COMMENTARY

How Do We Balance Small Business Interests With Social Distancing?

Arthur L. Caplan, PhD

Disclosures

November 19, 2020

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This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at New York University.

One of the toughest issues the United States faces — as does Europe and many other parts of the world — is trying to cope with this explosion of COVID cases and deaths that is overwhelming the hospital system in many parts of the US, such as Utah and Minnesota. Some viewers will remember that we had extreme pressure on healthcare systems back in March and April in New York and New Orleans.

We worry that this is going to come back and happen all around the country and in many European countries. We've seen efforts to initiate responses to explosions and disease rates in Britain, the Czech Republic, Germany, and many other places.

How do we balance the need to socially distance and close businesses that are high risk — bars, restaurants, gyms, maybe some sporting events — against the desire for people to go out and have a normal life, and the businesses themselves worrying that if they close for 6 weeks or 2 months, they're going to be finished?

I go to New York for medical appointments. When I'm there, in many neighborhoods it's a ghost town because those businesses that relied on people coming in to offices and commuting to work couldn't get enough business and they're closed. Many of them are shut. I hear from barbershops, gyms, and hairdressers where I live in Connecticut that they're terrified too — that if they're closed as a response to COVID and the spikes, they're going to be finished.

On the other hand, we know that these places are often superspreaders. They're where the virus really takes off. People are worried about being indoors this winter and the virus spreading from going, let's say, to a restaurant and bringing it home where more people are indoors. Even in warm climates, we're seeing explosions of the virus.

If you go to places where there are many people, such as a restaurant, and you're taking off your mask — many people are — it's still likely that you're going to see infection spread. How do we protect the at-risk people — the elderly, people with immune-compromised conditions, adults with disabilities — who die at very high rates?

I think we're going to try to do selective closures. I don't think the country is quite ready to do a mass shutdown for months. The economic consequences are too big. Unless we were prepared to subsidize all of the people whose businesses risk closure and the incomes of those people with government subsidies, which would cost a lot, I don't think we can do it.

What we can do is try selective closures by zip code, county, or area to try to stop the spread. If we're lucky in the spring, and we begin to get a large amount of vaccine available that's pretty effective and lasts for a while, those techniques will help us. That's the good news.

The bad news is, right now, I don't think we have time to stop what's coming in November and December. I think we're going to see many more deaths and many more cases. Remember, the deaths lag behind the case rate, and the case rate keeps going up.

Even if we started closures, restricting mass gatherings, and making sure that restaurant occupancy was severely restricted, with the economic fallout, Christmas and Thanksgiving are going to undercut us. People are not going to stay home. People are going to be at events, and I think that's going to ask us to pay a price. That's the bad news.

Maybe into next year we can have a two-pronged strategy — selective closure, more vaccination — that'll get us somewhat back to normal, although still masking and still distancing.

For the rest of this year, things are not looking good. I don't think we're going to be able to work ourselves out of what's going to be a tough time for healthcare providers, hospitals, Americans, and many Europeans.

I'm Art Caplan at the Division of Medical Ethics at New York University. Thank you for watching.

Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.

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