By “soft” lockdown, I mean a situation in which everyone from the governor to the local health authorities recognizes that the virus is spreading at a sufficiently dangerous rate that everyone should stay home — but no formal stay-at-home order is issued. That would be a “hard” lockdown, but for reasons of basic human psychology I’m not sure politicians are willing to do that again. Not because people won’t follow new stay-at-home orders; there’s reason to believe that they will. Rather, I think it’s a function of not wanting to admit “failure” by reverting to formal lockdown status after reopening. That would put us back at square one after a long effort to move forward.
Which would be terrifying. Even people like me who were skeptical of reopening early might be guilty of magical thinking with respect to COVID-19. That is, although we all had different opinions on when we thought it was “safe” to reopen, we all believed that it would be safe at some point. Red states thought it would be safe in May; blue states held out a bit longer. But everyone had their own personal benchmark for when they believed transmission might be at a sufficiently low level that we could reemerge and — with proper precautions — engage in commerce without triggering a major outbreak.
But what if we were all wrong? What if the virus is sufficiently contagious that there’s just no way to prevent what Arizona and Texas and Florida and California and South Carolina are going through right now? Yeah, if we all wore masks and we all kept six feet away at all times, maybe we could hold down transmission. But that’s never going to happen. Some segment of the population will always break the rules in the belief that it can’t happen to them — and if it does, it won’t be so bad. (The young are probably especially susceptible to that thinking.) What if we *can’t* reopen for any sustained period of time without sparking an outbreak that’s going to drive us into “soft” lockdown again within a month or two?
That’s no idle hypothetical. I remember reading about various epidemiological models in the early days of the pandemic that predicted exactly this outcome. We’d be stuck in an endless cycle of locking down, then reopening, then locking down again, then reopening again, etc, because there simply wouldn’t be a way to hold down transmissions to a “manageable” level during the reopening periods. We’d always end up having to take extreme measures to control the fire before it burned out of control, because it burns just that quickly.
It’s already happening in Texas. The “soft” lockdown now exists in all but name, with Gov. Greg Abbott explicitly warning residents that it’s best not to leave the house right now.
In Texas, Mr. Abbott renewed his warnings in an interview with the television station KBTX.
“Because the spread is so rampant right now, there is never a reason for you to have to leave your home unless you do need to go out,” he said. “The safest place for you is at your home.”…
“There remain a lot of people in the state of Texas who think the spread of Covid-19 is really not a challenge,” said Mr. Abbott, who has resisted the idea of another lockdown.
“Don’t go out unless you have a good reason” sure sounds more like a lockdown than a reopening. But what else can Abbott responsibly say? There is in fact a “massive” outbreak happening in Texas right now, to borrow his words, with authorities scrambling to make sure hospital capacity is available in case there are soon more critical cases than there are beds. That’s no idle hypothetical either:
*HOUSTON ON PACE TO EXCEED INTENSIVE-CARE CAPACITY BY TOMORROW
— Emma Kinery (@EmmaKinery) June 24, 2020
Update on utilization of general medical beds and ICU beds from Texas Medical Center in Houston. They are projecting that they will access sustainable surge capacity starting this week, and if current Covid trends continue, exceed that capacity in about two weeks. pic.twitter.com/QTk8nykvvU
— Scott Gottlieb, MD (@ScottGottliebMD) June 24, 2020
As of this morning ICU capacity in the city was at 97 percent, with Texas Children’s Hospital — the largest pediatric hospital in the U.S. — opening its doors to adults in order to handle the crush.
Hospitals having to prepare for surge capacity is one obvious hallmark of a lockdown scenario, replete with postponing elective surgeries in order to free up resources. That may be coming soon to Texas and other states as well:
"Very soon … hospitals in Texas, California, Florida and Arizona are going to have to make decisions to suspend elective surgeries again," says @ScottGottliebMD. "They're going to be on a trajectory to get overwhelmed again." pic.twitter.com/kHkrGvipOR
— Squawk Box (@SquawkCNBC) June 24, 2020
Another hallmark is businesses shuttering as the risk of transmission reaches frightening levels. In a “hard” lockdown, the state mandates that. In a “soft” lockdown, businesses do it voluntarily because they don’t want their employees or customers to die. Guess what:
— Meg Tirrell (@megtirrell) June 24, 2020
Consumers also act accordingly in a “soft” lockdown scenario by declining to patronize businesses in order to avoid being infected. We’ve all seen the graphs of restaurant reservations in New York City falling off a cliff in March even before stay-at-home orders went into effect there. Well, again, guess what’s happening in Houston and other new hot-spot areas like North Carolina:
Charlotte, NC too pic.twitter.com/DuRnrtK9o9
— Adam Ozimek (@ModeledBehavior) June 23, 2020
There’s a school of thought that appeals to me that holds that “hard” lockdowns don’t do much to contain the spread. When an outbreak reaches a point of such alarming prevalence that a formal stay-at-home order is necessary to try to contain it, the public will necessarily already be aware of it and will act voluntarily to limit its own exposure. (That’s why restaurant reservations in NYC tailed off before the lockdown began.) But watching cases spike in Houston as Texas attempts a “soft” lockdown has me rethinking that. There may be some segment of the public that simply will not believe there’s a dire emergency requiring them to stay home unless the state takes some extraordinary formal step to convey that. Greg Abbott telling people in morning news interviews “you’re better off not going out” just might not hack it. A person who really wants to go out will watch that and think, “If it’s as bad as he’s saying he’d just do a new lockdown.” Whereas a formal lockdown order will get that person to think, “Sh*t, it really must be bad if they’re locking down again.”
That is, “hard” lockdowns may work to limit the spread more effectively than “soft” lockdowns not because they force businesses to close their doors but because they communicate in a singularly urgent way how unsafe it is to be around others. Think of the old terror-alert system in the years after 9/11. If you tell people we’re at orange alert, with a highly elevated risk of terrorism, they’re not going to alter their behavior much. What does “highly elevated” even mean? Tell them we’re at red alert, though, and they’ll sit up and pay attention. Abbott’s “soft” lockdown may be the COVID-19 equivalent of orange alert. If you want people to sit up, red alert may be the only option.
Here’s video from CNN that’s making the rounds today showing people in Florida inveighing against masks. A nice explainer for why we just might not be able to sustain a durable reopening as a country without breeding new exponential growth.
it's like a youtube comments section come to life pic.twitter.com/b2AbN6GHBM
— jordan (@JordanUhl) June 24, 2020