On Wednesday, Bay Area health officials extended shelter-in-place orders through May, bringing their duration to 11 weeks. The new orders very minimally loosen restrictions to allow construction and some outdoor shops and activities, but most businesses remain closed. The announcement comes as California’s Covid-19 situation is looking better, in terms of infections, while the economic, social, and even health repercussions of its stay-at-home orders mounts. A rational cost-benefit analysis of the public-health response should encourage California and the Bay Area to begin a phased reopening.
The health situation in the Bay Area, and California as a whole, appears far from dire. Data on new Covid-19 cases show a clear flattening of the curve. The number of patients hospitalized for Covid-19 in the Bay Area has dropped almost every day for a week. According to the website rt.live, the effective reproduction number (known as Rt or Re) in California, and in almost every other state, is below 1, indicating a decline in infections. The seven-day average for new infections in the Bay Area is the lowest in a month. California’s 16 northernmost counties, with a population of more than 1 million, have seen only 181 confirmed cases—a lower known infection rate than South Korea’s.
Meantime, some 26 million people have filed for unemployment nationally over the past month, including 3.2 million in California, a crushing tide of layoffs that dwarfs prior job-loss records. Almost one-third of Americans did not pay their rent this month. Businesses everywhere are struggling, with small businesses faring the worst and museums and nonprofits in jeopardy, too. Transit agencies face enormous financial losses because of lost riders. Federal Reserve chairman Jerome Powell has said that the economy is deteriorating “with alarming speed.” In a tragic irony, hospitals that worried about an overflow of Covid-19 patients are now laying off workers due to cancellation of elective surgeries and also, perhaps, sick people avoiding treatment for fear of infection. Lines at food banks are staggering. People talk openly not just of recession but depression.
Luckily, recovery should be easier than from a typical recession, since this one is a forced abnormality. Millions of people could have their jobs back tomorrow if shelter-in-place orders were eased—and as the impact of the virus wanes, it makes sense to begin lifting them, as European nations such as Norway and Austria are doing, and as Texas has begun to do. Even New York, far harder hit than California, has tentatively scheduled an end to its statewide “pause” on May 15.
Yet California shows no inclination to ease up. The statewide order has no end date. Governor Gavin Newsom refuses to set one, saying only that the end is “weeks away.” Newsom has outlined criteria to lift the order, but some of his requirements—such as sufficient hospital capacity and progress toward a treatment—are unnecessary or unrealistic. The state’s 5,000 Covid-19 hospitalizations represent a small fraction of its approximately 75,000 staffed beds. A vaccine could be more than a year away and like the swine flu virus, Covid-19 may never even get a silver-bullet cure. Neither the Bay Area nor California have put together a clear plan for reopening.
Newsom is not the only one taking a hard line. Governor Phil Murphy of New Jersey has stated that there “is no cost that is too high to save any one precious life.” Some infectious-disease specialists argue that restrictions should remain in place until the infection rate is nearly zero. These are impossible standards to meet, and not applied to any other danger or disease. Governor Murphy has never ordered streets and highways closed despite more than one life lost each day in New Jersey car crashes. According to the CDC, swine flu has continued to kill about 7,500 Americans each year since the outbreak in 2009. We must accept that Covid-19 will probably never go away entirely.
For some observers, the idea of quantifying human life in economic terms sounds heartless. Yet we perform such cost-benefit analyses all the time, both as individuals—when we choose between riding a motorcycle or a station wagon—and as societies—when we choose whether to put more money into cancer research or into studies of rarer diseases. Every developed nation maintains value of statistical life (VSL) measures, for use in planning, transportation, and health policies.
There are social as well as economic costs. The effects of job losses and recession fall hardest on the poor and working class. People living paycheck-to-paycheck, or without savings, are suffering most. As the economy sinks, it takes with it the livelihoods and aspirations of tens of millions of Californians. It is reasonable to argue that we cannot destroy the economy trying to stop every possible Covid-19 death. When people can’t eat, that’s a health problem, too.
There are even direct health reasons to reopen. After six weeks of shelter-in-place, cracks are appearing in California. San Francisco police broke up an illegal nightclub, surely not the only infraction. More people are circulating outside, and the size of the groups suggests that it’s no longer just roommates walking together. People are more likely to take risks the longer their confinement lasts. Far better to begin a gradual reopening, with a highly publicized campaign to encourage mitigation measures, such as wearing masks.
Another public health reason to begin to lift restrictions is that if stay-at-home orders ruin the lives of millions, they will be much harder to implement in the future. A future disease could be worse than Covid-19—the fatality rate of SARS, in 2003, was 11 percent—but resentment over a “Covid recession” might make it much harder to get people to cooperate next time.
California led the nation in shutting down, but the state is lagging the country, and the world, in opening back up. New Zealand planned its successful lockdown on the scientific basis of two incubation cycles, or 28 days. The sequence lasted slightly longer, but after 33 days, the country began a phased reopening this week. Operating on the same parameters, California could have started lifting restrictions last week. Instead of waiting four more weeks, it should start a phased reopening now.
The stay-at-home orders have been very successful and given California a relatively low infection rate despite one of the earliest exposures. Most people have complied, and local officials should trust them to behave responsibly as restrictions lift, rather than trying to micromanage their activity. And all phases of reopening would include continuing effective mitigation measures—washing hands, wearing masks, social distancing, self-isolation of at-risk people, and tracking and quarantining of those testing positive for Covid-19.
Each region of the United States has experienced the pandemic differently; a phased reopening would work differently in each place. The current approach—where largely healthy Northern California lives under the same restrictions as harder-hit Los Angeles—is not tenable. It’s time to begin the gradual lifting of shelter-in-place orders before these orders do more damage than the illness they were issued to fight.