Gov. Greg Abbott is not a fan of stay-at-home orders or any kind of lockdown to try and slow the spread of COVID-19, despite the fact that cases have been soaring in Texas this fall.
Here's what he had to say about shutdowns in mid-November:
The City of Austin is flirting with a curfew to try and stem a post-Thanksgiving surge. Other states like California and countries like Germany have reimposed stay-home orders as cases and hospitalizations keep climbing.
So, who's right about lockdowns?
"It's hard to think of a situation where limiting or stopping people from interacting does not result in a curtailing and limiting of the pandemic," says Justin Lessler, associate professor of epidemiology at Johns Hopkins University's .
Lessler says it's been shown again and again that lockdowns are effective in stopping transmission and stopping cases from occurring.
"Every time there's been an aggressive lockdown or these aggressive social-distancing measures, it's effectively brought cases down," he says.
But lockdowns can have a cost, Lessler says, depending on how extreme a measure is. He cites economic impacts, mental health challenges and disruptions in access to health care and other services.
It's the tradeoff between the benefits and the costs that is the greatest unknown, he says.
"Is it worse to have something very extreme but have it for a short period of time?" he asks. "Or, is it worse to have something that's milder but have it continue over a very long period of time?"
Listen to the interview or read the transcript of the entire conversation below to hear more about what he says lockdowns can and cannot do to slow the spread of COVID-19.
This transcript has been edited lightly for clarity.
KUT: What can a lockdown or a shutdown or stay-at-home orders actually achieve from a medical and infection standpoint?
Justin Lessler, PhD: It's been shown again and again that they [lockdowns] are effective in stopping transmission and stopping cases from occurring. It takes a little bit because there's a little bit of a lag between when people get infected and then when they get sick and then when they show up in the hospital or die. But every time there's been an aggressive lockdown or these aggressive social-distancing measures, it's effectively brought cases down.
That's not surprising because we know the disease transmits through direct personal contact, and if you get rid of that contact the disease can’t spread.
What are the downsides or minuses to a shutdown or a lockdown?
It's going to depend on exactly how extreme the shutdown or lockdown is and exactly what different communities or states are doing to mitigate the potential effects.
When we say a lockdown or a shutdown, people mean everything from curfews and closures of particular types of businesses all the way to the type of complete stay-in-your-homes [orders], don't leave for any reason, that was going on in parts of China in the early part of the pandemic. And of course, the impacts of each of those are going to be different. But obviously, the economic impacts for businesses that rely on in-person transactions to survive, like restaurants or bars, are going to be some of the greatest.
But there are also mental health challenges. People who already are having trouble and lack of social support – that can be increased because of the isolation of stay-at-home orders and lockdowns. And people may be more hesitant or even unable to access routine medical services during a lockdown, because they may not feel safe about going out or the hours or availability of the services is reduced or even eliminated.
Are there any known severe medical consequences of asking people to stay home except for particular hours or for the most essential needs or services?
There are. I think these mostly revolve around mental health, access to care, and then access to food and other services. The people who have high levels of food insecurity [and] limited incomes can be really hurt by these lockdown measures.
What remains unclear is how the trade-off works because one thing we have to remember is that you're trading off how severe a lockdown is, or how severe your restrictions are, versus how long you have to put them in place. For instance, places like China or Australia that were much more aggressive in their lockdowns or social-distancing measures than we were in the United States had very severe disruptions for a short period of time or – not so short, a few months – but now are in a place where people can go about their normal lives and economic activity can resume completely.
Whereas in the United States, where we've taken more of the flatten the curve approach and didn't shut down as aggressively or for as long, we've had this situation where we have had some interruption to normal activity, normal interaction going on for seven to nine months.
What I don't know – and what I think we'll be trying to understand for a very long time – is which of those is actually worse in terms of health consequences. Is it worse to have something very extreme, but have it for a short period of time? Or, is it worse to have something that's milder but have it continue over a very long period of time?
Is there ever a time when a tool of a stay-at-home order or some kind of shutdown or lockdown wouldn't be effective in stopping the spread because there is so much spread? If community spread is just unchecked, is a lockdown or a shutdown ever too little, too late?
I think certainly if cases are already going down and we're already at sort of the end of the epidemic, maybe. But if cases are increasing, it's hard for me to think of a circumstance under which it wouldn't be effective in reducing transmission.
It may severely limit how much you reduce transmission. So, for instance, if you're sick with COVID-19, the people you're most likely to infect are the people you live with, and obviously a lockdown doesn't stop you from infecting those people. In fact, it may increase it because you're all going to be in your home together. So, if you have a lot of people infected, you might see that second generation of transmission within the households happen before you start to see decreases in cases because of the lockdown.
But ultimately, if people don't interact, the disease can't spread. And it's hard to think of a situation where limiting or stopping people from interacting does not result in a curtailing and limiting of the pandemic.
Texas Gov. Greg Abbott said one of the most common ways COVID-19 is spread is not by someone going to work, but by people gathering together in home settings or in casual settings after bars close. So he says a shutdown would not lead to the positive results that some people think. Is there logic to that?
There's logic to that, and it matters how people react. He's certainly right: If we shut down the bars and everybody just goes and starts drinking at house parties and people's houses that is not going to be effective or not going to be as effective. But [with] any shutdown order ... you need to include restrictions on mass gatherings in general, regardless of where they occur. So people should not be able to have house parties or even moderately small, even moderately large gatherings in their home. So I do think there's logic to that.
One thing I would say, though, is if the gatherings are relatively small and within, say, a bubble, I think they would have a lot less impact on spread than bars or restaurants normally. Each of us lives in our own social spheres. We live in our homes, and we interact with the people we live with there. And maybe we have a small group of friends. And for the virus to keep moving, it has to be able to jump between those social bubbles, and places where we all go, like bars and restaurants, and enable that spread in a way that home gatherings would not. But that being said, I think any lockdown order should include limitations on those type of home gatherings.
We're hearing positive news about a vaccine. I think people are starting to feel like it's the beginning of the end of the pandemic. But we also know the reality is we’re many, many months from returning to anything that might resemble normal. If local government decides to implement some kind of stay-at-home orders, what is effective messaging that can go along with that? It seems like a lot of times when that has come up, people were kind of confused and they weren't sure why [there was a lockdown] or weren't sure what was going on.
I study diseases, not health communication, but I do have some opinions here, and it gets to several things. So one of the shortcomings of our response in this country has been not being clear about what we're trying to accomplish. And I think that was one of the challenges with the first round of lockdowns and why some people maybe argue they were very successful. Some people argue they failed.
Some people argue they were unnecessary, because we never established what we were trying to achieve. Are you trying to achieve zero cases, a complete end of transmission? Well, that suggests very aggressive lockdowns that last long enough for that to happen. Or are you simply trying to make sure that cases remain low enough that you don't overwhelm emergency departments? Well, then that suggests a slightly less aggressive form of activity.
But I think a problem with these measures is we've never been very clear about what we're trying to accomplish, which makes it very uncertain when things are going to end and what conditions under which things are going to change. So that's the first thing for communication: clarity about the goals.
The second thing, I think, is a little bit more specific to the issue around vaccine and how it interacts with the aggressiveness of your social-distancing measures. The temptation is to say – "Oh, the vaccine is on its way, so we don't have to worry as much because the vaccine is coming soon." But I would argue that's the wrong way to think about it.
Before we knew the vaccines looked like they were going to be good, when you did a lockdown or very aggressive measures, you were just kicking the can down the road. You were stopping spread now, but you weren't accumulating immunity in your population or anything, so it was unclear that you wouldn't have to do the same thing again five, six months later.
Whereas now, when we know there's a vaccine, every case prevented right now is no longer simply a case delayed, it could be a case prevented altogether because that person could eventually be vaccinated. Emphasizing that because the vaccine is coming, we just need to hold on a little bit longer, and everybody you can stop from being infected right now has the potential to never be infected because they can be vaccinated is an important point to communicate.
And then the third is more of a general point; it's less about the government control and more about individual behavior. When we're careful about our social interaction, when we wear a mask, when we don't go to the restaurant or some gathering that we don't need to, I think we should not just think about that as us protecting ourselves, but as us giving a gift to the people around us this holiday season: the gift of not getting infected and not dying of COVID-19, which I think is an important one to give.
Something like a stay-at-home order or shutdown seems hard to communicate to people, because it's hard to tell that it's working. For some people, it's hard to communicate to them why it's effective when it may not necessarily be apparent that it's effective.
This is a problem that we have throughout public health in general. For instance, vaccines. It's very easy to get people to take vaccines if there's measles all throughout their community. But when you don't have any measles in your community because everybody is vaccinated, it becomes harder to convince people that there's value in getting the vaccine. I see this as the same sort of thing. It's a problem we struggle with a lot.
But I do think if we can communicate or show what happens when you don't follow this advice and when you do effectively, hopefully we can convince people. Driving on the right side of the road has a similar effect. It avoids you getting in a head-on collision. But it's so obvious; we rarely see head-on collisions because everybody drives on the right side of the road they're supposed to. It's very obvious to everybody that that's true.
I think if we can somehow figure out how to make it equally obvious that staying at home, following stay-at-home orders, avoids cases. Wearing masks avoids stay-at-home orders. If we can somehow make that clear to people, people will be more likely to follow. But I agree it is a hard thing to do.
Got a tip? Email Jennifer Stayton at jstayton@kut.org. Follow her on Twitter @jenstayton.
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