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What’s going on in the United States? Across the country, all states have begun to reopen, some more quickly, some more slowly than others. Data from Safegraph, which takes information from our mobile devices and layers them over building footprints, suggests that Americans are venturing out, particularly to parks, restaurants and gas stations, though in many places still below pre-lockdown levels. States vary in terms of residents returning to typical patterns of daily movement, with Mississippi, Wyoming, Alaska, South Carolina, Alabama, Montana, Oklahoma, South Dakota, Arkansas, and Tennessee, closest to normal and Hawaii, New York, Massachusetts, Nevada, New Jersey, California, Vermont, Michigan, Illinois, Connecticut, and Maryland farthest away from it.
On Sunday, Britain’s Imperial College of Medicine came out with a new state-by-state model of the SARS-COV2 epidemic, in which 24 out of our 50 states had an Rt (a time-varying measure of transmission intensity) of greater than 1, meaning a local epidemic is still not under control. Some of these states with an Rt above 1, like Mississippi, South Carolina, Alabama, Arkansas, and Tennessee are among the furthest along in re-opening according to SafeGraph data, and some , including Massachusetts, California, Illinois, Maryland, are still some distance away. But most of the states with Rt greater than 1 are clustered in the South and Midwest. The Imperial College report also suggests that the vast majority of Americans have not been infected with SARS-COV2—with a national average around 4 percent and 16 percent in hard-hit places like New York—and therefore remain susceptible to the disease.
The British statistician George E.P. Box famously once said, “All models are wrong, but some are useful.” The point is that models are approximations; they are not maps to a destination, but they can help guide our thinking and decision-making. As Harvard epidemiologist Marc Lipsitch recently said in a piece in the Boston Review, scientists “should keep their eyes open for any kind of information that can help them solve problems.” The data from SafeGraph, like the model from Imperial, may not be perfect. But we don’t need perfect to see a problem. This is a tale of two countries, one in which progress is being made on Covid-19; another which lags behind. Both “countries” too are inextricably locked together in an epidemiological embrace; we won’t get SARS-COV2 under control in the United States unless and until there is progress across the entire nation. Right now many, many people remain at risk.
As I said a few weeks ago, President Trump has washed his hands of us, has all but closed the door on a national response to Covid-19. In fact, just this week, pleas again rose up from public health experts and governors to address the ongoing four- or five-month failure to get testing scaled up in the United States, with Scott Becker of the Association of Public Health Laboratories saying to The New York Times, “You can’t leave it up to the states to do it for themselves. This is not the Hunger Games.”
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What can we do now? Well, we have to keep holding our local, state, and national officials’ feet to the fire. Just because President Trump will do nothing doesn’t mean we don’t keep asking. Governors and mayors, our community leaders, also require prodding to do the right thing or stay on the right track. And we speak up, correct misinformation and outright lies. There are those—locked up in prisons and jails, working in meatpacking plants—that need us to speak up as well, as they are in greater peril than most of us have faced from this virus. We have a duty to bear witness at this moment and if we’re called to protest, responsibly, with proper personal protective equipment and social distancing, and we can, we do it.
I am still in my apartment. I go to the grocery store. I walk the dog. That’s about it. I miss my family. I miss my friends. But I am not ending my stay-at-home. Why? Because I can still do it. I can afford to do it. I can work from home. This isn’t to protect me and my partner. It’s to protect the rest of my community. A few months ago, I suggested that social distancing was a tremendous act of generosity to one another. Millions of Americans have shown this kind of solidarity over the past few months. It’s the one shining silver lining of these terrible times. People are still vulnerable, though, and the virus is still out there. So I will continue to do my part.
This isn’t virtue signaling or an attempt to shame others. I know plenty of people who have never had a choice to stay-at-home and many who do not have a choice about whether they can continue their self-enforced isolation. I also know people who are not holding up well under the strain of all this, day after day after day. But being unable to work from home or needing to relax the strictness of our social distancing isn’t all-or-nothing.
My epidemiologist colleague Julia Marcus has written recently about how we have to embrace a practice of harm reduction over the next few months and years, where we can decrease our risk, even if we’re not holed up in our homes to the same degree we were in March. In fact, Vox has taken the ideas that Julia Marcus and Eleanor Murray (another epi colleague) have come up with, and made them into an infographic, with a list of activities from lowest risk to moderate, higher, and highest risk. The message? We can all do something and help others to do the same. We are not powerless. “Because things are the way they are, things will not stay the way they are,” wrote Bertolt Brecht. This epidemic will be over one day too. I hope that then we can look back and remember how we helped each other survive.
