off staff to balance the books. We’ve flattened the curve so much to prevent our hospitals from being overwhelmed that they’re now in greater danger of being underwhelmed.

It is, of course, a good thing that New York didn’t become Northern Italy, and that although there have been scary weeks in Seattle, Detroit, and New Orleans, none of those cities became New York. But when is the conversation going to change to reflect as much?

The lockdowns began with both suspicion and trust. The suspicion was that China wouldn’t shut down its industrial heartland and Italians wouldn’t give up their lives as free citizens for nothing. The trust was that our scientists were right. That Americans have cooperated so widely and readily with social-distancing directives is astonishing. But they have done so based on the conviction that COVID-19 was roughly twice as transmissible as the flu, and possibly ten times as deadly. Is that true in every environment? Every region? Every climate? Does avoiding a doubling and redoubling of the awful American death toll require this sustained and intrusive lockdown? Or can masks and a little more care and circumspection do the trick?

We haven’t gotten consistent answers to such questions, and it has left us unsure. In some cases, this confusion was understandable; there is no good science on a new virus. But if they expect continued compliance, authorities have to be clear, consistent, and honest about what their experts are telling them, and about how confident they are in its accuracy. In the absence of sounder science more soundly communicated, the public will act upon its own understandable anxiety and take signs of abatement as signs of hope, or even invitations to begin rebuilding their lives, livelihoods, and businesses. If the authorities find this behavior foolish, then they must persuade us through intelligent legislative acts, provision, and publicity.

If they can’t — if government institutions cannot tie public health and the economy together in a collective national effort — then Americans can, must, and will begin to divide and make their own arrangements. Non-essential workers who can will work illicitly. People will get into screaming matches over masks and personal space in grocery stores until new social norms emerge.

Nature is not obliged to cooperate with our civilization, however much we might wish it were. A disease could always come along that wrecks our arrangements for good. A previous civilization on the American continent was destroyed by plague. But humans have a nature too, and the present lockdowns cannot be sustained without the proper combination of hope for sufficient federal aid and fear of the virus that satisfies it.

Both of those things are diminishing, and so the lockdowns are not long for this world. They’ll end just as they began: with the American people taking the lead because their elected officials can’t or won’t, muddling their way through an impossible dilemma.