Lockdown and Divisions in American Society

In the United States, “confining” and “unconfining” have become terms of identity, depriving the country of a real societal debate on the responses to the pandemic, believes Rafael Jacob.

It didn’t take long for the COVID-19 crisis to bring out the divisions fracturing American society. As time moves on, the country seems to be increasingly swept up in an idiotic tribalism, poisoning almost all possibility of a healthy debate, while the volume and complexity of the issues facing the country, and the world, require precisely that.

The virus is now linked to the deaths of almost 100,000 Americans, the largest number associated with a pandemic in the country since the Hong Kong flu, which took hold half a century earlier.* The response to the pandemic has bought complete chaos to the country, which was already boiling over.

In this hyperdivided context, “confining” and “unconfining” have become terms of identity, preventing introspection and nuance, and fostering a climate of dogmatic confrontation.

The Real Bloodshed

In the American public domain, this dynamic is particularly found in the recurring dramatic predictions about jurisdictions refusing to lock down, or coming out of lockdown “too” quickly, which are predicted to cope the worst.

There was, for example, the incident of the packed beaches in Florida in March, beaches which the governor initially refused to close despite repeated demands to do so, followed by their reopening in April, accompanied by a similar wave of more accusations.

Then, perhaps more strikingly, there was the case of the reopening of Georgia, which the state announced in April as part of a rapid plan of easing confinement measures and allowing almost all businesses including restaurants, spas and gyms to reopen. The shutdown did not even last three weeks, from April 3 (starting after almost everyone else) to April 24 (ending before almost everyone else), and contained a series of exemptions allowing beaches and even churches to remain open. Its neighbor, Florida, followed a similar model. In both cases, the governors were berated for their laxity, accused by all sides of putting the lives of their fellow citizens in danger.

Described as “the human sacrifice” by The Atlantic, Georgia’s decision to reopen was welcomed by political columnist Ron Fournier (not the sports commentator from Quebec), in a tweet on April 20: “Mark this day. Because two and three weeks from now, the Georgia death toll is blood on his hands. And as Georgians move around the country, they’ll spread more death and economic destruction.”

On May 9, some three weeks later, the state’s governor announced that the number of hospitalizations linked to COVID-19 had reached its lowest level since the data started to be collected a month earlier. Ten days later, the governor announced that the state had reached a new, lower number of hospitalizations, with the number of deaths a little below 1,700.

In summary, to conclude that all social distancing measures don’t work would be a leap. It could, among other factors, be easier to maintain distancing in Georgia, where around 170 inhabitants live per 1,000 square meters (approximately 3,280 square miles), whereas in New Jersey, the most densely populated state, there are 1,200 inhabitants per 1,000 square meters, and public transport is used more frequently, for example. Preexisting health problems among the population, the organization of health care systems, and access to health care in particular, are also determining factors.

The fact remains that, according to data from the Centers for Disease Control and Prevention, Georgia has around two times fewer deaths per 1 million inhabitants than Pennsylvania; seven times less than New Jersey; and 10 times less than New York. Its neighbor, Florida, which imposed a short and limited shutdown, has seen three times fewer deaths than Pennsylvania, 13 times fewer than New Jersey and 17 times fewer than New York. Yet Florida’s population is more urban, with four major metropolitan areas (Miami, Orlando, Tampa and Jacksonville), the population is older, and includes more African Americans and Latinos ( communities particularly affected by the pandemic), than the other three states.

New York, New Jersey and Pennsylvania have been in stricter lockdown for two months now. However, since March, these states have also forced nursing homes to accept patients who have tested positive for COVID-19. But in Pennsylvania, 70% of the deaths connected to the coronavirus have occurred in these facilities.

All this data illustrates the extent to which lockdown and easing of confinement measures are not the only factors involved in tackling COVID-19.

Lockdown and Social Distancing

If there is nuance lacking in the American public discourse, it is perhaps this: that lockdown and social distancing are not necessarily synonymous. Not imposing lockdowns at the state level does not necessarily mean laughing in the face of tests, social distancing practices and advice about hygiene.

Let’s take the case of Kansas, a state of 3 million inhabitants, and Nebraska, with 2 million inhabitants. These two relatively rural neighboring states, located in the middle of the United States, have similar lifestyles and socioeconomic levels. Approximately 14% of their residents are over 65 and 80% are white, but they have handled the pandemic very differently. Kansas imposed an order mandating lockdown at the end of March. Nebraska has never done so.

What do their death curves look like?

It is true that deaths are a “delayed indicator.” People hospitalized today are not immediately counted. Nevertheless, almost two months later, there is nothing to indicate that Nebraska’s curve is in worse shape than Kansas. The two curves follow each other closely. Out of a population of almost 2 million inhabitants, the former has had 125 deaths linked to COVID-19 out of a population of almost 3 million inhabitants, the latter has counted 173.

And most significantly, neither the hospital system in Nebraska, Georgia nor Florida is struggling with anything resembling overcrowding due to COVID-19 in terms of a lack of beds, space in intensive care, or ventilators, which was, we must remember, the fundamental reason cited to impose lockdown orders in the first place.

The states had to protect their hospitals.

In fact, they have protected them so much that numerous American hospitals are experiencing serious financial difficulties.

The Sad Irony

As counterintuitive as this might appear at first glance, one of the sectors suffering the most from lockdown measures in the United States is that of health care. In many cases, hospitals are private profit-making entities. Yet since the start of April, doctors and nurses all over have said they fear for their hospital establishments, not because they are too full, but because they are too empty. Almost all appointments and operations, the primary source of income for hospitals in the United States, have been pushed back or cancelled, in anticipation of a tsunami of patients hospitalized for the coronavirus; a tsunami that was predicted by statistical models, and which inspired the draconian lockdown measures.

Week after week, we waited for the tsunami to appear. Hospitals remained empty. People normally scheduled for surgery stayed home. Financially, the situation hemorrhaged. Hospitals therefore started to suspend medical staff, including doctors and nurses, until the American Hospital Association, the most important hospital organization in America, published a report at the end of April declaring “the worst financial crisis in the history of hospitals and the health sector in the United States.” Week after week, hospitals lost billions of dollars.

The famous Mayo Clinic alone, which provides health care services to millions of Americans across the country, had to reduce its hours or face dismissing some 30,000 of its employees. Out of the approximately 5% decrease in the United States gross domestic product in the first quarter, almost half can be attributed to the decline in the health care sector.

The crisis shaking up hospitals has reached such a point that the president of emergency doctors at the largest hospital network in Pennsylvania, the University of Pittsburgh Medical Center, announced that he would resume routine surgeries. defying orders from the state. Out of the 5,500 beds in his 40 hospitals, 2% were occupied by patients suffering from COVID-19. The problems in Pennsylvania, just as everywhere else in the United States, were concentrated not in hospitals, but in nursing homes.

While Americans continue to tear each other to pieces, important questions are not being asked about the added value of obligatory lockdowns compared to respecting normal social distancing, the value of measures to take, and, above all, specific protections for the most vulnerable people.

*Editor’s note: The U.S. death toll from COVID-19 reached 100,000 on May 27.