Stay At Home Orders Don’t Limit Covid Cases

A sign informing visitors that Mulholland Scenic Overlook is closed during the coronavirus outbreak, Los Angeles, Calif., April 5, 2020. (Lisa Girion/Reuters)

Jeffrey D. Klausner and Rajiv Bhatia write at National Review Most States Can Safely Relax Some Coronavirus Restrictions.  Excerpts in italics with my bolds.

Continue more modest restrictions, keep watching the data, and focus on hospitals and protecting the most vulnerable.

One of the main questions on the minds of Americans is when government restrictions aimed at controlling the coronavirus epidemic can be safely lifted. In most states, we now have enough information to say that the strictest measures can be relaxed.

For our part, we have looked at the relationship between the timing of stay-at-home orders and the peaks in the number of reported cases in 31 U.S. states. We could not find a clear pattern relating the timing of such orders to the peaks in case numbers, suggesting no association between the orders and the limitation of cases. One would have expected, if there had been an effect of such state-at-home orders on the number of new cases, a consistent time-dependent effect —that is, a clear, observable average time, say ten to 14 days from the date of the order to the peak. That was not seen.

Closing down large sectors of society is a blunt tool, and its use comes with huge costs—the disruption of education, economic activity, and social interactions. The ongoing, and possibly future, use of such stay-at-home orders deserves timely and rigorous evaluation. As much as possible, we want to know how necessary, and how costly, each intervention (e.g., limiting gatherings, closing restaurants and retail businesses) is on its own. In the realm of public health, first principles of disease control dictate the use of the least costly set of interventions sufficient to prevent and mitigate illness.

Overall, several pieces of evidence suggest that the pace of new SARS-CoV-2 infections had declined significantly before government officials imposed the most severe restrictions. Those findings, along with the fact that most hospitals, outside of certain severely affected areas like New York City, had adequate capacity throughout the month of April, should give us confidence that self-protective changes in personal behavior along with testing, isolation, and quarantine can adequately mitigate the epidemic.

It is time to step back from restrictions like prohibition of access to outdoor spaces, universal orders for home confinement, and closure of small businesses. In stages, and watching the data on test-positivity in key populations and COVID-19–related emergency-room visits and hospital admissions, we can get back to work and school while limiting person-to-person contact with measures such as occupancy limits, promoting hand-washing, and adopting policies for paid sick leave to enable ill workers to avoid others and reduce the spread of infection. Public health should focus on protecting the most vulnerable with screening and rapid response to outbreaks in nursing homes and shelters.

Finally, ensuring that we’re using the least restrictive means necessary also requires that we focus on keeping hospitals above water. That can be done by adjusting policies specifically to hospital-admission rates of COVID-19 patients and local bed-capacity for their care (e.g., dedicating 50 percent of acute-care beds). Leading indicators like daily COVID-19–related outpatient and emergency-room visits can now be monitored to provide an early warning system.

The findings described above, and increasing experience in other settings, lead us to believe that relaxing the strictest interventions while continuing more modest ones will not cause an unmanageable resurgence in cases.

Jeffrey D. Klausner, a former CDC medical officer, is a professor of medicine and public health at UCLA. Rajiv Bhatia, a former San Francisco City and County deputy health officer, is an assistant clinical professor of medicine (affiliated) at Stanford School of Medicine.

See also Good Virus News from the Promised Land

 

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