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Will the U.S. go under lockdown?
China and Italy have restricted the movements of hundreds of millions of people. Will we?
Welcome to Not a Doctor, the only free newsletter about health and science with an unlimited supply of asterisks.
I know I promised an update involving vodka today, but then some ~news~ happened, and I wanted to break it down for you: why it’s important, why we should be paying attention, and what it does and doesn’t mean.
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But wait — who are you?
My name is Melody Schreiber. I’m a journalist based in Washington, DC, and the editor of a book about premature birth, What We Didn’t Expect, which will be published in November 2020.
What I’m not: A doctor. I’m also not a scientist, or really an expert of any kind. I just like asking questions and following the news. If I ever get something wrong (here or elsewhere), please get in touch so I can correct the error.
As usual, I’m including a glossary of technical terms at the end of this letter; if there’s an asterisk next to a term or phrase you don’t recognize, just scroll down to learn more.
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In the News
Yesterday, New York Gov. Andrew Cuomo announced that they are creating a "containment area" around part of New Rochelle, a suburb of New York, which contains 108 of the state’s 173 confirmed cases.
Many cases have been traced to a synagogue in New Rochelle, where the rabbi recently confirmed he has tested positive for COVID-19* after many members of the congregation came down with the viral pneumonia.*
The “containment area” will include everything within a one-mile radius of the synagogue. Within that circle, schools, religious services, and all large gatherings are canceled for two weeks, starting tomorrow.
Residents will still be able to leave their homes — going to work, the grocery store, and wherever else they please — as long as they are not under self-quarantine* because of a confirmed case or possible exposure. People can still move freely in and out of the zone.
“You are not containing people,” Cuomo said. “You are containing facilities.”
The National Guard is deploying to New Rochelle to help clean common areas, including disinfecting schools, and to deliver food.
Although the one-mile circle is called a “containment area,” it’s not going stop the virus in its tracks entirely. Instead, it’s intended to limit the rapid spread within a community’s public places.
Photo: Victor Hugo Marques/Flickr
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How does that stack up to other places?
So, why does this matter to you? (Aside from concern for those who are affected, of course.)
This is important to watch because it could set the precedent for other communities throughout the United States.
If your neighborhood or county starts seeing a surge in cases, schools and churches could close down and public gatherings could be canceled within a certain radius of the outbreak “hotspot” (ugh I hate that word). People in those zones would still be free to go about their day, but perhaps with more caution, and with 100% less childcare.
As countries have seen their confirmed cases grow, they have taken different approaches to trying to slow the epidemic.
China locked down hundreds of millions of people in several provinces, as well as restricting some travel and movements throughout the country. In many places, this was a strict lockdown, enforced by guards and local leaders to make sure people stayed indoors; highways were blocked, and planes and trains were kept in place.
Italy also issued a lockdown on the entire country of 60 million people. People are allowed only to go to work and attend to family emergencies. Otherwise, all public gatherings are banned — no weddings, funerals, or sporting events; no trips to the gym or the movies. All schools and universities are closed throughout the country.
Although officials from the WHO* praised China’s “aggressive” actions, others have decried these methods as human rights violations.
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Can we talk more about international health regulations?
According to international health law, governments should only restrict trade and travel when absolutely needed. Locking down entire regions or even the entire country can have massive economic fallout, with dubious public health returns.
South Korea has taken just that route, with no mention of a cordon sanitaire,* the word public health experts use to describe these lockdowns.
They have aggressively tested about 160,000 people, using innovative drive-through testing sites; they’ve done contact tracing and self-quarantining; they developed an app users can opt into to track whether they’ve come into contact with people who have COVID-19; and they have a history of affordable and high-quality health care.
And here’s what cases look like in South Korea as of yesterday:
Focus on the green bars here — new cases are actually falling, and pretty dramatically at that.
Nothing is perfect, of course; South Korea’s system is still being pushed to the limit with existing and new cases. They’re closing some schools and calling off concerts, and they’re also trying to find more hospital beds and prioritizing more severe cases. And things can change in an instant, as we’re learning. The world is still nowhere close to seeing the end of this virus.
But we can still learn quite a bit from these tactics.
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So, what does that mean for us?
Experts say it’s unlikely we’ll see wide-scale lockdowns like those in China and Italy; instead, we may see restrictions on public places in specific communities — more like South Korea.
On Sunday, Dr. Anthony Fauci, the director of NIAID,* said it was possible the United States would begin seeing regional lockdowns.
“I don’t think it would be as draconian as ‘nobody in and nobody out,’” Dr. Fauci said on Fox News. “But there’ll be, if we continue to get cases like this, particularly at the community level, there will be what we call mitigation.”
What does all that mean for you? It means it’s definitely time to prepare and have plans in place for school closures and the cancelation of gatherings.
And it means we should start something called “social distancing” now — staying home when you’re sick, working from home, pretty much everything we talked about yesterday. (You subscribers are so ahead of the curve!)
I’ll talk about social distancing more in another update. But as Tom Inglesby, director of the Johns Hopkins Center for Health Security, has pointed out in a fantastic Twitter thread, these measures don’t have to be all or nothing.
Above all, these need to be measures that we’re all taking together.
We can do that for each other, can’t we?
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Tomorrow, I promise there will be 100% more alcohol-based content.
In the meantime, if you know someone who might appreciate this newsletter, please share it to them! I’m planning to host a Q&A on Friday, but if you have any questions, concerns, feedback, or better words for “hotspot,” please reach out to firstname.lastname@example.org.
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cordon sanitaire: a zone where people are prevented from leaving or entering
COVID-19: A form of pneumonia caused by the virus SARS-CoV-19
NIAID: National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health (NIH)
self-quarantine: when you stay home and avoid contact with others, in this case for 14 days; this is usually recommended when you’ve had contact with someone with COVID-19
viral pneumonia: a lung infection caused by a virus
WHO: World Health Organization