Crowds gather at Buffalo Bayou Park as social distancing guidelines to curb the spread of COVID-19 are relaxed in Houston, Texas, May 4, 2020, photo by Callaghan O'Hare/Reuters

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(The RAND Blog)

Relaxing COVID-19 Restrictions Presents Stark Health and Economic Choices

Crowds gather at Buffalo Bayou Park as social distancing guidelines to curb the spread of COVID-19 are relaxed in Houston, Texas, May 4, 2020

Photo by Callaghan O'Hare/Reuters

After weeks of drastic measures to slow the spread of COVID-19, state leaders are now rolling out plans about when and how to ease restrictions.

The choices have been stark. Many states are opening up businesses in return for economic gains but at the cost of more illness and fatalities. Other states are willing to endure a longer period of economic pain to maintain a healthier population, which may in turn lead to a healthier economy.

RAND's new publicly available COVID-19 interventions impact tool uses epidemiological and economic models and continually refreshed data to estimate what could happen as restrictions are eased in each state.

Though the results vary from state to state, our models show that peaks in the number of cases and deaths can be pushed back and potentially diminished by extending the duration of current interventions. Some states (such as New York) may have passed their peaks of active cases and hospitalizations. But for most states, the worst is yet to come.

In places that already have high numbers of cases, drastically relaxing interventions can increase caseloads to unmanageable levels very rapidly. In addition, there is a time lag between a policy change and spike in hospitalizations, making the effects difficult to see until it is too late.

Peaks in the number of cases and deaths can be pushed back and potentially diminished by extending the duration of current interventions.

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Projections from Texas and Wisconsin illustrate the potential risks and benefits of relaxing restrictions. Although these results are not precise forecasts, they do quantify the relative risks and benefits of altering state COVID-19 social distancing interventions. (As economic conditions and case numbers change, our tool will be updated to refine its longer-term projections.)

Texas currently has relatively loose restrictions in place: schools closed and large gatherings banned. The governor of Texas has announced plans to relax restrictions further. What if Texas were to shift on June 1 to opening everything except schools? What if Texas waited to do so until July 1? How does that compare to leaving the current restrictions in place?

Estimated Effects of Different Strategies and Timelines for Relaxing Restrictions in Texas

  • Current restrictions: Schools closed, large gatherings banned
  • Relaxed restrictions: Schools closed
  • No restrictions: New normal with reduced activity

Leave current restrictions in place until August 1

Cumulative deaths by September
16,000
Economic loss by September
$26.4 billion (4.9% of total)

Begin to relax restrictions on July 1, then step down to no restrictions on August 1

Cumulative deaths by September
23,000
Economic loss by September
$25.7 billion (4.7% of total)

Begin to relax restrictions on June 1, then step down to no restrictions on July 1

Cumulative deaths by September
58,000
Economic loss by September
$19.2 billion (3.5% of total)

Wisconsin has had moderate, bordering on strict, restrictions in place until very recently. On May 13, the Wisconsin Supreme Court overturned the governor's stay-at-home order and allowed restaurants and bars to reopen. Though the situation is fluid, the court decision will reduce restrictions and perhaps end all of them. What happens if the new, more moderate restrictions are left in place through the middle of the summer? What if they are relaxed sooner? Our model provides insights into these questions.

Estimated Effects of Different Strategies and Timelines for Relaxing Restrictions in Wisconsin

  • Current restrictions: Schools closed, large gatherings banned
  • Relaxed restrictions: Schools closed
  • No restrictions: New normal with reduced activity

Leave current restrictions in place until July 14

Cumulative deaths by September
1,500
Economic loss by September
$7.9 billion (6.1% of total)

Begin to relax restrictions on June 15, then step down to no restrictions on July 15

Cumulative deaths by September
4,000
Economic loss by September
$7.6 billion (5.9% of total)

Begin to relax restrictions on May 15, then step down to no restrictions on June 15

Cumulative deaths by September
9,300
Economic loss by September
$6.1 billion (4.7% of total)

For both states, the trade-offs are similar. Having more restrictions in place for longer periods leads to fewer COVID-19 deaths through September 1 at an economic cost. That strategy also pushes the problem into the future. We can expect to see rebounds in cases and deaths whenever restrictions are lifted because a large proportion of the population remains susceptible to infection.

Keeping social distancing restrictions in place buys states time. It is vital to use that time to improve communities' ability to interact safely (e.g., redesign workspaces, produce and distribute personal protective equipment) and counter the virus (e.g., improve treatments, broaden testing, expand contact tracing and, of course, develop a vaccine).

In the near future, we will explore adding local data as well. If that is feasible, it should allow the tool to estimate the effects of reopening some localities while keeping restrictions in place in others.

Our tool cannot make the choices confronting state leaders less painful. But it can provide clear, evidence-based estimates of the health and economic trade-offs to aid the development of recovery roadmaps.


Jeanne S. Ringel is director of the Access and Delivery Program and a senior economist at the nonprofit, nonpartisan RAND Corporation. Raffaele Vardavas is a mathematician at RAND whose expertise is primarily in constructing and analyzing epidemic models for the spreading of infectious disease. Aaron Strong is an applied microeconomist at RAND. All three teach at the Pardee RAND Graduate School.

Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.