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For many of us, it has been nearly a month since the world shut down and we came under stay at home orders. As I write, I sense growing pressure from, and on, government officials to begin opening up our society. The US leads the world in deaths (over 20 percent of all deaths) from Covid-19 and the infection rates have only flattened and possibly begun to decline. Some claim all this is an over-reaction although the best evidence is that given the contagiousness of the virus, the fact that no one has immunity who has not been infected, and the mortality rates are much higher than seasonal flu, the measures have averted a horrendous catastrophe where lives that could be saved are lost due to lack of hospital capacity.

Some are OK with that. One person I’m friends with on social media claimed it was all a big mistake not to keep society open. I asked him if would be OK to see 50 million infected and at least 1 million die. He was OK with that. This is troubling to me, because while I know death comes to all, this was conceding that far more deaths than are necessary are acceptable to get the economy going.

I wonder, though if that will work. Several years ago, when Ebola had spread to the US, one of the health care providers caring for a patient was diagnosed with Ebola after trying on gowns at a bridal shop. No matter the information that demonstrated that the shop was safe, had been thoroughly sterilized, people would not shop there. They went out of business. When I hear of a restaurant cited for violations or food poisoning, that one gets crossed off my list. Just because things open up, business won’t pick up until people know its safe. And should a business become an infection hot-spot, that could spell then end of that business.

I get that people are hurting. Nearly half of all Americans live paycheck to paycheck, with little or no savings in reserve. Unemployment checks are slow in coming from an overburdened system. “Stimulus” checks are just starting to come, and for many, they are already spent. The social cost to the most vulnerable, including children, could be great. Whole industries potentially could be lost. And these conditions may make people more vulnerable to the virus. State governments have taken some measures to forestall the worst, but for how long?

Like so many things, this discussion tends to get framed in stark either-or terms. We must prevent deaths, or we must protect the economy and jobs in our country. Is that the best we can do? Why must we oppose lives and livelihoods. Might it be possible to value both? As I’ve listened to different sources and what other countries are doing, I wonder if something like the following may be the way we go:

1. We will keep stay at home orders in place, or something like them at least another month to reduce infection rates to the point where health departments can track, trace, and isolate new infections and where testing can monitor for community spread. We probably should do this anyway because what needs to be in place is not ready.
2. Extensive testing capacity, including anti-body testing which is still under development needs to be readily available for early detection of new infections and to know who is immune and who is susceptible.
3. We all need to agree that hygiene, social distancing, and masks become part of our habits until there is a vaccine.
4. Businesses and workplaces that are “non-essential” should be able to open up as they can demonstrate that sanitation, distancing, and other health department mandated practices are in place that ensure worker and consumer safety. Telework should continue wherever possible. Employers should make modifications and provide personal protective wear needed to ensure worker safety. All sick workers should be able to stay home without reprisal. All workplaces should be subject to these regulations and inspected. Mechanisms should be in place to protect whistle-blowers from reprisals.
5. Public accommodations such as stores and restaurants should have reduced occupancy limits to ensure safe distancing, as “essential” businesses like groceries have implemented. All these places must be mindful that if an outbreak of infection can be traced to them, this can mean shutdowns, and negligence could bring civil suits.
6. If there is a “pause” in infections, the time should be used to establish the best treatment protocols and make these universally available to provide the best treatment for those newly infected in a more open situation.
7. Steps that protect the most at-risk should be maintained and enhanced including dedicated shopping hours, priority access to delivery services, and any other measures that minimize there risk of infection. Some of this will need to be the voluntary choices of these at risk persons, best supported at safe distances by friends and relatives who are not at as great a risk. Addressing the impact of long-term isolation of this population is important.

It seems that bringing any group of people, particularly large groups in close proximity for any length of time risks spread, although there is some indication that masks help. Are crowd size limits at events possible? Is social distancing possible and economically feasible for travel? What about schools and universities?

That is but a beginning. The question of how freely travel occurs between countries and even states, and how this may be screened pose large questions. This pandemic arose so rapidly by combining a highly infectious virus with ubiquitous global travel.

Even vaccines, which seem like the magic wand, must work long enough to snuff out the spread of the virus through vulnerable hosts, requiring a massive campaign for global vaccination. It’s staggering to think about.

Writing this makes clear that the changes in my own life as one in the at-risk population are going to last a long time, at least another year seems likely, assuming we stay healthy. But I do find myself grieving. When will I be able to visit family in person without social distancing, or share a meal outside my own house? When will I get to hang out at a bookstore? When will I sing with my choir? When will I get to go to a baseball game? While parts of America open up in 2020, I have real questions about that for me. It looks to me like 2020 will be The Year of Staying Home.