“Anything worth doing is worth doing badly.” – G. K. Chesterton
Without a vaccine to protect against the spread of SARS-CoV-2, communities across the United States have turned to non-pharmaceutical interventions, such as community mitigation activities, to slow the spread of infection. Many citizens seek a perfect solution to this challenging problem. We want the answer and the ability to move on with our lives.
However, the leader who pursues only the perfect solution will rarely find it in a world filled with trade-offs and competing interests. In the context of our current pandemic, G. K. Chesterton’s quote applies in a slightly modified form: any pandemic policy intervention worth doing is worth attempting in an imperfect and phased fashion.
The necessity for a phased approach suggests that community mitigation strategies offer imperfect, yet reasonable protections. If there is such a thing as a perfect intervention, a phased approach would not be required. Existing interventions are not bad; they are imperfect in that the virus spread is not stopped, only slowed. Moreover, an effective phased approach offers value.
What is community mitigation? Think of it as rules to promote a positive health outcome. The rules come in the form of local and state public policies designed to enforce different forms of social distancing. These rules or policies provide the steps that people can take to slow down the spread of a virus. The CDC Community Mitigation Framework calls for a phased approach at the community level during periods when evidence of the spread of disease increases or begins to decrease after a period of significant growth.
In the case of SARS-CoV-2, many public policy strategies align with research findings from other viral respiratory diseases. Mandated inventions associated with efforts to flatten the curve of virus spread include: emergency declarations, bans on mass gatherings, limits on senior living facilities, school closures, restrictions on business activity, curfews, and shelter-in-place orders.
Policies are important. And the timing of policy implementation represents a critical factor in slowing the pace of disease spread.
Understanding the effectiveness of public policy during a pandemic provides clarity for leaders and community residents. Mandates deemed as effective policies offer specific benefit to individuals and distribute benefits to the broader community. For the St. Louis region, understanding the effectiveness of policies implemented in other urban communities represents an opportunity to inform our civic decision-making. A recent CDC report provides this understanding.
The CDC examined data available from February 26 to April 1 from New Orleans, San Francisco, and five boroughs of New York City, specifically looking at four factors: “types and timing of policies implemented, cumulative number of reported cases, average 3-day percentage change in reported cases, and community mobility.” This information was collected through Google Alerts and searches. All four of these cities issued different levels of limits on mass gatherings, as well as state of emergency declarations. Only three parishes in New Orleans enforced a curfew; the other cities only issued stay-at-home orders. At the national level, on March 16, the White House announced the 15 Days to Slow the Spread guidelines to slow the spread of COVID-19. On March 30, federal officials extended these guidelines for 30 more days.
On the basis of the CDC’s preliminary report, emergency declarations by themselves failed to drastically change mobility trends, but a combination of policies did. This represents a critical finding.
Emergency declarations alerted the community of pending trouble, but issuing a declaration did not alter residents’ mobility behavior in robust fashion. However, limitations on mass gatherings, business restrictions, and school closures were associated with slower mobility. Additionally, increased public awareness of the severity of the pandemic, in combination with policy mandates designed to slow mobility, appears to offer a cumulative effect.
Evaluating the effectiveness of various mitigation strategies is useful for understanding how to slow the spread of COVID-19 most productively. However, these findings are only preliminary, and more information is necessary to better understand and assess the effect of viral transmission.
Limitations to the CDC report include building the analysis on correlation and association rather than causation and using mobile device data to represent mobility, which does not capture fully the mobility patterns of residents in the four cities. Additionally, it is important to note that larger, metropolitan cities such as those evaluated in the report do not represent other communities, such as rural regions of the country. The limitations, however, do not lessen the insightful value of the report, as “anything worth doing is worth doing badly.”
William F. Tate IV is the dean and vice provost for Graduate Education; Edward Mallinckrodt Distinguished Professor in Arts & Sciences; and Faculty Scholar, Institute for Public Health, Washington University in St. Louis. He will begin his tenure at the University of South Carolina as executive vice president for academic affairs and provost on July 1. Find him on twitter @WFTate4.
Kally Xu is a John B. Ervin Scholar and Gephardt Institute Civic Scholar at Washington University in St. Louis, where she is a candidate in the 3-2 Masters of Public Health in the George Warren Brown School of Social Work and the A.B. program in International and Area Studies and Asian American Studies.
