With the number of new COVID-19 cases spiking to record levels here in Massachusetts and hospitalizations and deaths rising inexorably, Governor Charlie Baker needs to do more to reduce infections. His weak actions in the face of the spike in cases, against which he announced the lightest of new restrictions on Tuesday, are inexcusable.
The bad news is that we need to adopt even more stringent measures than the governor’s rollback to Phase 3, Step 1 if the second wave of COVID-19 is to be knocked down decisively. The good news is that Baker doesn’t have to revert to the total lockdowns of the spring either; instead, he needs to act smarter and faster.
Rather than a full lockdown — a very blunt instrument that is highly effective at reducing new infections but also has severe consequences for businesses and the economy — a partial rollback and pausing of business and social activities that are known to be high-risk could reduce financial pain while reducing new infections, hospitalizations, and deaths.
A partial rollback has the potential to be effective now because, in contrast to the first wave, we now know much more about treating and preventing COVID-19 and about the rules by which the virus plays.
We know from contact tracing that the majority of infections are triggered by exposures at indoor restaurants and bars, gyms, and social gatherings where masks are not worn, and/or where physical distance is limited and the ventilation is poor. The infections are then brought back into the household and spread to family members.
A recent study in Nature found that keeping some lower-risk businesses open actually lowered overall infection and mortality rates by encouraging people to go to relatively safe places like car dealerships and pharmacies rather than indoor restaurants, cafes, snack bars, and similar confined spaces with larger crowds.
This is why the governor’s actions are not enough. Reducing outdoor gatherings from 100 to 50 is still too large. Reducing by just 10 percent the allowed occupancy levels for high-risk venues with crowds and poor ventilation like gyms, and for retail spaces and places of worship, will not be enough to slow new infections. A risk assessment tool developed by researchers at Georgia Tech shows why letting many people congregate in close proximity to one another, even with masks, is unacceptably large: At the current record rates of infection in Massachusetts, you should expect that there will be at least one infected person when a typical group of 50 gathers — the perfect setting for a superspreading event.
The current rollback is wasting valuable time and lives and may end up forcing us to turn to a full-scale and economically damaging lockdown. This can be avoided if we move decisively and in a unified way in the next weeks to:
▪ Focus on the temporary closing of high-risk businesses, with financial support extended to business owners and employees to ensure their survival until the arrival of widespread vaccination and warmer summer weather. Some restaurants have already enacted this measure on their own by going into planned “hibernation” until the spring.
▪ Implement and enforce strict bans on gathering indoors with anyone other than immediate household members. With the testing positivity rate rising fivefold over the past month to 7.4 percent, the current guidance from Baker to allow up to 25 persons to gather is dangerous and must stop until the positivity rate falls again to below 2 percent.
Several European countries have shown that selective closures and other prevention measures can contain the spread of COVID-19. France has cut the number of new infections from 50,000 to less than 10,000 per day in the past month by closing bars and indoor dining. Italy is doing the same.
With an end to the global trauma of COVID-19 now in sight, thanks to the prospects of a vaccine, it is time for all of us to pull together in the coming months to make it through with the fewest lives and livelihoods lost. Accepting additional deaths now would be profoundly cruel.
We urge Governor Baker and our fellow citizens to commit to one final push to mask up, maintain disciplined social distancing despite the holidays, and accept the temporary pausing of high-risk businesses. Based on the recent European experience, we could set a time limit on this “tightening of the screws” to six weeks, assuming we see improvements in the positivity rate, so that everyone understands that this will not go on indefinitely.
Nobody gathers with friends and family thinking it will lead to infections. The game of COVID roulette worked in our favor in the summer, when the prevalence was lower, but now that the risk is the highest it has ever been, even one or two seemingly harmless gatherings can lead to rapid spread. It is these micro-decisions that are driving the pandemic forward.
Stronger measures and strict social discipline could mitigate the pandemic with only a small increase above the 11,000 lives already tragically lost in Massachusetts. If we continue to accept half-measures and play chicken with the virus, the number of deaths could easily increase just as we start to vaccinate, simply because we did not make the tough decisions and necessary sacrifices that are still required of us.
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 the president of Pharos Global Health Advisors and a clinical professor of epidemiology at the Yale School of Public Health.