If, And, Then, But.
Everyone asks when we can safely reopen the economy. Our initial mitigation strategy of nationwide lockdowns and limited movement was necessary at the time and has helped flatten the curve. Now, citizens who live in communities experiencing few coronavirus cases are becoming increasingly uneasy with restrictions born from novel coronavirus (nCoV) hotspots. Something has to give.
The answer to when our nation can reopen is complex. A one-size-fits-all solution likely will not work. It is best to consider individual and community circumstances by approaching reopening through an IF, AND, THEN, BUT lens, often requiring difficult decisions and sacrifices. For example, IF I work late AND finish the project, THEN I am prepared for tomorrow’s meeting, BUT I miss bedtime with my children.
Individuals and communities must have the information needed to make similar, educated decisions. First, we must remember that those who are older than 49 (and especially above 70) or who have diabetes, hypertension, and obesity are at higher risk. Younger, otherwise healthy people may not show symptoms, but can still transmit to others. And we must keep in mind that science suggests people gain immunity for at least some time after clearing nCoV infection.
Answering IF, AND, THEN, BUT for an individual depends upon one’s risk factors and probable immunity.
IF you are a 22-year-old AND you are healthy, THEN most likely you will not have problems with nCoV, BUT if infected, you can still infect others, so be careful. Another example: IF you are 35 years old AND have recovered from nCoV, THEN you are most likely immune to nCoV, BUT until it is fully established that you are immune, observe basic precautions. This contrasts with, IF you are 55 years old AND have diabetes, THEN you are at high risk of complications from nCoV infection, BUT if you use personal protective equipment while observing other precautions, you can go out.
The IF, AND, THEN, BUT for a community depends upon the collective risk of those who live there. A community’s leaders can say IF we have neighborhood with elderly and/or those with risk factors AND nCoV is spreading, THEN we should have a community or neighborhood lockdown, BUT aggressive screening with quarantine can limit spread of the disease. Or, IF my community has a limited number of nCoV cases, AND we have the ability to protect those at higher risk, THEN there can be a more open economy, BUT we should monitor for new cases and trace contacts of anyone who is infected.
Until now, many parts of our country enforced a broad mitigation strategy restricting movement and closing schools and businesses. Regional variation in the impact of coronavirus disease versus social distancing effects are drawing a focus on the wisdom of nationwide versus a local response. While a mitigation strategy on a national scale might have made sense at one point in time – and still might in some parts of the country and society – areas where the disease prevalence is low may be better served by a strategy of containment.
These determinations should be made on a case-by-case basis with the IF, AND, THEN, BUT analysis, considering transmission, case rates, and other relevant data to inform contingency decisions. For example, IF we know a city has a low number of coronavirus cases AND we have a strategy in place should that change, THEN it can re-open, BUT must continue to actively monitor for changes in case rates as restrictions ease.
Most of the important decisions we make in our lives are nuanced and complex. The decisions that federal, state and local leaders face now are no different. The IF, AND, THEN, BUT analysis encourages consideration of both the positive and negative consequences of actions – both intended and unintended – not only on ourselves, but others.
Leaders must employ a similarly nuanced and thoughtful approach, encouraging individuals to do the same, as they consider the potential consequences of coronavirus response actions and their severity of impact on the physical, social and economic well-being of all affected populations.
Embracing IF, AND, THEN, BUT reopens the economy sooner while protecting Americans against novel coronavirus infection. The new normal in the nCoV era requires this.
The Delicate Calculus of Reopening
COMMENTARY
May 08, 2020
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