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Reopenings Mark a New Phase: Global ‘Trial-and-Error’ Played Out in Lives Reopenings Mark a New Phase: Global ‘Trial-and-Error’ Played Out in Lives
(about 20 hours later)
The world is entering a period of high-stakes experimentation, with cities and countries serving as open-air laboratories for how to most safely and effectively reopen amid the coronavirus.The world is entering a period of high-stakes experimentation, with cities and countries serving as open-air laboratories for how to most safely and effectively reopen amid the coronavirus.
Unable to wait indefinitely for science to answer every riddle about what makes infections spike in some circumstances and not others, governments are pushing ahead with policies built on a growing but imperfect understanding of the virus.Unable to wait indefinitely for science to answer every riddle about what makes infections spike in some circumstances and not others, governments are pushing ahead with policies built on a growing but imperfect understanding of the virus.
And with little consensus on how best to balance public health against social and economic needs, societies are feeling their way through trade-offs that would be gut-wrenching even with better information on any given policy’s likely cost in lives and livelihoods.And with little consensus on how best to balance public health against social and economic needs, societies are feeling their way through trade-offs that would be gut-wrenching even with better information on any given policy’s likely cost in lives and livelihoods.
“We’re in the middle of a global trial-and-error period to try to find the best solution in a very difficult situation,” said Tom Inglesby, who directs the Center for Health Security at Johns Hopkins University.“We’re in the middle of a global trial-and-error period to try to find the best solution in a very difficult situation,” said Tom Inglesby, who directs the Center for Health Security at Johns Hopkins University.
The first wave of reopenings, predominantly in Asia and Europe, are providing a preview of what could become a continual process of experimentation and recalibration.The first wave of reopenings, predominantly in Asia and Europe, are providing a preview of what could become a continual process of experimentation and recalibration.
Each policy, like distancing students at Danish schools or temperature checks at Hong Kong restaurants, however based in scientific knowledge and calculated cost-benefit, is also a trial of what works, what’s worthwhile and what people will accept.Each policy, like distancing students at Danish schools or temperature checks at Hong Kong restaurants, however based in scientific knowledge and calculated cost-benefit, is also a trial of what works, what’s worthwhile and what people will accept.
Though experience bought in lives will convert some unknowns to knowns, many questions may remain unanswered for the duration of what is expected to be a one-to-two-year crisis.Though experience bought in lives will convert some unknowns to knowns, many questions may remain unanswered for the duration of what is expected to be a one-to-two-year crisis.
That includes what may be the hardest but most urgent question of all: What is the value of a life saved?That includes what may be the hardest but most urgent question of all: What is the value of a life saved?
Countries have little choice but to guess at stomach-turning ethical calculations. How many lives should be risked to save a thousand people from unemployment? To stop a generation of kids from falling behind in school? To salvage a sense of normalcy?Countries have little choice but to guess at stomach-turning ethical calculations. How many lives should be risked to save a thousand people from unemployment? To stop a generation of kids from falling behind in school? To salvage a sense of normalcy?
While Dr. Inglesby stressed that “there are a lot of principles that are based on public health and common sense” to guide us, he also said, “There’s no road map for this.”While Dr. Inglesby stressed that “there are a lot of principles that are based on public health and common sense” to guide us, he also said, “There’s no road map for this.”
Many countries’ policies are shaped, in part, by how they navigate the gaps in knowledge about the virus.Many countries’ policies are shaped, in part, by how they navigate the gaps in knowledge about the virus.
For example: Does being outdoors drastically limit transmission?For example: Does being outdoors drastically limit transmission?
Lithuania, on the belief that it does, is closing streets in the capital to allow restaurants and bars to open outdoor-only services.Lithuania, on the belief that it does, is closing streets in the capital to allow restaurants and bars to open outdoor-only services.
Others are testing this hypothesis more tepidly. Bangkok is reopening parks but forbidding most activities that involve multiple people. Sydney is reopening beaches for swimming and surfing but not sunbathing or socializing.Others are testing this hypothesis more tepidly. Bangkok is reopening parks but forbidding most activities that involve multiple people. Sydney is reopening beaches for swimming and surfing but not sunbathing or socializing.
Another mystery: How easily, and widely, do children transmit the virus?Another mystery: How easily, and widely, do children transmit the virus?
Some countries are reopening schools, taking a calculated risk on indications that children might be relatively safe, while imposing restrictions in case they aren’t.Some countries are reopening schools, taking a calculated risk on indications that children might be relatively safe, while imposing restrictions in case they aren’t.
Denmark is opening schools to younger children, who are tentatively thought to be less at risk, but hedging with restrictions on class size.Denmark is opening schools to younger children, who are tentatively thought to be less at risk, but hedging with restrictions on class size.
Germany, meanwhile, is inviting back older children who, the thinking goes, might pose a higher risk of transmission but will better comply with rules on masks and distancing.Germany, meanwhile, is inviting back older children who, the thinking goes, might pose a higher risk of transmission but will better comply with rules on masks and distancing.
There is another set of unknowns: those pertaining to people’s behavior.There is another set of unknowns: those pertaining to people’s behavior.
South Korea’s government is gambling on citizens voluntarily observing a litany of guidelines on everyday interactions, like bowing instead of hugging at funerals.South Korea’s government is gambling on citizens voluntarily observing a litany of guidelines on everyday interactions, like bowing instead of hugging at funerals.
In other areas, it is less trusting, using fines and digital monitoring to enforce mandatory quarantines for those thought to have even come into contact with an infected person.In other areas, it is less trusting, using fines and digital monitoring to enforce mandatory quarantines for those thought to have even come into contact with an infected person.
California will allow some businesses to offer curbside pickup, in the hopes that enough workers and consumers will embrace this, and safely enough, to halt the economy’s free-fall without infections resurging.California will allow some businesses to offer curbside pickup, in the hopes that enough workers and consumers will embrace this, and safely enough, to halt the economy’s free-fall without infections resurging.
Georgia, meanwhile, lifted restrictions on businesses only to find that customers were largely unwilling to come back.Georgia, meanwhile, lifted restrictions on businesses only to find that customers were largely unwilling to come back.
Any reopening measure aims “to balance at least three different things,” said Ezekiel J. Emanuel, chairman of the Department of Medical Ethics and Health Policy at the University of Pennsylvania.Any reopening measure aims “to balance at least three different things,” said Ezekiel J. Emanuel, chairman of the Department of Medical Ethics and Health Policy at the University of Pennsylvania.
These are: Keeping infections low, to prevent health services from getting overwhelmed; keeping deaths low, which entails deterring higher-risk infections; and controlling economic and social burdens.These are: Keeping infections low, to prevent health services from getting overwhelmed; keeping deaths low, which entails deterring higher-risk infections; and controlling economic and social burdens.
But even if we expect a given policy to improve one metric and worsen another, gaps in knowledge about the coronavirus mean we don’t know by how much.But even if we expect a given policy to improve one metric and worsen another, gaps in knowledge about the coronavirus mean we don’t know by how much.
“Figuring out the right balance is obviously the chief problem here,” Dr. Emanuel said. “It’s really hard.”“Figuring out the right balance is obviously the chief problem here,” Dr. Emanuel said. “It’s really hard.”
German officials who partially reopened factories, for example, have little way of anticipating either how many people will get sick or how many jobs will be saved as a result.German officials who partially reopened factories, for example, have little way of anticipating either how many people will get sick or how many jobs will be saved as a result.
The only way to know for sure whether a policy’s upsides are worth its costs is, in many cases, to try it and watch what happens.The only way to know for sure whether a policy’s upsides are worth its costs is, in many cases, to try it and watch what happens.
Each step toward reopening, then, is also a set of experiments with whole societies serving as guinea pigs — or, if you prefer, explorers stepping boldly into the unknown. Either way, few expect the process to be clean.Each step toward reopening, then, is also a set of experiments with whole societies serving as guinea pigs — or, if you prefer, explorers stepping boldly into the unknown. Either way, few expect the process to be clean.
“I think it’s unlikely we’ll get the balance all correct at the start, since it’s the first time we’re doing any of this,” Dr. Inglesby said.“I think it’s unlikely we’ll get the balance all correct at the start, since it’s the first time we’re doing any of this,” Dr. Inglesby said.
Sure enough, Germany’s infection numbers ticked back up, though modestly enough that the country continues its slow reopening.Sure enough, Germany’s infection numbers ticked back up, though modestly enough that the country continues its slow reopening.
India, on the other hand, saw a sharper increase after some restrictions were lifted — raising the possibility of a return to lockdown, as some Chinese cities have already done.India, on the other hand, saw a sharper increase after some restrictions were lifted — raising the possibility of a return to lockdown, as some Chinese cities have already done.
Even failed experiments might offer hard-won lessons, in theory allowing each reopening to be safer than the last.Even failed experiments might offer hard-won lessons, in theory allowing each reopening to be safer than the last.
“Is there a resurgence of cases based on particular patterns of easing social distancing?” Dr. Inglesby asked. “Do we discover that there are cases occurring in mass transit? Are the things that Hong Kong is doing with restaurants working?”“Is there a resurgence of cases based on particular patterns of easing social distancing?” Dr. Inglesby asked. “Do we discover that there are cases occurring in mass transit? Are the things that Hong Kong is doing with restaurants working?”
Updated June 2, 2020 Updated June 1, 2020
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.
But there is a wrinkle: Cities and countries are tending to change several things at once, and that makes it hard to isolate specific lessons. A policy might appear to fail in some circumstances and succeed in others, slowing the world’s ability to learn.But there is a wrinkle: Cities and countries are tending to change several things at once, and that makes it hard to isolate specific lessons. A policy might appear to fail in some circumstances and succeed in others, slowing the world’s ability to learn.
Even if the world could quantify with certainty how a particular policy affects both the virus and social welfare, there is no formula for how to balance the two.Even if the world could quantify with certainty how a particular policy affects both the virus and social welfare, there is no formula for how to balance the two.
That has forced world leaders to confront a question that ethicists have wrestled with for years: How much should society be willing to sacrifice to save a life?That has forced world leaders to confront a question that ethicists have wrestled with for years: How much should society be willing to sacrifice to save a life?
Put another way, how many people should lose their jobs to save one life, knowing that extended unemployment is associated with reduced life expectancy? How many people should be allowed to die if it lets a community keep the local factory running?Put another way, how many people should lose their jobs to save one life, knowing that extended unemployment is associated with reduced life expectancy? How many people should be allowed to die if it lets a community keep the local factory running?
“One of the things that’s new here is the trade-off between people’s long-term futures,” said Dr. Emanuel, the medical ethicist.“One of the things that’s new here is the trade-off between people’s long-term futures,” said Dr. Emanuel, the medical ethicist.
With no easy formulas or answers, he said, “Someone’s got to make those trade-offs. I don’t know what else to do.”With no easy formulas or answers, he said, “Someone’s got to make those trade-offs. I don’t know what else to do.”
For President Trump, more than any other leader so far, the upsides of reopening exceed even the most extreme risk — he is also among the few leaders to push for reopening as cases continue rising in many parts of the country. That, experts warn, could invite more economic damage than relief.For President Trump, more than any other leader so far, the upsides of reopening exceed even the most extreme risk — he is also among the few leaders to push for reopening as cases continue rising in many parts of the country. That, experts warn, could invite more economic damage than relief.
Other courses of action demand weighing human life against civil liberties, social inequality, even cultural value.Other courses of action demand weighing human life against civil liberties, social inequality, even cultural value.
South Korea is taking steps toward restarting its baseball league, which is both a business and a source of enjoyment for millions. Hong Kong is allowing some access to libraries.South Korea is taking steps toward restarting its baseball league, which is both a business and a source of enjoyment for millions. Hong Kong is allowing some access to libraries.
And Americans are already debating whether there is a point at which enforcement of social distancing — through monitoring, fines or outright coercion — carries unacceptable costs to individual liberty.And Americans are already debating whether there is a point at which enforcement of social distancing — through monitoring, fines or outright coercion — carries unacceptable costs to individual liberty.
What begin as economic or public health questions quickly become, with no other way to answer them, matters of philosophy and values.What begin as economic or public health questions quickly become, with no other way to answer them, matters of philosophy and values.
How aggressive should schools be in reopening? New outbreaks might imperil adults who are older or have pre-existing conditions. But a year of lost school can set back a child for life.How aggressive should schools be in reopening? New outbreaks might imperil adults who are older or have pre-existing conditions. But a year of lost school can set back a child for life.
Is the value of partially reopening a cultural site like Broadway measured in economic terms alone, or also in the happiness it brings to theater goers, and its contribution to culture? Is that enough to put lives at risk?Is the value of partially reopening a cultural site like Broadway measured in economic terms alone, or also in the happiness it brings to theater goers, and its contribution to culture? Is that enough to put lives at risk?
Concessions in freedom and privacy — already being made in individualistic South Korea — could endure after the pandemic is over. The choices that are made could add up to societies reconfigured around the values that informed them.Concessions in freedom and privacy — already being made in individualistic South Korea — could endure after the pandemic is over. The choices that are made could add up to societies reconfigured around the values that informed them.
As the consequences of those choices mount, the costs of fighting the pandemic will become clearer every week.As the consequences of those choices mount, the costs of fighting the pandemic will become clearer every week.
“It’s going to be a very difficult balancing act,” Dr. Inglesby said.“It’s going to be a very difficult balancing act,” Dr. Inglesby said.