As the virus flares globally, new strategies target hot spots

After entire nations were turn off through the first surge of the coronavirus earlier this year, some countries and U.S. states try more targeted measures as cases rise again all over the world, especially in Europe and the Americas.

New York’s new round of virus shutdowns zeroes in on individual neighborhoods, closing schools and businesses in hot spots measuring just a handful of square miles.

Spanish officials limited happen to be and from some parts of Madrid before restrictions were widened through the entire capital plus some suburbs.

Italian authorities have sometimes quarantined spots as small as a single building.

While countries including Israel and the Czech Republic have reinstated nationwide closures, other governments hope smaller-scale shutdowns can work this time, in conjunction with testing, contact tracing, and other initiatives they've now developed.

The idea of containing hot spots isn't new, but it's being tested under new pressures as authorities try to avoid a dreaded resurgence of illness and deaths, this time around with economies weakened from earlier lockdowns, populations chafing at the thought of renewed restrictions plus some communities complaining of unequal treatment.

Some scientists say a localized approach, if well-tailored and explained to the public, can be a nimble response at a complex point in the pandemic.

“It is pragmatic in appreciation of ‘restriction fatigue’ ... nonetheless it is strategic, enabling mobilization of substantial resources to where they are needed most,” says Dr. Wafaa El-Sadr, who's following NY City's efforts closely and is on some city advisory boards.

Other scientists are warier.

“If we’re seriously interested in wiping out COVID in an area, we are in need of coordinated responses across” as wide a swath as possible, says Benjamin Althouse, a study scientist with the Institute for Disease Modeling in Washington state.

In a study that is posted online but not published in a journal or reviewed by independent experts, Althouse and other scientists discovered that amid patchwork coronavirus-control measures in the U.S. this spring, some persons traveled farther than usual for such activities as worship, suggesting they could have taken care of immediately closures by hopscotching to less-restricted areas.

Still, choosing between limited closures and widespread restrictions is "an extremely, very hard decision,” Althouse notes. "I’m glad I’m not the one making it.”

Early in the outbreak, countries tried to quell hot spots from Wuhan, China - in which a stringent lockdown was seen as type in squelching transmission in the world's most populous nation - to Italy, in which a decision to seal off 10 towns in the northern region of Lombardy evolved within weeks into a nationwide lockdown.

After the virus's first surge, officials fought flare-ups with city-sized closures come too early July in places from Barcelona, Spain, to Seoul to Melbourne, Australia.

In the English city of Leicester, nonessential shops were shut down and households banned from mixing in late June.

The infection rate fell, dropping from 135 cases per 100,000 to around 25 cases per 100,000 in about two months.

Proponents took that as evidence localized lockdowns work. Skeptics argued that summertime transmission rates were generally low anyway in Britain, where the official coronavirus death toll of over 43,000 stands as Europe’s highest, according to figures published by Johns Hopkins University.

With infection levels and deaths rising anew in Britain, scientists have advised officials to implement a national, two-week lockdown. Instead, the federal government on Monday carved England into three tiers of coronavirus risk, with restrictions ranging accordingly.

“As a general principle, the targeting of measures to specific groups or geographical areas is preferable to one-size-fits-all measures, because they allow us to reduce the damage that social distancing inevitably imposes on society and the economy,” said Flavio Toxvaerd, who specializes in monetary epidemiology at the University of Cambridge.

The damage doesn't feel so minimal to Steven Goldstein, who had to close his New York City men's hat shop last week.

The 72-year-old business, Bencraft Hatters, is in another of a small number of small areas around the state with new restrictions. Authorities hope they'll avert a wider crisis in circumstances that beat back the deadliest spike in the U.S. this spring, losing over 33,000 persons to date.

Goldstein takes the virus seriously - he said he and his mother both had it in early stages - and he sees the monetary rationale behind trying local restrictions rather than another citywide or statewide shutdown.

But he questions if the zones are capturing all of the trouble spots, and he's rankled that the restrictions are falling on his shop after, he says, he faithfully enforced mask-wearing and other rules.

“I did so my part, and lots of other persons did our part, yet we’re being forced to close,” said Goldstein, 53, who tapped into savings to sustain the third-generation business through the sooner shutdown.

In New York's most restricted “red zones,” houses of worship can't admit a lot more than 10 people at a time, and schools and nonessential businesses have already been closed. Those zones are ensconced in small orange and yellow zones with lighter restrictions.

Some researchers, however, say officials have to consider not just where persons live, but where else each goes. In New York City, persons can escape restrictions totally by firmly taking the subway a couple of stops.

“There’s room for improvement by firmly taking into account some spillovers across neighborhoods,” says John Birge, a University of Chicago Booth School of Business businesses research professor. He, colleague Ozan Candogan and Northwestern University graduate student Yiding Feng have already been modeling how localized restrictions in NEW YORK could best minimize both infections and monetary harm; the research hasn't yet been reviewed by other experts.

If spot measures could be strategic, there is also been criticized as unfairly selective.

In Brooklyn, Orthodox Jews have complained their communities are being designated for criticism. In Madrid, residents of working-class areas under mobility restrictions said authorities were stigmatizing the indigent. Restaurant and bar owners in Marseille, France, said the location was unfairly targeted last month for the country's toughest virus rules at that time. As of Saturday, several French cities, including Paris and Marseille, were subject to restrictions including a 9 p.m. curfew.

When a flat complex housing mostly Bulgarian migrant farm staff was locked down in late June in the Italian city of Mondragone, the personnel protested, and in regards to a dozen broke the quarantine.

Other denizens of Mondragone feared infection would spread and, at one point, surrounded the buildings and jeered at the residents, among whom tossed down a chair. Eventually, authorities called in the army to maintain the quarantine and keep the peace.

For spot shutdowns to work, public health authorities say, the message behind the measures is key.

“Lead with: ‘Here’s a community in need. ... We should be empathetic,’” said Rutgers University epidemiology and biostatistics professor Henry F. Raymond. “It’s not really a criticism of these people’s behaviors. It’s just saying, ’These communities may need more attention.'”