Officials tell public to stay home to stop the spread of covid. But is anyone listening?

By and Ben Guarino,

America is not in shutdown, but every day, it edges closer to something like that. With minimal help from the White House or Congress, governors and mayors are trying desperately to tamp down a fall surge in coronavirus infections without crashing their economies — or inciting a revolt from pandemic-fatigued constituents who want this ordeal to be over.

In Newark, Democratic Mayor Ras Baraka announced what he described as a 10-day “lockdown” starting Wednesday — although city officials say this is an ask, not an order.

In Denver, Democratic Mayor Michael Hancock on Friday pleaded with residents to stay home for the next month. “I know this is hard. I know you hate this,” Hancock said.

In Ohio, Republican Gov. Mike DeWine this month announced he would enforce a statewide mask mandate. And Vermont Gov. Phil Scott, also a Republican, put a limit on how many guests can be invited to a household gathering. The number: zero.

http://www.washingtonpost.com/video/national/superspreader-events-explained/2020/10/14/1eccd0dc-3256-44ef-8e57-e9bcdfb509be_video.html

But it is not clear that the measures imposed across the country in the past few weeks are stringent or timely enough to halt the dismaying autumn surge of coronavirus infections that already has put some hospitals into crisis and driven up death tolls. The numbers have gone from ominous to disastrous in just a few weeks. More than 170,000 people a day on average are now becoming infected and more than 85,000 are hospitalized.

That is before millions of people congregate for the holidays, many of them having journeyed home with an invisible pathogen potentially along for the ride.

“Most governors are trying to fight a forest fire of infection with garden-hose measures, and they aren’t even aiming at the right targets or starting at the right time,” warned Anne Sosin, program director at the Dartmouth College Center for Global Health Equity.

Timing is key, experts say. Modest restrictions can be effective if imposed early, said Toby Phillips, executive director of the Oxford Covid-19 Government Response Tracker, a project that has been collecting pandemic-response policies from 190 countries.

His organization considers “early” to be when a state or country has no more than 40 new cases per day per million of its population. Once the number goes over 200 cases per million, that’s considered “maximum risk.” The United States is now over 500 cases per million, Phillips said.

“The moment for acting early with a fast response has passed,” he said.

Taiwan, Vietnam and China had success with swift measures that combined targeted restrictions with strong communication. Taiwan has never had a full shutdown, Phillips pointed out, because people are conscientious about wearing masks and reducing interactions with others.

But in the U.K., where Phillips lives, weeks of a curfew weren’t enough to stop the escalation of cases.

“The most expensive way to deal with the virus is to delay the pain until the point when you have to put the economy into a lockdown,” he said.

Several vaccines have proved effective and in coming weeks probably will be approved and begin to be distributed. But that will take months. The short-term future of the pandemic in America — and the severity of the crisis that President-elect Joe Biden will inherit Jan. 20 — depends largely on individuals’ choices in the coming days and weeks.

Pandemic fatigue, personal hardships and a lack of financial resources have combined with anti-government sentiment and science denialism to drive a wedge between what public health officials say should be done and what people are actually doing.

In addition, many people remain unpersuaded that the novel pathogen and covid-19, the disease it causes, warrant sweeping restrictions on commerce, schooling, sporting events and other cultural activities. They don’t think the virus is as dangerous as public health experts claim.

These attitudes to some degree echo President Trump’s message that the “cure can’t be worse than the disease.” But they are also shaped by personal experiences over the past nine months, said Michael Mugavero, an infectious-disease physician at the University of Alabama at Birmingham.

“What is the public health messaging that aligns with people’s very real, lived experiences?” Mugavero said. “At the end of the day, for most people, their lived anecdotal personal experience supersedes any broader health data.”

Political leaders and the general public alike are loath to see the imposition of the kind of economy-crushing shutdowns seen in the spring during the first pandemic wave. But that may be the only option if hospitals become so overwhelmed they start turning away seriously ill or injured patients, or have to ration care because of staff and equipment shortages.

There are no painless options. Many of the new restrictions have sparked protests, derision and second-guessing. State and city leaders have been accused of doing too little — or too much.

Exasperated parents have protested the abrupt closing of in-school learning in public schools in New York City, which still permits restaurant patrons to dine indoors and work out in fitness centers. Curfews, ordered in states from Massachusetts to California, have been met with jeers about the virus’s inability to tell time. Some local law enforcement agencies publicly vowed not to enforce limits on family gatherings.

Utah Gov. Gary R. Herbert (R), who issued a mask mandate earlier this month, let a two-week ban on household gatherings expire Monday, saying the government shouldn’t tell people what they can do inside their homes. And while North Dakota’s Doug Burgum and Iowa’s Kim Reynolds are among the Republican governors who have ordered new restrictions in the past two weeks, others continue to take a largely hands-off attitude — most notably South Dakota’s Kristi L. Noem, who has refused to issue a mask mandate, despite some of the nation’s highest rates of infection and hospitalizations.

Curfews work best as a strong opening move, said Caitlin Rivers, an epidemiologist at Johns Hopkins Bloomberg School of Public Health. They also are most effective when coupled with strong messaging explaining why they’re necessary, she said.

“If people don’t understand the purpose of the restrictions, then, sure, they’ll just find a way to do what they were going to do anyway, within the bounds of the restriction,” Rivers said.

For much of the summer and early fall, New York state managed the pandemic by targeting specific sites for shutdowns, such as factories with outbreaks or neighborhoods with significant infection numbers.

But the recent spike in infections spurred state officials to limit hours at gyms, bars and restaurants after 10 p.m. Outdoor dining is still allowed, but indoor dining is capped at 25 percent capacity in New York City and 50 percent outside the city. People are free to leave their homes after 10 p.m. but there is little, by design, for night owls to do. Violators potentially face $10,000 fines.

The biggest flash point involves public schools. On Nov. 18, New York Mayor Bill de Blasio (D) closed the city’s public schools, citing a citywide threshold — a 3 percent positivity rate on coronavirus test results averaged over seven days — that had been exceeded.

Disappointed parents and schoolchildren rallied at City Hall last week, holding signs with slogans such as “De Blasio Failed Families.”

“Our priorities are totally backward,” said New York City Councilman Mark Levine, who chairs the council’s health committee. He and others noted that testing has shown low rates of infection in the schools, and that children are unlikely to develop severe illnesses from the virus.

“By far, the bigger threat are venues like indoor dining, gyms, salons, and those continue to operate as if nothing had happened,” Levine said.

The mayordefended the school closures, saying it that it was only “a matter of time before indoor dining will close” in New York City.

Public health professionals in recent days have turned up the volume of their warnings about Thanksgiving. On Thursday, officials at the Centers for Disease Control and Prevention made a striking announcement: “CDC is recommending against travel during the Thanksgiving period.”

Celebrate with your immediate household, the officials said. They defined “household” narrowly as people who have been present over the past two weeks. College students coming home for Thanksgiving, for example, or other adult children arriving from out of town would not be considered part of the household.

In Virginia, Maryland and the District, elected officials in recent days have implored residents not to travel or host guests for the holidays, and have tightened restrictions on restaurant hours, capacity inside retail establishments and houses of worship and the size of both indoor and outdoor gatherings.

D.C. Mayor Muriel E. Bowser (D) on Tuesday banned live entertainment and limited indoor gatherings to 10 people or fewer — including for Thanksgiving dinner. Maryland announced new statewide enforcement efforts, including an expanded hotline for people to report violators and plans to send an emergency alert to every cellphone in the state at 5 p.m. on Wednesday.

Officials have caught heat from those who consider restrictions draconian. White House coronavirus adviser Scott Atlas, in a since-deleted tweet, called for the people of Michigan to “rise up” against Gov. Gretchen Whitmer (D) after she announced restrictions in mid-November that close schools, universities and workplaces for three weeks. Whitmer earlier this year had been targeted for kidnapping by a group who saw such restrictions as a violation of their personal liberties, according to law enforcement authorities.

This week protesters gathered outside New York Gov. Andrew M. Cuomo’s house in opposition to his order limiting gatherings to 10 people. A decal company in Upstate New York began selling stickers of the governor’s face that, when stuck to a window, give the impression he is surveilling those within.

California Gov. Gavin Newsom (D), who announced a curfew for some regions of the state, is facing accusations of hypocrisy after being photographed recently sitting next to lobbyists at a crowded table in an expensive San Francisco restaurant — unmasked.

Even the advocates for aggressive public health measures are quick to note the hardships that restrictions can cause, particularly on working-class families, for whom shutdowns can mean no money to put food on the table. In New York City and other metro regions, people unable to isolate at home because they share a living space may be given a hotel room, free, through local programs.

But there is mounting anger and dismay among many experts over the lack of a new government relief package that could make it easier for people to stay at home or to isolate away from vulnerable family members.

And, finally, there’s the issue of what’s psychologically tolerable.

“I think what we need to be talking about is how we can have safe pandemic fun,” said Dartmouth’s Sosin. “We can’t just lock up the American public for another six months and think that’s going to work.”

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