_ How we know ending social distancing will lead to more deaths, in
one chart _
People gather on a hiking trail in Griffith Park in Los Angeles on
March 22, 2020, Mario Tama/Getty Images
President Donald Trump already wants to pull back social distancing
policies and guidances
[[link removed]] implemented
in response to the coronavirus pandemic. But we know, based on the
nation’s history with past outbreaks, what will happen if we do this
too early: People will die.
In 1918, the world was ravaged by a horrible flu pandemic, which was
linked to as many as 100 million deaths globally
[[link removed]] and about
675,000 deaths in the US
In response, cities across America adopted a variety of social
distancing measures to combat the pandemic. Based on several studies
of the period
these measures worked to reduce the death toll overall.
But many cities, also worried about the effects of social distancing
on normal life and the economy, pulled back their social distancing
efforts prematurely. When they did, they saw flu cases — and deaths
— rise again.
Consider St. Louis. The city is now
[[link removed]] heralded
[[link removed]] as
an example of how to do social distancing right because it took an
aggressive and layered response to the flu pandemic early on. But as a
2007 study [[link removed]] published
in _JAMA_ found, St. Louis in 1918 pulled back its social distancing
efforts prematurely — and that led to a spike in deaths.
Here’s how that looks in chart form, with the line chart
representing excess flu deaths and the black and gray bars below
showing when social distancing measures were in place. The highest
peak comes after social distancing measures were lifted, with the
death rate falling only after they were reinstituted.
[A chart showing St. Louis’s flu deaths during social distancing
measures.]_JAMA_ [[link removed]]
This did not just happen in St. Louis. Analyzing data from 43 cities,
the _JAMA_ study found this pattern repeatedly across the country.
Howard Markel, an author of the study and the director of the
University of Michigan’s Center for the History of
Medicine, described the results
[[link removed]] as
a bunch of “double-humped epi curves” — officials instituted
social distancing measures, saw flu cases fall, then pulled back the
measures and saw flu cases rise again.
Notably, the second rise in deaths only appeared when cities removed
social distancing measures, the _JAMA_ study found: “Among the 43
cities, we found no example of a city that had a second peak of
influenza while the first set of nonpharmaceutical interventions were
still in effect.”
Another 2007 study [[link removed]],
published in _PNAS_, looked at 17 US cities and found the same trend:
“[N]o city in our analysis experienced a second wave while its main
battery of [nonpharmaceutical interventions] was in place. Second
waves occurred only after the relaxation of interventions.”
A lot has changed in medicine since 1918, with knowledge of viruses
and the widespread use of vaccines and other medications to combat all
kinds of diseases. But we still need to rely on nonpharmaceutical
interventions, like social distancing, to combat epidemics and
pandemics when we don’t have a vaccine. And since we likely won’t
have a vaccine for the novel coronavirus for another year or so,
we’ll need social distancing for, potentially, months.
As the _PNAS_ study concluded: “In practice, and until emergency
vaccine production capacity increases, this means that in the event of
a severe pandemic, cities will likely need to maintain
[nonpharmaceutical interventions] for longer than the 2–8 weeks that
was the norm in 1918.”
This is one reason public health experts are against pulling back
social distancing right now, even as Trump talks about a quick end.
The US is still seeing coronavirus cases rise
and cases seem to be rising more quickly here than in other
[[link removed]] models
[[link removed]] also
suggest coronavirus cases will rise if social distancing measures are
relaxed, potentially causing
[[link removed]] hundreds
of thousands if not millions of deaths in the US alone.
It can be hard to see this, because successful public health measures
are often invisible. As Tara Smith, an epidemiologist at Kent State
University, previously told me
“It’s the paradox of public health: When you do it right, nothing
happens.” So if we’re doing social distancing right, we’ll
prevent deaths — but it’s not like people will see each death that
What we are seeing, instead, is that the economy is tanking as
restaurants, workplaces, and businesses close. That’s what Trump
seems to be worried about when he tweets
[[link removed]] about
how “WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF.”
But it’s important to remember the alternative here: People will
die, maybe up to in the millions.
_German Lopez is Senior Correspondent at Vox. He has written for Vox
since it launched in 2014, with a focus on criminal justice and public
health. Previously, he worked at CityBeat, a local newspaper in
Cincinnati, covering politics and policy at the local and state level.
[[link removed]] Twitter.
[[link removed]] RSS.
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