Governor Charlie Baker is taking many of the right steps to slow the spread of COVID-19 across the Commonwealth, even as the pandemic threatens to overwhelm our hospital emergency rooms and ICUs. Baker issued a stay at home advisory in March and later extended it to May 4, he closed many non-essential businesses, urged people to maintain social distancing and wash hands frequently, and expanded testing.
As public health professionals, however, we implore the governor to do more, and do it right away, to block the further spread of COVID-19 in our community. We can’t afford to wait another day for tough federal guidance, which has been too slow in coming.
There are five things that Baker needs to do immediately:
Issue a stay-at-home order, not an advisory
Asking nicely has not been enough. It’s time for our state and city officials to lead and direct people on what to do.
When Baker issued the statewide stay-at-home advisory on March 23, he said, “I do not believe I can or should order US citizens to keep confined to their homes for days on end. It doesn’t make sense from a public health point of view, and it’s not realistic.” Yet here we are in April and there are still too many Massachusetts residents who are failing to maintain social — read, physical — distance and are continuing to congregate and socialize, and non-essential businesses that are still operating. Every unnecessary social interaction increases transmission of the coronavirus, adding to the delay in resuming normal life and costing lives. Pickup basketball games are ongoing, forcing officials in cities like Boston and Newton to attach barriers to block the hoops. Vehicle traffic to the Plug Pond recreational area in Haverhill had to be closed after fishermen were found congregating at the pond in large numbers. There have been reports of soccer games and other gatherings on BOS:311.
Enforce the stay-at-home order
Although data show that travel has fallen significantly in Massachusetts, there are still many residents who congregate and non-essential businesses that keep operating in contravention to the current advisory. Armed with the stronger stay at home order, Baker and local mayors should deploy police and the Army National Guard to patrol recreational areas and break up groups, and close businesses that should not be operating. They should set up dedicated coronavirus tip lines, which are now being used in Canada, to report on people and businesses not complying with the state’s orders.
Fines should be levied on violators, as is happening in New York City where Mayor Bill De Blasio has authorized police to hand out $500 fines to people who “haven’t gotten the message.” Let’s do the same in Massachusetts. The money collected can go to a COVID-19 response fund.
Implement a universal mask policy for Massachusetts
As we advised in mid-March, you should cover your face to help stop the spread of the coronavirus. The White House and Centers for Disease Control and Prevention on Friday issued a long overdue recommendation in favor of cloth mask use by the general public. Baker can go further in implementing this federal guidance by personally promoting the use of non-surgical masks. Los Angeles Mayor Eric Garcetti called on his city’s 4 million residents on Wednesday to don non-surgical masks, and Garcetti led by example by wearing a mask to his own televised briefing. Baker should do the same.
A universal mask policy in Massachusetts, in addition to social distancing and handwashing, would contribute an additional 5 to 20 percent reduction in infections and flatten the rising curve of COVID-19 deaths.
Protect our first responders
Not enough is being done to help police, firefighters, and ambulance drivers. These first responders are not able to maintain social distance due to the nature of their work and are thus at heightened risk for infection. Alarmingly, 18 percent of New York City police have been infected with COVID-19 as of April 3, and there is no reason to believe that the infection rate will be any lower for Boston police if they continue to work without masks and gloves. All first responders should be provided with personal protective gear to protect them and the public.
Explain what “stay-at-home” means
Baker needs to explain the importance of assuming everyone is infected with the coronavirus. Asymptomatic carriers could number up to 25 percent of all infections and are unwittingly spreading COVID-19. Go out only for food and medicine, and in the smallest groups necessary to get what you need. And no, the Starbucks drive-through doesn’t count as food. Going to Target is not an excuse to take your restless children on an outing — imagine that everyone in your aisle is infected. Jogging in crowds is also a no-no — every breath exhaled by a passing runner could be a cloud of COVID-19 droplets.
A brilliant but forgotten article by Yaneer Bar-Yam, a pandemic expert, published in USA Today two weeks ago showed that a comprehensive lockdown — a complete prohibition on unnecessary travel, closure of borders and airports, and staying at home except to obtain food — could end the pandemic in five weeks. As of April 4, more than 8,000 Americans have died of the coronavirus — and we expect that number to rise exponentially in the coming days. We are already prolonging the economic agony — nearly 10 million Americans have sought unemployment benefits in the past two weeks — with the half measures we have adopted.
To make the sacrifice count and ensure that the economic gut-punch we are experiencing is as short as possible, we must do everything we can to save lives and the economy. Rigorous social distancing and universal cloth mask use would lower the peak of daily new infections and deaths in Massachusetts while speeding up the forecasted date for returning to normal life. These are relatively inexpensive and easy actions which will yield huge benefits to our state and nation. The stakes have never been higher and the clock is counting down. Since the Trump administration won’t act quickly enough, Baker must act now.
Shan Soe-Lin is managing director of the Boston-based Pharos Global Health Advisors and a lecturer in global health at the Jackson Institute for Global Affairs at Yale University. Robert Hecht is president of Pharos Global Health Advisors and a professor of clinical epidemiology of microbial diseases at the Yale School of Public Health.