Lessons from the lockdown — and what comes next

We are nowhere near finished with the coronavirus, but the next phases of our response will — if we do it right — be more targeted and risk-based than the sweeping national lockdown we’re now emerging from.

Why it matters: Our experience battling this new virus has taught us a lot about what does and doesn’t work. We’ll have to apply those lessons rigorously, and keep adapting, if we have any hope of containing the virus and limiting the number of deaths from here on out.

Where it stands: The national lockdown is easing and the pandemic is no longer the single dominant storyline of our lives, but nothing has really changed — we didn’t develop a treatment and the virus didn’t get naturally weaker. It’s just as contagious as it ever was.

• Tom Frieden, who led the Centers for Disease Control and Prevention under Barack Obama, told me he thinks there will be another 20,000 coronavirus deaths within the next month.
• “I think people think we’ve come out of something,” said Jennifer Nuzzo, an epidemiologist at Johns Hopkins University. In reality, though, “We hit pause, and now we’re hitting play, and we don't know what the next song’s going to be.”

The big picture: If we’re able to contain new outbreaks without the massive economic costs of the national lockdown — and that’s still an open question — there will be three big reasons:

• We’ve learned a lot about the virus itself; we’ve learned from our experience so far; and we’ve gotten better at some of the basic things we screwed up so badly at the beginning.

What we’ve learned: This coronavirus doesn’t survive on surfaces as long as once feared, and it appears to transmit much more easily indoors than outside.

• Both of those scientific lessons have already helped develop more nuanced guidelines about which activities are and aren’t safe — you may not need to be as vigilant about wiping down packing, for example — and elevated the importance of wearing a face mask.

We know the virus is deadliest for people older than 60 or who have an underlying medical condition, and experts say it is important to do a lot more to protect those vulnerable populations.

• One of the most straightforward lessons of our experience so far, said Boston University epidemiology professor Eleanor Murray: Hospitals shouldn’t be discharging stable coronavirus patients back into nursing homes or assisted-living facilities.
• Those senior-care facilities also need to invest heavily in protective equipment, conduct frequent testing and draw up plans to minimize contact among workers and residents.

Yes, but: Experts also warn against taking those lessons too far, into over-simplified logic that says this is only a problem in nursing homes, or only for some small part of the population. It's still everyone's problem.

• Put together everyone who’s over 60 or has an underlying health condition that’s tied to severe coronavirus illness, and you’re looking at almost 40% of the U.S. population, per the Kaiser Family Foundation.
• Essential workers — including nursing-home workers — often have to use public transportation. Many work two jobs in order to put together 40 hours per week. Overcrowded housing not only increases the risk of infection, but makes it harder, if not impossible, to safely quarantine.
• “The idea that there's any one part of society that we can just cut off from the rest of society is kind of foolhardy,” Murray said. “If there’s infection anywhere, then there’s infection everywhere.”

Although older and sicker people are at more risk for death and serious illness, the virus does still infect and kill young, healthy people. Doctors and scientists are also discovering additional health effects, including damage to the heart and immune system, that outlast the infection itself.

Also in the name of a more risk-based approach, Nuzzo said she hopes hospitals and health agencies won’t be so quick to shut down non-coronavirus care, even as new outbreaks inevitably bubble up.

• That decision was understandable as the still-nascent American response looked at Italy’s overrun hospitals, but it likely led to patients foregoing care they needed, she said.

Between the lines: The sweeping national lockdown was no one’s first choice, and it was never designed to last forever. It was a Hail Mary designed to buy some time because the U.S. simply could not do the basic things, like testing and contact tracing.

• And so a more risk-based, targeted approach going forward is in some ways not a lesson at all, but simply a reflection of our improved ability to actually do things we always knew we needed to be doing.

What’s next: We’re going to keep learning — both from experience and about the virus — and that means our public-health response could change again.

• Among the most important things to figure out: Whether exposure to the virus confers immunity, and if so, how strong that immunity is.
• And of course, the hunt for a treatment or vaccine continues.

The bottom line: “Outbreaks of emerging infectious diseases are fluid by definition,” said Rebecca Katz, who leads the Center for Global Health Science and Security at Georgetown University. “You don't expect to know everything on day 1. There’s no way you can."