Osterholm, Kashkari: The U.S. needs another stint of staying at home

In just weeks we could almost stop the viral fire that has swept across this country over the past six months and continues to rage out of control. It will require sacrifice but save many thousands of lives.

We believe the choice is clear. We can continue to allow the coronavirus to spread rapidly throughout the country, or we can commit to a more restrictive lockdown, state by state, for up to six weeks to crush the spread of the virus to less than one new case per 100,000 people per day.

That's the point at which we will be able to limit the increase in new cases through aggressive public health measures, just as other countries have done. But we're a long way from there right now.

The imperative for this is clear because as a nation what we have done so far hasn't worked. Some 160,000 people have died. And in recent days, roughly a thousand have died a day. An estimated 30 million Americans are collecting unemployment.

On Jan. 30, when the World Health Organization declared COVID-19 a public health emergency, there were 9,439 reported cases worldwide, most in China, and only six reported cases in the United States.

On July 30, six months later, there were 17 million cases reported worldwide, including 676,000 deaths. The U.S. had 4 million reported cases and 155,000 deaths. More than a third of all U.S. cases occurred during July alone.

And the next six months could make what we have experienced so far seem like just a warm-up to a greater catastrophe. With many schools and colleges starting, stores and businesses reopening, and the beginning of the indoor heating season, new case numbers will grow quickly.

Why did the U.S. containment response fail, particularly compared with the successful results of so many nations in Asia, Europe and even our neighbor Canada?

Simply, we gave up on our lockdown efforts to control virus transmission well before the virus was under control. Many other countries didn't let up until the number of cases was greatly reduced, even in places that had extensive outbreaks in March and April. Once the number of new cases in those areas was driven to less than one per 100,000 people per day as a result of their lockdowns, limiting the increase of new cases was possible with a combination of testing, contact tracing, case isolation and extensive monitoring of positive tests.

The U.S. recorded its lowest seven-day average since March 31 on May 28, when it was 21,000 cases, or 6.4 new cases per 100,000 people per day. This rate was seven to 10 times higher than the rates in countries that successfully contained their new infections. While many countries are now experiencing modest flare-ups of the virus, their caseloads are in the hundreds or low thousands of infections per day, not tens of thousands, and small enough that public health officials can largely control the spread.

In contrast, the U.S. reopened too quickly and is now experiencing around 50,000 or more new cases per day.

While cases are falling in the hard-hit areas of Arizona, California, Florida and Texas because of the imposition of some physical-distancing measures, they are rapidly increasing in a few Midwestern states. In Minnesota, we recently documented the most new cases in a one-week period since the pandemic began.

At this level of national cases — 17 new cases per 100,000 people per day — we simply don't have the public health tools to bring the pandemic under control. Our testing capacity is overwhelmed in many areas, resulting in delays that make contact tracing and other measures to control the virus virtually impossible.

Don't confuse short-term case reductions in some states as permanent. We made that mistake before. Some have claimed that the widespread use of masks is enough to control the pandemic, but let us face reality: Gov. Gavin Newsom of California issued a public masking mandate on June 18, a day when 3,700 cases were reported in the state. On July 25, the seven-day daily case average was 10,231. We support the wearing of masks by all Americans, but masking mandates and soft limitations on indoor crowds in places such as bars and restaurants are not enough to control this pandemic.

To successfully drive down our case rate to less than one per 100,000 people per day, we should mandate sheltering in place for everyone but the truly essential workers. By that, we mean people must stay at home and leave only for essential reasons: food shopping and visits to doctors and pharmacies while wearing masks and washing hands frequently. According to the Economic Policy Institute, 39% of workers in the U.S. are in essential categories. The problem with the March-to-May lockdown was that it was not uniformly stringent across the country. For example, Minnesota deemed 78% of its workers essential. To be effective, the lockdown has to be as comprehensive and strict as possible.

If we aren't willing to take this action, millions more cases with many more deaths are likely before a vaccine might be available. In addition, the economic recovery will be much slower, with far more business failures and high unemployment for the next year or two. The path of the virus will determine the path of the economy. There won't be a robust economic recovery until we get control of the virus.

If we do this aggressively, the testing and tracing capacity we've built will support reopening the economy as other countries have done, allow children to go back to school and citizens to vote in person in November. All of this will lead to a stronger, faster economic recovery, moving people from unemployment to work.

We know that a stringent lockdown can have serious health consequences for patients who can't get access to routine care. But over the past six months, medical professionals have learned how to protect patients and staffs from spreading the coronavirus; therefore we should be able to maintain access to regular medical care during any new lockdown.

This pandemic is deeply unfair. Millions of low-wage, front-line service workers have lost their jobs or have been put in harm's way, while most higher-wage, white-collar workers have been spared. But it is even more unfair than that; those of us who've kept our jobs are actually saving more money because we aren't going out to restaurants or movies, or on vacations. Unlike in prior recessions, remarkably, the personal savings rate has soared to 20% from around 8% in January.

Because we are saving more, we have the resources to support those who have been laid off. Typically when the government runs deficits, it must rely on foreign investors to buy the debt because Americans aren't generating enough savings to fund it. But we can finance the added deficits for COVID-19 relief from our own domestic savings. Those savings end up funding investment in the economy. That's why traditional concerns about racking up too much government debt do not apply in this situation. It is much safer for a country to fund its deficits domestically than from abroad.

Congress should be aggressive in supporting people who've lost jobs because of COVID-19. It's not only the right thing to do but also vital for our economic recovery. If people can't pay their bills, it will ripple through the economy and make the downturn much worse, with many more bankruptcies, and the national recovery much slower.

There is no trade-off between health and the economy. Both require aggressively getting control of the virus. History will judge us harshly if we miss this life- and economy-saving opportunity to get it right this time.

Michael T. Osterholm is a professor and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Neel Kashkari is president of the Federal Reserve Bank of Minneapolis. They wrote this article for the New York Times.