With COVID-19 vaccines on the horizon but virus cases spiking, should the United States double down on policies that seek to control community spread of the virus, or focus more tightly on protecting vulnerable populations such as the elderly?
Two prominent health policy experts took differing positions during a webinar at the USC Schaeffer Center for Health Policy & Economics, part of the Richard N. Merkin Distinguished Speaker Series. The webinar, titled Public Policy and COVID-19: The Path Forward, was moderated by Darius Lakdawalla, director of research at the USC Schaeffer Center.
Jay Bhattacharya, professor of medicine at Stanford University’s Center for Primary Care and Outcomes Research, argued that the spread of the virus in the United States has been so vast that efforts to contain the new wave of infections through reestablishing lockdowns would fail, and instead cause more unnecessary economic damage and well as mental and physical health problems.
This winter will see “more spread as people move indoors,” he said. But the effect of the spread will be uneven among age groups, with death stalking the elderly to a much greater degree. Implementing policies that “protect the vulnerable is the most important thing we can do,” he said.
Sten H. Vermund, professor of public health and Dean at the Yale School of Medicine, agreed that COVID-19 most threatens the elderly, but contended that deemphasizing community control puts both public health and the economy at risk.
“It is a false premise to let it run wild to get herd immunity,” he said. The country’s “indulgent, undisciplined response” to the virus last spring has “given us the worst of both worlds”—uncontrolled spread and a damaged economy. “We will have 40 people die in the country in the time of this conversation,” he said, while the ability of people to find work is greatly diminished.
The standard practices advocated by public health experts—wearing masks, washing hands, and maintaining social distances—were clear last March but not given enough emphasis, Vermund said. “It was a leadership failure,” he said. He pointed to lockdowns in late spring in New York, Connecticut and New Jersey which proved necessary to save hospitals from being completely overwhelmed and helped contain the virus.
Bhattacharya said these standard public health practices are reasonable responses to the virus, but should not be seen as a panacea. That kind of response “would not have been enough to stop the virus in February or March,” he said. “It was already too widespread.” Community control strategies have slowed the spread, but haven’t stopped people from dying. Lockdowns simply push the spread of the virus off to the future. “It is impossible to get to zero COVID,” he said. “It is not going to be irradicated.”
Lakdawalla, who is also a professor at the Price School of Public Policy and the School of Pharmacy, asked if lockdowns might be a bridge to the era of vaccines, which now appears tantalizingly close.
Bhattacharya said a far more efficient strategy is to protect the vulnerable. “We were terrible at protecting” the elderly last spring. Now we know we need to keep nursing home residents safe through implementing several precautions, provide services to people living at home who are vulnerable, and try to keep older workers from being exposed to possible transmission.
Vermund countered that lockdowns, properly implemented, have a role. “I completely agree that lockdowns have severe negative consequences,” he said. “But logic tells you that if you shrink networks, you can slow the spread of the virus.” The experience of the past few months shows that “we can mitigate the economic and social harm” of lockdowns “while ratcheting down the spread.”
“If this were easy to solve, Jay, Darius and I would have already solved it,” concluded Vermund. “This is immensely complex.”
Schaeffer Center experts are informing the conversation with their analysis on its impact on health, the economy, public policy, and human behavior. Learn more about this work here.