America shut down in response to covid. Would we ever do it again?
In early March 2020, Allison Arwady watched in horror as covid-19 devastated Northern Italy. Hospitals were overrun, patients jamming the corridors. The crematoria operated day and night, while the local newspaper's obituary section expanded to 10 pages.
Just a few weeks earlier, about 40,000 soccer fans from Bergamo had traveled to Milan to watch their team triumph in a prestigious Champions League match. But the coronavirus, a silent spreader, had surely been there, too. It went off like "a biological bomb," as one doctor put it. By the time local officials imposed quarantines, the virus was running wild in its human hosts.
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Arwady, the health commissioner for the city of Chicago, told herself: We're next. We have to act.
"I have never been a part of something that moved that fast at that scale with that amount of urgency," Arwady said. "It was a compression of what might have taken six months into six days."
Arwady and her colleagues had to find ways to limit community spread. But how far should they go? Close all the restaurants? She recalls looking at her chief medical officer and saying: "Oh my God, schools too?"
Yes, schools, and much more, not just in Chicago but across the country. What unfolded in March 2020 was a national shutdown unlike anything the country had tried before.
The shutdown was profoundly strange and has had lasting effects on our national psyche. But memories fade, circumstances change, opinions shift. Three years later, the decision by local, state and federal government officials to limit spread of the virus continues to spark rancorous battles in the pandemic-fueled arenas of the culture war.
So what will the country do the next time a deadly virus comes knocking on the door?
A traveler from China brought the first documented coronavirus case to the United States, the Centers for Disease Control and Prevention announced on Jan. 20, 2020. For weeks afterward there was only a smattering of isolated cases, and no deaths.
But this was a stealthy virus, able to move among people who didn't show any symptoms.
During a late February teleconference, Nancy Messonier of the CDC said the virus would likely spread within the United States, a grave scenario that officials had avoided discussing publicly. She outlined the concept of non-pharmaceutical interventions - working from home, school closures, canceling mass gatherings, cleaning surfaces.
"I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe," she said.
For many Americans, the real sign that the coronavirus had arrived came on March 11, when the National Basketball Association suspended its season. That same day, the World Health Organization declared the outbreak a pandemic.
In truth, no one knew the extent of infections at that time. An early error in test development by the CDC, as well as inflexibility about the use of externally developed tests, limited national surveillance.
"We had no eyes on the virus. We were flying completely blind," said Deborah Birx, the White House covid task force coordinator.
But modeling, according to the infectious-disease experts, showed exponential spread. Every infected person was spreading the virus to more than two other people, creating an epidemic curve that threatened to go vertical, as if aiming for the moon. It was obvious to epidemiologists that dramatic actions were necessary to prevent an explosion of sickness and death in major cities across the country.
"I could see the tsunami coming," Birx said. "The whole thing was, could we limit it to 15 of our major metros, and what does it look like if spreads to all 25 or 30 major metros?"
The administration's top doctors ultimately persuaded President Trump to issue a national public health order, a stay-at-home guideline titled "15 Days to Slow the Spread," effective March 16. The doctors knew a mere 15 days of social distancing and other precautions would not be enough to bring the contagion under control. But that's all they thought they could sell to Trump and his aides.
"I learned in that White House there's only so far you can push at one time," said Birx.
"The president listened - to his credit - listened to what Dr. Birx and I said about it," said Anthony S. Fauci, until recently the director of the National Institute of Allergy and Infectious Diseases.
The scale of the viral calamity became increasingly clear. At a briefing on March 31 to announce the 30-day extension of the shutdown, Birx provided shocking new modeling projections: 100,000 to 240,000 people would die of covid-19 in coming months even if the country followed the mitigation efforts. Without the restrictions, modelers forecast as many as 2.2 million deaths. Trump was persuaded.
The guideline set out for those 45 days had no force of law. It certainly was not a lockdown akin to what had been imposed in China. But it was a dramatic dictate from the pinnacle of government, carrying the imprimatur of Trump in concert with the doctors and scientists advising him.
Among the directives:
"If you are an older person, stay home and away from other people."
"Avoid social gatherings in groups of more than 10 people."
"Avoid touching your face."
"Disinfect frequently used items and surfaces as much as possible."
Everyone was forced to play the role of amateur epidemiologist. The pandemic created fertile ground for rumor and bunk. Information went to war with misinformation.
People also had to make sense of confusing guidelines. Stay three feet apart, the World Health Organization said. Stay six feet apart, the CDC said. A study from MIT said the coronavirus could theoretically travel 27 feet across a room. One study that seized global attention showed how the virus can linger ominously in a jogger's slipstream.
No wonder some people went into a kind of hibernation, venturing no further than the porch, maybe daring to wave at a neighbor barely within earshot.
Downtowns emptied. Much of the national workforce discovered that it was "nonessential." Tens of millions of people began working from home. Restaurants switched to takeout, though some simply went out of business.
Gyms and bars closed. So did national parks and museums, and even local playgrounds. In the nation's capital, officials ordered the removal of basketball rims, leaving bare backboards.
New recommendations and orders from the public health officials kept coming: Wear glasses, because the virus can invade through your eyes. Maybe you could catch it from a dog.
Haircuts were put on hold. A nation turned shaggy.
There were some things (spoken about sotto voce) to like about the pandemic shutdown. Traffic noise disappeared. People remarked on how easily they could hear the birds.
Crises bring out the good in people, the desire to help those more desperate. Let's keep our spirit up, was the message. In his book on the pandemic, "Apollo's Arrow," Nicholas Christakis describes a favorite moment in that early period: "Orchestra musicians, all of them isolated in their own homes, recorded themselves individually performing their parts in a symphony; the videos were then edited together to show each musician playing beautifully. The New York Philharmonic's rendition of Ravel's Bolero reduced many people to tears."
Citizens of New York City, emulating the Italians who had been hit by an earlier wave of sickness and death, banged pots and pans every night in the windows to signal solidarity with the health care workers.
But of course there was also much to hate about the national shutdown. It was chaotically implemented, and inequitable in its effects. The privileged drew their usual salaries at home, sourdough rising in the kitchen. The "essential workers" had no such flexibility. Some health-care workers came to resent the banging and clapping as they struggled with burnout.
For a brief period, though, belligerent political warriors largely went to ground. The new polarization was humanity vs. covid.
"At least in the beginning, fear is a great mobilizer," recalls Robert Wachter, professor of medicine at the University of California at San Francisco. "People kind of suspended their politics for a while."
That didn't last long.
The shutdown didn't instantly halt the upward surge of cases. Because of a lag between infections and deaths, the death toll nationally didn't peak until mid-April. But the shutdown had an effect.
"That original surge never took down Houston, Miami, Dallas, L.A., San Francisco - many of our major large cities were protected in that large surge," Birx said.
That meant many parts of the country still had not been hit hard by the virus, and it was easy for people in those places to imagine that this was someone else's problem, or even an invented crisis, a wild nanny-state overreaction.
In the meantime the economy was very clearly in shambles. Millions of people were out of work, and the stock market had tanked. Anti-government protests broke out in Michigan in April, where the Democratic governor had issued strict public health orders. The pandemic response soon became fully entangled with the country's ongoing culture war.
Some communities stayed in shelter-in-place mode as if a hurricane was nigh, while others largely shrugged off the crisis, treating the pandemic as if it were a coastal rumor.
Trump pivoted, persuaded by economic advisers that the modelers had been excessively dire in their forecasts, Birx writes in her pandemic memoir "Silent Invasion." She recalls Trump saying one day in early April, "We will never shut down the country again. Never."
Fauci today is the primary target of those furious about the pandemic mitigations. #ProsecuteFauci is a popular social media message.
Many disease experts worry that the rage over pandemic restrictions has kneecapped public health leaders. The country may now have fewer tools to fight the next contagion.
"Nobody likes mandates," Fauci said. "But we have a tradition of accepting mandates when they are for the common good or for the good of the individuals. For example, the requirement of vaccinations for students before they go to school. This has now taken a very, very sharp turn."
Birx has a different concern: The country's public health establishment hasn't fixed many of the testing problems that undermined situational awareness when the virus began spreading in early 2020.
"There are simple common-sense innovations we can put in place today so we are never crushed by infectious-disease again," she said in an email.
The public health establishment admits its mistakes and stumbles - "Everything we did we could have done better," Fauci recently told The Washington Post - but it has portrayed the efforts as necessary and successful moves in a highly volatile situation. An incalculable number of lives were likely saved by delaying what would have been the natural spread of the virus. That gave doctors more time to develop techniques and drugs for treating patients in the brutal period before vaccines helped lower the fatality rate.
"It is entirely plausible that we might have seen a million or more dead before anyone had the chance to be vaccinated, had we done nothing," suggests Harvard epidemiologist William Hanage.
In public health, though, success is measured against counterfactual outcomes: hypothetical infections, conjectured suffering, imaginary deaths.
By contrast, the pain of the national shutdown - businesses going under, weddings postponed, protracted isolation of the elderly, learning losses among schoolkids - is glaringly obvious. Critics of pandemic restrictions contend that the cure was worse than the disease. In response, Republican-dominated legislatures in many states have passed laws limiting public health interventions, such as vaccine or mask mandates.
The pandemic schooled everyone. It taught many office workers how to function remotely. It taught restaurateurs how to turn sidewalks into dining spaces. It taught the CDC how critically important it is to communicate clearly with the public - and the consequences of failing to do so.
And it taught the opponents of the public health authorities how to block government mandates and restrictions.
This is not an esoteric dilemma: There are more pathogens out there poised to spill into the human species. A novel strain of avian influenza, H5N1, already has seized the attention of scientists as a potential spillover hazard.
Wachter, of UC San Francisco, said the opposition to emergency measures "will emerge on Day One" of any new pandemic: "It will create a tension and a level of pushback against any public health mandates to do anything."
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