The key to halting a pandemic is, not surprisingly, reducing the spread of the disease. No tactic is as effective in achieving that goal as simply keeping people away from one another. That’s why China, facing a relatively small outbreak of COVID-19 in Beijing, has imposed travel restrictions, closed down businesses, imposed curfews, and instituted strict stay-at-home orders for affected neighborhoods. That will work. Because that kind of imposed social distancing will shift the transmission rate of the virus, and the outbreak will end.
Nowhere in the United States have stay-at-home orders been as rigidly imposed as they were in China during the initial outbreak in Hubei province, or in nations like Italy at the height of the epidemic there. But Donald Trump’s abdication of leadership in a time of crisis left the nation with a hodgepodge of rules, many of them little more than suggestions that were rarely, if ever, enforced. Even that inadequate lockdown was enough to temporarily slow the pace of the COVID-19 epidemic in the United States, level the national caseload, and initiate a slow decline. But because that lockdown was so inadequate, so hit-or-miss, so uneven, the recovery that it generated was also slow and fitful. And well before that recovery had been bolstered by an adequate system of testing and case management, the uneven pressure being applied to COVID-19 fell apart in the form of “reopening.” And now the nation is utterly unwilling to undergo a second, absolutely necessary, round of restrictions, so it’s placing its hope on one thing: masks. Which could work. Only the implementation of this round looks to be even less consistent than the first.
Take a balloon. Not one filled to bursting, but one only partially full of air. Now squeeze. Rather than bursting, the air only bulges out in another direction. That’s exactly what has happened with the COVID-19 epidemic in the United States.
Some locations, especially those where the disease gained a foothold even before it was recognized that it was circulating in the population, reacted with tight lockdowns that included strict stay-at-home orders, business closures, and tight controls on gatherings. Even more importantly, a few places actually enforced these rules. That last part is the rarest portion of the formula. The number of people in America who actually received some form of ticket for violating stay-at-home rules is probably not much higher than the count of Americans with an active case of Ebola. In many states that theoretically imposed lockdowns, businesses publicly flouted rules to close, people openly defied regulations on travel, and dozens (or hundreds) gathered in sweaty celebration of their ability to infect one another with impunity. Take that, constitutional authorities attempting to preserve the public health! Freedom!
To pop that balloon, it has to be squeezed everywhere at once. Hard. That never happened in the United States. Instead, at a point where the rate of new cases had been seriously depressed in a few locations where the rules were treated seriously, but where most areas were still frighteningly near their peak, the pressure was released. And, as everyone absolutely knew would happen, the rate began to grow.
On Thursday, Florida logged another 3,200 cases of COVID-19, by far its highest number so far and part of a explosive trend that is catapulting the state toward disaster. Despite the rapid rise in cases, Republican Gov. Ron DeSantis has made it clear that he’s going to take absolutely no steps to restrict business, schools, or anything else. “You have to have society function,” DeSantis said in his address on Tuesday. “You have to be able to have a cohesive society, that’s the best way to be able to deal with the impacts of the virus. But particularly when you have a virus that disproportionately impacts one segment of society, to suppress a lot of working-age people at this point I don’t think would likely be very effective.”
The combination of disinformation and cruelty bundled into DeSantis’ statement demands some unpacking. He’s flat-out saying that if old people have to die so that business owners can turn a profit … then it sucks to be old. That’s not just the distilled wisdom of Ron DeSantis, this is absolutely the philosophy that our nation has adopted as its driving principle at this point in the pandemic. And it’s unlikely to change.
Of course, COVID-19 doesn’t only kill old people, or unhealthy people. Despite all the claims that as more cases were confirmed and more tests were done, the fatality rate for COVID-19 would come down, but that has not proven to be the case. With over 2.2 million cases in the United States, the case fatality rate for COVID-19 is still 5.3%. One person in 20 who catches this disease is dying. Another three are experiencing critical, life-threatening illness that, at best, takes weeks or months for recovery. An unknown number of people are being left with consequences from the disease that represent a lifelong disability.
None of that really matters at this point, because it seems the nation has made its decision. Not reopen or day, but reopen and die. Despite all the talk of those trying to protect themselves from the disease being sheep, the alternative appears to be a nation of lemmings. And the lemmings are winning.
In fact, it appears that there is only one fig-leaf remaining that might make a possible difference in blunting the damage between now and whenever an effective vaccine becomes available. Masks.
Spiking case numbers in California have brought Gavin Newsom to institute a statewide mask mandate. Even some Republican governors have turned to masks as a lifeline. In Arizona, Doug Ducey didn’t flip the switch on masks himself, but he did flip his previous stance and allowed cities and counties to impose their own mandates.
The bad news is that to effectively block the transmission of COVID-19 and bring America to a point like that of China, South Korea, or any other nation where cases are relatively few and manageable through local action, requires both masks and enforced social distancing. The good news is that masks alone can be sufficient to achieve an effect at least as good as the poorly imposed set of state, county, and city rules that the nation experienced before reopen fever tore that pitiful bandage away.
And it works like this …
Early in the COVID-19 pandemic, some nations (including the U.K. and the U.S.) toyed briefly with the idea of just letting things run their course until the nation achieved “herd immunity.” The awfulness of this idea turned out to be so epic, that even the most ardent believers were silenced after a quick trip to the calculator. Achieving true herd immunity, of the sort where outbreaks can’t be sustained in a community, requires that 70% to 90% of the population be immune. No one has innate immunity to COVID-19, so that means that 70% to 90% of the population would first need to be infected. In the United States alone, that means that 12 million people would die of COVID-19 to achieve herd immunity. Minimum. So … bad plan.
However, herd immunity can be achieved in other ways. Vaccines provide immunity without the cost of going through an infection. So a well vaccinated community can provide protection against even a disease with a staggering rate of transmission, like measles. If a vaccine were available, herd immunity could be earned with the application of a few hundred million needles. A vaccine is not available. It won’t be available for, at best, months.
But masks are available. In the pre-pandemic period, both the CDC and the World Health Organization were rather blasé when it came to mask wearing, recommending masks for those showing symptoms and telling everyone else to just skip it. But as we’ve learned more about the transmission of COVID-19, it turns out that having everyone wear a mask can be fearsomely effective. If both parties in a transaction are wearing masks, the current estimate from WHO is that transmission rates are reduced by 85%. In a recent real-world situation, two infected hair stylists in Missouri worked on 140 clients. Both the stylists and the customers wore masks. The rate of transmission was 0%.
Assuming the 70% value as the number necessary for true (ersatz) herd immunity, and taking the 85% value from the WHO as a standard, then if 82% of Americans wore a mask in all public transactions, the United States could achieve effective immunity almost overnight. That level of mask wearing would, within a space of three weeks, put the nation back on a path of declining cases and improving prospects. It would work better in combination with restrictions and continued stay-at-home orders, but it would be effective even without those orders.
If the wearing of masks was somewhat less universal, say 70%, it would still have a tremendous positive effect. That would be equivalent to a 60% immunity value—though, considering that people would also be interacting with the 30% of the population not wearing masks, where the transmission rate was reduced at a much lower level, the actual effective amount of immunity would be closer to 40%.
That 40% is not even to generate the kind of herd immunity that stops an outbreak in its tracks. But it’s still absolutely enough to generate a depressive effect on the epidemic that’s greater than what was seen at the height of the lockdowns in April. Wearing masks at that level would absolutely save tens of thousands of lives between now and deployment of an effective vaccine. It could save much more.
Better still, wearing masks does not require that the economy be shut down. Knowing what we know now, we can achieve the effect of earlier lockdowns through a simple action, using cheap materials, at a minor inconvenience. We get to keep our lives, our jobs, and maybe even our tattered sanity.
All it needs is a national mandate for wearing masks and enforcement of that mandate.
If you want to save your own life and contribute to thwarting the course of the pandemic, stay at home. If you must go out (for example to participate in socially essential protests against police violence), wear a mask. If you want to save millions, push for a mask mandate.