As Memorial Day signals the start of summer, Americans are yearning for a return to normal. Restrictions are falling by the wayside throughout the country. Maine's governor is allowing sleepaway camps to open. New York City is considering opening beaches. Florida Governor Ron DeSantis lifted prohibitions on all youth activities. "At the end of the day," he said, "we trust parents to be able to make decisions."
The United States and the rest of the world are entering a new, uncertain phase of the COVID-19 outbreak. Severe social-distancing measures have broken the initial wave, with cases flattening and heading downward in hard-hit places like New York, Italy and the U.K. What comes next is the trickier task of loosening up on restrictions enough to save people's livelihoods and sanity while keeping the virus from roaring back to overwhelm emergency rooms and intensive-care units.
The trouble is, there's no consensus on how to reopen a nation reeling from both the disease and the cure. The language from politicians and even public health experts is often conflicting. Some experts are calling for a massive effort in contact-tracing, which involves tracking down anyone who may have come into contact with an infected person and asking them to quarantine themselves for 14 days. Other experts don't think contact tracing is a workable defense against the coronavirus, especially in America, where people don't like strangers asking prying questions and telling them what to do.
Amid the uncertainty, we're entering what you might call the personal-responsibility phase of the COVID-19 outbreak. About 40 percent of Americans are either older or have underlying conditions that put them at high risk of death from COVID-19. This summer, it will be incumbent on them and their families and communities to decide how much risk of exposure to the coronavirus they're willing to accept.
"What is an individual's ability to protect themselves versus what is government's ability to help protect them?" says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "We all agree that government should take drunk drivers off the road. But we also take responsibility for our own behavior and not being drunk while driving."
Osterholm, a leading epidemiologist, was quick to sound the alarm that SARS-CoV-2 was going to spread as a pandemic and hit urban areas hardest. Now he's saying that the shape of the pandemic is highly uncertain. Although SARS-CoV-2 is a coronavirus—the same category as viruses that cause the common cold—the pandemic has so far played out more like an influenza pandemic, with rapid spread and big initial peaks in cases. As summer unfolds, nobody knows which personality the virus will adopt.
Some facts are clear. Economic hardship is taking a devastating toll on livelihoods and mental health. At the same time, the pandemic is far from over. The virus continues to circulate, with the prospect of a second wave in the fall that could be deadlier than the first. "This virus is going to continue to spread by the force of what I call viral gravity," says Osterholm. "It's biology, chemistry and physics. No policy decisions are going to keep it from happening."
Newsweek spoke with Osterholm about the next phase of COVID-19. The following are excerpts from the conversation.
NEWSWEEK: Forty percent of Americans are vulnerable because they are older or have underlying conditions. What should they do to protect themselves?
OSTERHOLM: That is the challenge. We're at a crossroads in terms of how we recommend what we're going to do to protect people who are at highest risk.
If you are in a high-risk group for a serious illness, it's your choice whether to go into the public and do grocery shopping or whatever you do. Most people don't have the [luxury] of making that decision. They don't have the ability to say, "I'll limit my contact." They also have to deal with all the mental health issues of being isolated.
I don't have the answers, but I have the questions that I wish people were talking about. We've got to have that discussion soon. One set of guidelines cannot make this happen. There's got to be a national consensus, at least among a significant number of people.
At my local hardware store the other day, some people had N95 masks and others walked around with no masks and didn't seem to care about social distancing. What should a vulnerable person do in that circumstance? Leave the store?
That's exactly what we're struggling with right now. My advice would be: If you are at increased risk, or you are a routine contact of somebody at increased risk, you just have to consider this.
This is not an answer—there is no good answer right now.
The very question is critical to being better prepared for what's going to happen in the months ahead. My greatest fear is that we're not even beginning to address them, let alone answer them.
You say that the virus won't slow down until it has infected 60 to 70 percent of the population. Do most people understand that it's not going away?
There's a mistaken belief that if we just somehow get over [the initial peak] and get to summer, we're okay. It's understandable. Everybody wants to get back to normal. I'm just saying, "No, this is just a momentary, quiet period in this horrible storm."
Did Vice President Pence and President Trump create false hopes by saying over the past few months that we'll soon have the pandemic behind us?
Yes, that's exactly right. If you look historically at all pandemics involving a respiratory pathogen, they play out over months to years, not over weeks to months. People are just not understanding that that's the case.
You've said the prospect of the virus disappearing over the summer scares you. Why?
Because it would [lead to a] big peak of cases. Imagine the experience they had in New York City, but a much, much larger event, where cases were two or three times what they were. For much of the New York City metropolitan area, much less than 20 percent of the population have been infected. That's a long way from the 60 to 70 percent to begin to achieve herd immunity. That tells you, with all the pain suffering and death and economic disruption that we've had to date, we really are just in the second inning of a nine inning game.
How is this next phase of the pandemic different from what we've seen in the last few months?
In late January we knew that this [outbreak] would unfold in countries around the world, likely showing up in late February, early March and most likely show up in the higher density population areas of the world. It followed exactly as we predicted.
The reason I'm telling you that is because now we're at the end of our headlights.
Is this virus going to act like an influenza virus and unfold a pandemic that looks like a previous influenza pandemic? Or is it to be a coronavirus pandemic that we've never seen before and don't know what it's going to do?
The one thing we do know is a respiratory pathogen like this is not going to rest until basically it infects as many humans as it possibly can. We're stuck with the notion that all we can really do for the moment is control how quickly this thing goes through the population and try to keep it below kind of a threshold where we don't overwhelm our hospitals.
Do you think more testing is the answer?
We need to get rid of this "testing, testing, testing" mantra. People look at testing almost like a Dow Jones average—if we have 20,000 tests in a day, it's even better to have 30,000.
We want smart testing. You want the right population and the right person in that population to be tested at the right time, with the right test, with the right result and the right outcome for what you're going to use that test result for. It's about being strategic.
What about contact tracing?
Contact tracing has been largely a groupthink concept. Nobody's really looked at whether it makes any difference. We know that there are countries in Asia that if you test positive, you are automatically sent to an isolation center for 14 days. Would that work in the United States?
Are you saying contact tracing is not possible or realistic?
I don't think it's realistic.
What messages should people be getting from leaders right now?
None of us have the right answer because I don't know if there is a right answer. How do we protect, as much as we can, those who are most likely to have severe illness and die? And how do we also function as a society? I see our job right now is to ask the question, not to answer it. Because it takes all of society to come together here.
We have to continue to have debate, discussion and consensus development, and we've got to do it soon. Because we could have really very, very horrible days ahead of us in terms of this pandemic.
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