USA Fails to Stop Pandemic, Will Stay-at-Home Orders Return?

By Denise Chow - NBC News

To the health authorities it may seem that if people are given a finger, they will take up to the elbow. In the months when most states left quarantine orders behind due to the COVID-19 pandemic, the issue of whether or not to wear a mask became more of a political issue than a safety one. "Pandemic parties" have been held in California, New York and Florida, and many states that went ahead with their reopening plans in May were forced to halt or reverse them.

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In this climate of tension, public health experts warn that if other less severe measures do not work or are ignored, a new period of confinement orders - with all the political unpopularity that could characterize it - could be the only way to avoid a situation Terrible in itself gets even more out of control.

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"We understand that people are not in the mood for such extreme measures, but right now we are headed for a collision with destiny," said Michael Osterholm, director of the Center for Infectious Diseases Policy and Research at the University of Minnesota.

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Some areas of the United States, like many places in the world, imposed stay-at-home orders for the first time in March, but the truth is that they were never as strict as in Europe, for example.

While that helped some countries to get their outbreaks under control, it didn't work in the United States, which is now nearing the 170,000 death toll associated with the coronavirus. And the number of new infections remains alarmingly high in different states.

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While the quarantine periods in March initially managed to lower the number of infections, in many states the restrictions were lifted too quickly to allow those numbers to remain low, and new outbreaks have quickly outstripped testing capacity. and contact traces. At this point, according to Osterholm, new quarantines could be the fastest and most efficient way to contain the spread of the virus.

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The number of new daily cases across the country appears to be declining, having peaked at more than 60,000 at the end of July. However, new foci are emerging in the Midwest. The case count is stubbornly high in California and much of the South, and deaths from coronavirus - which tend to lag a couple of weeks behind peak cases - are on the rise in at least 15 states.

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And with no signs of a summer hiatus, experts warn the country is running out of time before the coronavirus pandemic collides with flu season and winter , when any kind of socially distant and outdoor activities will be much less attractive and much more difficult.

But the widespread lockdowns have proven to be politically unpopular , in large part because of how damaging they are to local economies, even as a consequence of the out-of-control public health crisis.

People trained to get tested for COVID-19 in Los Angeles, California. AP / Mark J. Terrill

Dr. Mike Ryan, Director of Emergencies at the World Health Organization, recognized the difficult balance between keeping countries and economies open while curbing new infections.

"The trick is to really focus on identifying clusters of diseases, identifying any new transmission in a community, and putting in place the kind of localized measures that may contain the virus," he detailed Monday in a briefing. 

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However, while stay-at-home orders can be financially painful , they may be the only practical option in places where other, less extreme public health measures are not enough or are completely neglected.

Osterholm said reducing infections to less than one new case per 100,000 people a day would make the response to periodic outbreaks more manageable and prevent evidence and contact tracing measures from being overloaded.

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"Right now, trying to contact these numbers is like trying to plant petunias in a Category 5 hurricane, " he said.

Ideally, states would not need full shutdowns and could instead find a middle ground with strong mask policies , social distancing guidelines and indoor gathering bans, said Dr. Steven Goodman, a professor of epidemiology and medicine at the University. Stanford. However, the success of these strategies has varied widely between states.

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"We are having trouble, as a society, finding that middle ground because there is a lot of politicization around basic security measures, " Goodman said.

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"If we don't have a comprehensive testing strategy, good contact tracing, and all these other means to control the virus, then we have to take more extreme, crude and forceful measures ."

Countries like Italy and New Zealand that enacted lockdowns across the country in the spring have since been able to reopen and have so far been effective in managing local outbreaks when they do occur.

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"What we did was a slowdown, " Osterholm said. 

Both Osterholm and Goodman predict that cases will spike again in the fall, when some schools and universities across the country resume face-to-face classes. Some public health measures will also be more complicated in the winter when temperatures drop.

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While strict stay-at-home orders can dramatically reduce the number of new infections, states must carefully plan what to do after restrictions are lifted , something that was not handled as well after the March closures, according to Justin Lessler. , associate professor of infectious disease epidemiology at Johns Hopkins University Bloomberg School of Public Health.

"Those of us who are part of the epidemiological community have been saying that closures are not a permanent solution, but that it is about buying time, " Lessler said.

"The problem with the US response has been that it lacks a clear , long-term plan beyond the hope of a vaccine."