Social vs. Science: Finding the middle ground as pandemic restrictions loosen

DOVER — As the state begins its first phase of recovery following the three-month state of emergency, the social end and the scientific end of the pandemic may not align.

While Delaware and surrounding states may begin to loosen restrictions, the pandemic is still ongoing — and isn’t likely to be declared “over” until a treatment or vaccine is developed, noted Jennifer Horney, professor and founding director of the University of Delaware’s program in epidemiology.

“I think we had the initial declaration that was in place until May 15 and so I think people were expecting, when that got extended one last time, that we would start moving toward some relaxation,” she said. “Although the decisions in the emergency declarations are on a state basis, I think it also becomes difficult especially when nearby states start to make moves toward relaxation. So when Maryland began opening its beaches and boardwalk, it became more difficult for our governor to maintain those closures.”

Phase I, which begins June 1, will maintain strict social distancing and face covering guidelines, but will allow for restaurants, arts and culture institutions, retail stores, malls, salons and gyms to open at 30% capacity.

Other businesses, such as realty, casinos, racetracks and parks and recreation will also see modified restrictions at the start of the month.

Beyond giving the economy a boost, there are benefits socially to opening the state.

“I think that the discussion in public health circles has, to some extent, turned to efforts at measuring some of the indirect impacts of the stay-at-home orders,” she said. “We’re seeing more evidence around the impacts of missed appointments for things like childhood vaccines or care of chronic conditions. And then, I think there’s a real concern about the mental health impacts, especially for children.”

She noted that a study came out comparing children in Italy to Spain, where both had stricter stay-at-home measures than in the U.S.

“In Italy children were allowed to play outside and they’re seeing evidence of the benefit of that,” she said. “So I do think that we need to think about the relative risk of different activities as we open up. And outdoor play for children, I think, is something that’s relatively low risk, as long as it’s done socially distanced and could have huge benefits, particularly for their mental health.”

While there are benefits of entering recovery, she noted that it’s important to still be cautious and take individual precautions, like social distancing, hand washing and mask-wearing.

“We are seeing increased number of cases in the states that have already opened up. So Texas and North Carolina have been open for several weeks, and do have an increased number of cases,” she said. “They are not seeing tremendous capacity issues with hospitalization, except for in some small areas that have limited capacity.”

Dr. Horney noted that the stay-at-home orders were put in place with the goal of stifling the surge from exceeding health care system capacity. While it’s likely that cases will rise upon a loosening of restrictions, Dr. Horney said that the hospital systems and health care systems have had time to prepare.

For the states, like Texas and North Carolina, that are seeing an increase in cases, she said hospitals aren’t seeing “tremendous capacity issues.”

“I think we’re still trying to understand where that case growth is coming from, and if most of those people are relatively healthy — people who are becoming infected, but then recovering on their own without needing hospitalization,” she said.

As the state moves toward recovery, she noted that she is seeing a lot of caution on social media.

“I think people will begin to slowly expand their social circles, so maybe seeing more of their family or more of their neighbors,” she said, adding that she thinks some people will have to have “awkward conversations” with friends about family about being careful.

“What everyone seems to have come to understand is how quickly our group of contacts can grow,” she continued. “If we open up our network, only a little bit, we’re connecting ourselves not only to those people but to everyone that they’ve been connected with.”

Part of the coronavirus conversation has centered on the second wave of the virus. Dr. Horney said that a lot more is known about the virus than when the stay-at-home orders began in March.

She said that there are a lot of asymptomatic infections, and that asymptomatic people can spread the disease, but “it appears that they spread mild or asymptomatic disease,” she said.

“If we do have a second wave, we can hope that many of those cases are asymptomatic or don’t spread to a large number of people who might be highly vulnerable to needing to use the hospital system,” she said. “And, on the other hand, that the hospital system is more prepared.”

When the southern hemisphere begins to experience its winter — coinciding with the northern hemisphere’s summer — that will give a preview of what to expect for the winter here, she said.

“We’ll get a preview as to what we might expect, just like we do every year for seasonal influenza. So we look at what happens in Australia during our summer, their winter, and that influences the decisions that we make about preparing for our winter,” she said. “So I think that’ll be the first one of the first things that people are looking for in terms of: are we still in a pandemic?”

She noted that people will be researching the pandemic for at least a decade to come — from the testing, to lasting impacts.

The vaccine is nine to 18 months away, she said, “but even if it could be developed more quickly, the capacity to manufacture enough doses, and the ability to purchase or manufacture enough medical materials — so the vials that it needs to be made in and those kinds of things — that limitation is almost as difficult to surmount as the development of the vaccine itself.”

Even with the vaccine, there needs to be acceptance of it.

“It’ll be interesting to see what the acceptance of a vaccine is once it’s developed,” she said. “We saw that in H1N1 [swine flu]. When H1N1 first started in spring of 2009, a lot of people indicated that they would get the vaccine but then when it was available that fall, far fewer people actually got it.”

Even with strong evidence that supports childhood immunization, there are still groups that eschew vaccinations, she noted.

“Then when we do have either a treatment or a vaccine, I think research will continue in general about coronaviruses and other viruses that have the potential to jump from animals to people that would be novel and have the potential to cause a pandemic,” she said.

Helpful Coronavirus links

Delaware Division of Health Coronavirus Page
CDC: About the Coronavirus Disease 2019
CDC: What to do if You Are Sick
Johns Hopkins Coronavirus Resource Center
AP News Coronavirus Coverage
Reopening Delaware: Resources for Businesses
Delaware Phase 2 guidance

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